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Research Letter |

Acquired Lymphangiectasia Associated With Treatment for Preceding Malignant Neoplasm: A Retrospective Series of 73 Japanese Patients FREE

Koji Chiyomaru, MD; Chikako Nishigori, MD, PhD
Arch Dermatol. 2009;145(7):841-842. doi:10.1001/archdermatol.2009.124.
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Acquired lymphangiectasia (AL), previously called acquired lymphangioma, was first described in 1956 by Plotnick and Richfield1 as a complication of radical mastectomy. Like lymphangiosarcoma, which may arise as a complication of chronic lymphedema,2,3 AL mainly occurs after surgery and radiation therapy for malignant neoplasms such as breast carcinoma4 and uterine carcinoma,5 which suggests that these therapies might cause AL. In addition, the period from the preceding illness to the development of AL varies. The present study investigates the relationship between therapy and the onset of AL.

Seventy-three cases of AL in Japan were investigated. The mean latent period before the appearance of AL was statistically assessed using the Welch t test in relevance to therapies the patients underwent: surgery, irradiation, or both. We also examined the relationship of lymph node dissection (LND) to the development of AL.

The male to female ratio among our patients was 23:50. The mean (SD) age was 55.6 (20.2) years, and about 60% of patients were older than 60 years. The most frequent site of AL was the external genitalia (71%). In 46 cases of 67 (69%), the preceding disease was a malignant neoplasm, usually uterine carcinoma (80%).

In 44 cases, the most frequent preceding therapy was a combination of surgery and irradiation (77%), followed by surgery alone (18%) and irradiation alone (5%). The mean (SD) interval from completion of therapy to the development of AL was shorter after combination therapy (10.3 [5.8] years) than after surgery (16.5 [12.2] years) or irradiation (14.7 [11.8] years) alone. Where LND was performed, the mean (SD) interval to the appearance of AL was much shorter (3.7 [2.4] years) (Table) (P < .001).

Table Graphic Jump LocationTable. Relation Between Therapy for Preceding Diseases and Time to Develop Acquired Lymphangiectasia

More aggressive combination therapy can induce AL earlier than treatment with a single entity. Our study population was small, especially the number of patients treated with only irradiation, so further study in a larger population is needed. Combination therapy with both surgery (including LND) and irradiation shortens the interval to the appearance of AL. These results indicate that patients who undergo LND should receive careful follow-up for several years.

ARTICLE INFORMATION

Correspondence: Dr Chiyomaru, Division of Dermatology, Department of Internal Related [sic], Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan (079m855m@stu.kobe-u.ac.jp).

Author Contributions: Dr Chiyomaru had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Chiyomaru. Acquisition of data: Chiyomaru. Analysis and interpretation of data: Chiyomaru and Nishigori. Drafting of the manuscript: Chiyomaru. Critical revision of the manuscript for important intellectual content: Chiyomaru and Nishigori. Statistical analysis: Chiyomaru. Study supervision: Chiyomaru and Nishigori.

Financial Disclosure: None reported.

Plotnick  HRichfield  D Tuberous lymphangiectatic varices secondary to radical mastectomy. Arch Dermatol 1956;74 (5) 466- 468
PubMed Link to Article
Stewart  FWTreves  N Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer 1948;1 (1) 64- 81
PubMed Link to Article
King  DTDuffy  DMHirose  FMGurevitch  AW Lymphangiosarcoma arising from lymphangioma circumscriptum. Arch Dermatol 1979;115 (8) 969- 972
PubMed Link to Article
Leshin  BWhitaker  DCFoucar  E Lymphangioma circumscriptum following mastectomy and radiation therapy. J Am Acad Dermatol 1986;15 (5, pt 2) 1117- 1119
PubMed Link to Article
Fisher  IOrkin  M Acquired lymphangioma (lymphangiectasis): report of a case. Arch Dermatol 1970;101 (2) 230- 234
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable. Relation Between Therapy for Preceding Diseases and Time to Develop Acquired Lymphangiectasia

References

Plotnick  HRichfield  D Tuberous lymphangiectatic varices secondary to radical mastectomy. Arch Dermatol 1956;74 (5) 466- 468
PubMed Link to Article
Stewart  FWTreves  N Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer 1948;1 (1) 64- 81
PubMed Link to Article
King  DTDuffy  DMHirose  FMGurevitch  AW Lymphangiosarcoma arising from lymphangioma circumscriptum. Arch Dermatol 1979;115 (8) 969- 972
PubMed Link to Article
Leshin  BWhitaker  DCFoucar  E Lymphangioma circumscriptum following mastectomy and radiation therapy. J Am Acad Dermatol 1986;15 (5, pt 2) 1117- 1119
PubMed Link to Article
Fisher  IOrkin  M Acquired lymphangioma (lymphangiectasis): report of a case. Arch Dermatol 1970;101 (2) 230- 234
PubMed Link to Article

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