Pathological Investigation of Acquired Lymphangiectasia Accompanied by Lower Limb Lymphedema: Lymphocyte Infiltration in the Dermis and Epidermis
Pathological Investigation of Acquired Lymphangiectasia Accompanied by Lower Limb Lymphedema: Lymphocyte Infiltration in the Dermis and Epidermis
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DOI：
10.1089/lrb.2016.0016
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发表时间：
2016-09-01
影响因子：
1.4
通讯作者：
Koshima, Isao
中科院分区：
文献类型：
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作者：
Hara, Hisako;Mihara, Makoto;Koshima, Isao
背景：有时获得性淋巴管扩张（局限性淋巴管瘤）伴有淋巴水肿，其病理机制尚不清楚。本研究的目的是更好地了解获得性淋巴管扩张症的病理变化。方法和结果：我们检查了2008年3月至2015年12月在东京大学医院接受治疗的获得性淋巴管扩张症伴淋巴水肿的患者的病理特征。总共对10名患者的16个活检进行了调查。患者平均年龄为57.2岁（范围43-69岁），均为继发性淋巴水肿女性。将手术标本固定在福尔马林中，并将组织切片用苏木精-伊红染色。在病例 1-3 和 8-10 中进行了额外的免疫染色（podoplanin、淋巴管内皮透明质酸受体 [LYVE]-1、CD4、CD8、CD20 和 CD31）。 10例均存在真皮乳头状淋巴管扩张。尽管没有炎症的临床症状，但在所有病例的真皮和表皮中也观察到炎症细胞的浸润，其中大部分是淋巴细胞。浸润淋巴细胞主要为CD4+T细胞，较少见的是CD8+T细胞和CD20+B细胞。真皮浅层的三种淋巴细胞数量明显多于深层，这可能表明它们是从位于真皮浅层的扩张的淋巴管中渗出的。八个样本中有七个 CD8+ T 细胞浸润了表皮。在病例4中，观察到淋巴管内有凝固的淋巴液。观察到真皮内胶原纤维增生和棘皮症。结论：获得性淋巴管扩张症（局限性淋巴管瘤）可见真皮内淋巴管扩张和胶原纤维增生。真皮和表皮淋巴细胞持续浸润可能与频繁发生蜂窝组织炎有关，这种情况常见于淋巴水肿患者。
Background: Sometimes acquired lymphangiectasia (lymphangioma circumscriptum), the pathological mechanism of which is unknown, accompanies lymphedema. The purpose of this study was to better understand the pathological changes present in acquired lymphangiectasia.Methods and Results: We examined the pathological characteristics of acquired lymphangiectasia with lymphedema among patients treated at the University of Tokyo Hospital from March 2008 to December 2015. In total, 16 biopsies from 10 patients were investigated. The average age of the patients was 57.2 years (range 43-69), and all were female with secondary lymphedema. Surgical specimens were fixed in formalin, and tissue sections were stained with hematoxylin-eosin. Additional immunostaining (podoplanin, lymphatic vessel endothelial hyaluronan receptor [LYVE]-1, CD4, CD8, CD20, and CD31) was performed in cases 1-3 and 8-10. Dilation of lymphatic vessels in the papillary dermis was present in all 10 cases. Infiltration of inflammatory cells, most of which were lymphocytes, was also observed in the dermis and the epidermis in all cases, even though there were no clinical signs of inflammation. The infiltrating lymphocytes were mainly CD4+ T cells, and less commonly, CD8+ T cells and CD20+ B cells. The number of three types of lymphocytes was significantly larger in the superficial layer of the dermis than in the deep layer, which may indicate that they oozed out from the dilated lymphatic vessels located in the superficial dermis. CD8+ T cells infiltrated the epidermis in seven of eight specimens. In case 4, coagulated lymphatic fluid inside the lymphatic vessel was observed. Proliferation of collagenous fiber in the dermis and acanthosis were observed.Conclusions: Lymphatic dilation and proliferation of collagenous fiber in the dermis were seen in cases of acquired lymphangiectasia (lymphangioma circumscriptum). Constant infiltration of lymphocytes in the dermis and the epidermis may have a relation to frequent cellulitis, which is often seen in lymphedema patients.