Histopathologic Features of Lymphedema: A Molecular Review

Li, Claire Y.; Kataru, Raghu P.; Mehrara, Babak J.

doi:10.3390/ijms21072546

Cited by 42 publications

(35 citation statements)

References 77 publications

(114 reference statements)

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“…In BC survivors, this tissue is in the ipsilateral arm of BC and most often appears after axillary lymph node dissection and axillary radiotherapy [ 7 , 8 ]. This secondary lymphedema often causes functional problems, adversely affects quality of life, and may be accompanied by recurrent infections [ 9 ]. However, the published prevalence of lymphedema in women who have suffered from BC varies significantly, with a 5-year prevalence of 42% [ 10 ] and a 2-year prevalence of 5% [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

et al. 2020

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Among female breast cancer survivors, there is a high prevalence of lymphedema subsequent to axillary lymph node dissection and axillary radiation therapy. There are many methodologies available for the screening, diagnosis and follow-up of breast cancer survivors with or without lymphedema, the most common of which is the measurement of patients’ arm circumference. The purpose of this study was to determine the intra-rater minimal detectable change (MDC) in the volume of the upper limb, both segmentally and globally, using circumference measurements for the evaluation of upper limb volume. In this study, 25 women who had received a unilateral mastectomy for breast cancer stage II or III participated. On two occasions separated by 15 min, the same researcher determined 11 perimeters for each arm at 4 cm intervals from the distal crease of the wrist in the direction of the armpit. The MDC at the segmental level ranged from 3.37% to 7.57% (2.7 to 14.6 mL, respectively) and was 2.39% (42.9 mL) at the global level of the arm; thus, minor changes in this value result in a high level of uncertainty in the interpretation of the results associated with the diagnosis of lymphedema and follow-up for presenting patients.

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Section: Introductionmentioning

confidence: 99%

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

et al. 2020

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“…31 The data in this article were based on an AVP and collagen spacing that if incorrect as markers of leaky vessels and increased interstitial fluid, respectively, would negate our findings. However, our phenotype was based on published data demonstrating perivascular spaces around capillaries in fat tissue in lipedema, 12 perivascular spaces, 11 and spaces between collagen fibers in the dermis 24 in lymphedema, perivascular immune cell infiltrate in the skin in lipedema, 8,19 and endothelial cell rounding as a marker of increased paracellular transport. 17,18…”

Section: Discussionmentioning

confidence: 99%

“…1). 8,19 Interstitial space Five to eight images of the dermis at 40 • magnification were obtained avoiding empty spaces beyond the skin biopsy. Dermal collagen was highlighted and quantitated as percent field (density) using ImageJ, 20 and then averaged and subtracted from 100 to get percent dermal collagen space.…”

Section: Abnormal Vessel Phenotypementioning

confidence: 99%

Interstitial Fluid in Lipedema and Control Skin

Allen

Schwartz

Herbst

2020

Women's Health Reports

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Background: Fluid in lymphedema tissue appears histologically as spaces around vessels and between dermal skin fibers. Lipedema is a painful disease of excess loose connective tissue (fat) in limbs, almost exclusively of women, that worsens by stage, increasing lymphedema risk. Many women with lipedema have hypermobile joints suggesting a connective tissue disorder that may affect vessel structure and compliance of tissue resulting in excess fluid entering the interstitial space. It is unclear if excess fluid is present in lipedema tissue. The purpose of this study is to determine if fluid accumulates around vessels and between skin fibers in the thigh tissue of women with lipedema. Methods: Skin biopsies from the thigh and abdomen from 30 controls and 80 women with lipedema were evaluated for dermal spaces and abnormal vessel phenotype (AVP): (1) rounded endothelial cells; (2) perivascular spaces; and (3) perivascular immune cell infiltrate. Women matched for body mass index (BMI) and age were considered controls if they did not have lipedema on clinical examination. Data were analyzed by analysis of variance (ANOVA) or unpaired t-tests using GraphPad Prism Software 7. p < 0.05 was considered significant. Results: Lipedema tissue mass increases beginning with Stage 1 up to Stage 3, with lipedema fat accumulating more on the limbs than the abdomen. AVP was higher in lipedema thigh (p = 0.003) but not abdomen skin compared with controls. AVP was higher in thigh skin of women with Stage 1 (p = 0.001) and Stage 2 (p = 0.03) but not Stage 3 lipedema versus controls. AVP also was greater in the thigh skin of women with lipedema without obesity versus lipedema with obesity (p < 0.0001). Dermal space was increased in lipedema thigh (p = 0.0003) but not abdomen versus controls. Dermal spaces were also increased in women with lipedema Stage 3 (p < 0.0001) and Stage 2 (p = 0.0007) compared with controls. Conclusion: Excess interstitial fluid in lipedema tissue may originate from dysfunctional blood vessels (microangiopathy). Increased compliance of connective tissue in higher stages of lipedema may allow fluid to disperse into the interstitial space, including between skin dermal fibers. Lipedema may be an early form of lymphedema. ClinicalTrials.gov: NCT02838277.

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“…Es resultiert also eine weitere Verschlechterung der Pumpfunktion [18,19]. Die Inflammation ist verantwortlich für die weitere Lymphödem-assoziierte, lokale Fettgewebshypertrophie, die zunehmende Fibrose des umliegenden Gewebes, die Entstehung dysfunktionaler Kollateralen sowie die Sklerose der Lymphgefäße [11,20]. Es hat sich ein Circulus vitiosus entwickelt (▶ Abb.…”

Section: Introductionunclassified

Lymphstase und Fettgewebshypertrophie – Pathophysiologische Zusammenhänge und therapeutische Optionen

Faerber¹

2021

Phlebologie

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ZusammenfassungAngeborene oder erworbene, iatrogene, traumatische oder postinfektiöse Störungen des Lymphabflusses führen aufgrund der Lymphstase im Laufe der Zeit zu Gewebeveränderungen wie Fibrosierung und vermehrter lokaler Fettgewebebildung. Häufig kommt es hierdurch zu einer extremen Volumenzunahme der betroffenen Extremität, die nicht durch das Lymphödem allein, sondern vor allem durch die massive Fettgewebshypertrophie bedingt ist. Lymphgefäße und Lymphknoten sind immer in Fettgewebe eingebettet. Dieses perilymphatische Fettgewebe ist essenziell für die lymphatische wie auch immunologische Funktion des Lymphsystems, da das Lymphsystem Fettsäuren als primäre Energiequelle nützt. Kommt es nach Lymphadenektomie und/oder Unterbrechung von Lymphgefäßen zur Lymphstase in der betroffenen Extremität, signalisiert diese einen gesteigerten Energiebedarf für die notwendige Immunantwort und die chronische Inflammation verursacht eine Überstimulation der Fettgewebsproliferation, um ausreichend Energie zur Verfügung stellen zu können. In der Folge kommt es zu weiteren pathophysiologischen Veränderungen, die die Drainagefunktion und damit die Lymphstase weiter verschlechtern. Es hat sich ein Circulus vitiosus aus Lymphstase, Fettgewebsproliferation und Fibrosierung entwickelt.Da die komplexe Entstauungstherapie diesen Zustand allein nicht wesentlich verbessern kann, kommen therapeutisch zusätzliche gewebereduzierende operative Verfahren, in erster Linie die Liposuktion, ggf. in Kombination mit mikrochirurgischen Operationstechniken, zum Einsatz.

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Histopathologic Features of Lymphedema: A Molecular Review

Cited by 42 publications

References 77 publications

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

Determination of the Minimum Detectable Change in the Total and Segmental Volumes of the Upper Limb, Evaluated by Perimeter Measurements

Interstitial Fluid in Lipedema and Control Skin

Lymphstase und Fettgewebshypertrophie – Pathophysiologische Zusammenhänge und therapeutische Optionen

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