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Breast-nonmalignant
Benign tumors / changes
Lymphangioma
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 8 October 2012, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Either congenital or acquired
Terminology
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● Congenital lesions are also called cystic hygroma
● Acquired lesions are also called lymphangiectasis
● Lymphangioma circumscriptum: the classic lesion appears at birth or in early years, but most cases described in literature are post-surgery or radiation therapy
● See also atypical or benign vascular proliferations post-radiation
Epidemiology
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● 90% of congenital lesions present by age 2 years
Sites
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●
Etiology
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Clinical features
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● Congenital lesions are very rare
● Tends to infiltrate surrounding tissues
● Associated with pain, chronic drainage, cellulitis (South Med J 1999;92:69)
Prognostic factors
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Case reports
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● 6 year old boy with cystic lymphangioma (J Pediatr Surg 2009;44:2015)
● 20 year old woman with recurrent lymphangiomas (Afr J Paediatr Surg 2009;6:44)
● 38 year old woman with cavernous lymphangioma (World J Surg Oncol 2007;5:69)
● 40 year old woman with multiple vesicles (The Internet Journal of Dermatology 2006;3(2))
● 49 year old woman with mammographic lesion (Arch Pathol Lab Med 1986;110:353)
● 68 year old woman (Dermatology Online Journal 10:9)
Treatment
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● Excision, although this is not always possible (Lymphology 2006;39:147)
● Cryosurgery, electrocautery, laser therapy to vaporize surface lymphatics (Dermatol Surg 1998;24:893)
● Frequently recurs and causes substantial morbidity
Clinical images
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Vesicles on breast Oozing of clear fluid from vesicles
Extensive sponge-like subcutaneous tissue
containing serous fluid and lying between
the skin and the muscle layer
Gross description (Macroscopy)
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●
Gross images
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Micro description (Histopathology)
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● Dilated lymphatics involve superficial and deep dermis and possibly subcutaneous tissue, occasionally fascia and skeletal muscle
● May have hemosiderin deposition
Micro images
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Distended lymphatic channels interspersed with breast lobules
Lymphatic channel has attenuated lining
Papillary dermis shows ectatic lymphatic spaces
Neck (not breast)
Drawings
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Virtual Slides
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Videos
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Cytology description
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Cytology images
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Positive stains
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Negative stains
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Electron microscopy descriptions
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● Endothelial cells have cytoplasmic microfilaments and pinocytotic vesicles
● Intermediate junctions are present between adjacent cells (Jpn J Clin Oncol 1991;21:129)
Electron microscopy images
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Molecular / cytogenetics description
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●
Molecular / cytogenetics images
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Differential Diagnosis
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● Benign lymphangioendothelioma (acquired progressive lymphangioma): Anastomosing, tortuous, endothelial-lined, vascular channels, dissecting between dermal collagen bundles; channels tend to wrap around and isolate collagen bundles and cutaneous appendages; may resemble well differentiated angiosarcoma (Am J Surg Pathol 2000;24:1047)
Additional references
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End of Breast-nonmalignant > Benign tumors / changes > Lymphangioma
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