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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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eMedicine

 

End of Breast-nonmalignant > Benign tumors / changes > Lymphangioma

 

 

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