Current status, pitfalls and future directions in the diagnosis and therapy of lymphatic malformation

Abstract

Lymphatic malformations are complex congenital vascular lesions composed of dilated, abnormal lymphatic channels of varying size that can result in significant esthetic and physical impairment due to relentless growth. Lymphatic malformations comprised of micro-lymphatic channels (microcystic) integrate and infiltrate normal soft tissue, leading to a locally invasive mass. Ultrasonography and magnetic resonance imaging assist in the diagnosis but are unable to detect microvasculature present in microcystic lymphatic malformations. In this review, we examine existing tools and elaborate on alternative diagnostic methods in assessing lymphatic malformations. In particular, photoacoustics, low-toxicity nanoparticles and optical clearing can overcome existing challenges in the examination of lymphatic channels in vivo. In combination with photothermal scanning and flow cytometry, Photoacoustic techniques may provide a versatile tool for lymphatic-related clinical applications, potentially leading to a single diagnostic and therapeutic platform to overcome limitations in current imaging techniques and permit targeted theranostics of microcystic lymphatic malformations.

Congenital cutaneous pedicled macrocystic lymphatic malformation on the upper extremity: A rare case report and review of the literature

“…The etiology of lymphatic malformations is unclear. However, it is certain that lymphatic malformations consist of an accumulation of fluid resulting from an abnormal drainage pattern of lymphatic vessels [8]. In the head and neck region, the incidence rate of this condition is roughly 1 in 2,000 to 4,000 live births, but it is only rarely seen on the upper extremities as a macrocystic lesion [8].…”

“…However, it is certain that lymphatic malformations consist of an accumulation of fluid resulting from an abnormal drainage pattern of lymphatic vessels [8]. In the head and neck region, the incidence rate of this condition is roughly 1 in 2,000 to 4,000 live births, but it is only rarely seen on the upper extremities as a macrocystic lesion [8]. Okazaki et al [9] reported their experiences with 128 cases of lymphatic malformation, none of which were cutaneous cystic lymphatic malformations on the upper extremities.…”

“…Diagnostic tools can be utilized to detect lymphatic malformations, such as magnetic resonance imaging, grayscale ultrasonography, or Doppler ultrasonography [8]. While no consensus currently exists on the best method of treatment of this tumor, the main option used to eliminate a malformation is surgical treatment.…”

“…Ogita et al [11] first presented intracystic injection of OK-432 (group A Streptococcus pyogenes, human origin) for sclerotherapy. Currently, molecular targeting and phototherapy are gaining increasing popularity as curative options [8]. However, for macrocystic lymphatic malformations, especially for cutaneous cases like this, surgery is still the main option.…”

Measurement of tissue optical properties in the context of tissue optical clearing

“…1,17 Recent studies from different research groups on immersion OC at application of widely used OCAs to OA/PA systems showed great benefits expressed in much better probing depth and spatial resolution of these systems. 198,285,[286][287][288][289][290][291][292][293] First, it was demonstrated for optical resolution PA microscopy (OR-PAM) in two different modifications. 287,288 As in OR-PAM, the lateral resolution is determined by the diffraction-limited light focusing, which degrades due to light scattering, and the probing depth is limited by the photon transport mean free path, which is also in tissues determined by light scattering, suppression of scattering at tissue interaction with an OCA strongly improves these characteristics of the microscope.…”