Potential biomarkers of kaposiform lymphangiomatosis.

BACKGROUND: Kaposiform lymphangiomatosis (KLA) has recently been distinguished as a novel subtype of generalized lymphatic anomaly (GLA), and is characterized by foci of spindle endothelial cells amid a background of malformed lymphatic channels. The etiology of these diseases remains unknown and diagnosis is confounded by their similar clinical findings. This study aimed to clarify differences in the clinical findings and plasma cytokine profiles of GLA and KLA patients. PROCEDURE: Clinical features data of GLA and KLA patients were obtained from a national survey. Differences in clinical findings, plasma levels of cytokines, and survival were analyzed. Plasma was obtained from healthy controls and GLA and KLA patients. Thirty-six angiogenic and lymphangiogenic factors were evaluated for cytokine concentration. RESULTS: Twenty-one patients with GLA and 11 with KLA were recruited. Mediastinal masses, hemorrhagic pericardial and pleural effusion, coagulation disorders, and thrombocytopenia were more frequent in KLA than in GLA. KLA had a significantly poorer outcome than GLA (P = 0.044). Soluble VEGFR3, angiopoietin 2, HGF, soluble HER2, tenascin C, and soluble HGFR levels were higher in KLA. Notably, soluble VEGFR3 and angiopoietin 2 levels were approximately 10-fold higher than those of other molecules measured. However, soluble VEGFR1 and soluble TIE2 were lower in KLA than in GLA and the controls. CONCLUSIONS: Patients with KLA have an unfavorable prognosis and serious symptoms (hemorrhagic pleural effusion and coagulation disorders). Our data indicate that eight angiogenic cytokines might be potential biomarkers of KLA.

[Pulmonary lymphangioleiomyomatosis. Morphologic and immunohistochemical findings]. / Pulmonale Lymphangioleiomyomatose. Morphologische und immunhistochemische Befunde.

Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease affecting only women which is characterised by cystic parenchymal changes and smooth muscle proliferation and has to be considered in the differential diagnosis of interstitial lung disease. The LAM cell is classified as a so-called perivascular epithelioid cell (PEC) showing immunohistochemical co-expression of smooth muscle and melanocytic markers (melanomyopericyte). A total of 18 cases of LAM and 56 cases of various other pulmonary diseases were analysed by immunohistochemistry. For the diagnosis of LAM in transbronchial or open lung biopsies, immunohistochemistry using the antibody HMB 45 is decisive because it shows a highly specific and sensitive, but often only faint reaction for pulmonary LAM. The immunohistochemical detection of nuclear localised microphthalmia transcription factor (MiTF) in LAM as an additional melanocytic marker further emphasises the melanocytic (as well as smooth muscle) line of differentiation within the cells of LAM. Using the concept of a melanomyopericyte, pulmonary LAM could be classified as a hamartomatous interstitial lung disease showing perivascular smooth muscle and partial melanocytic differentiation.

[Clinical and molecular epidemiology of lymphangioleiomyomatosis and pulmonary pathology in tuberous sclerosis]. / Epidémiologie clinique et moléculaire de la lymphangioleiomyomatose et de l'atteinte pulmonaire de la sclérose tubéreuse.

Pulmonary lymphangioleiomyomatosis is characterized by a proliferation of abnormal smooth muscle cells in peribronchial, perivascular and perilymphatic areas leading to cystic destruction of the pulmonary parenchyma. Recent clinical series of LAM have been helpful in better describing the various clinical and radiological forms of the disease, although our understanding of the pathophysiological mechanisms of LAM remains very limited. Significant progress has been noted in recent years with the discovery of probable antigenic and genetic similarities between pulmonary lymphangioleiomyomatosis, Bourneville tuberous sclerosis and renal angiomyolipoma. The proliferating cells in LAM share with normal smooth muscle cells their reactivity with desmine, vimentin and actin but certain are different by their reactivity with the monoclonal antibody HMB45, a common antigen marker of melanocyte differentiation cells, clear-cell lung carcinomas or renal angiomyolipomas. A loss heterozygosity in the region of the TSC2 gene in renal angiomyolipomas has been demonstrated in association with pulmonary lymphangioleiomyomatosis. The TSC2 gene is particularly implicated in the pathogenesis of Bourneville tuberous sclerosis.

Linfangioleiomiomatosis pulmonar: reporte de un caso

La linfangioleiomiomatosis es una enfermedad rara con menos de 250 casos reportados en la literatura universal, que ocurre únicamente en mujeres, usualmente en edad reproductiva y que se caracteriza por la proliferación de células de musculo liso en tejido pulmonar y en los vasos linfáticos. Presentamos el caso de una mujer de 29 años, con disnea progresiva, tos con escasa espectoración y neumotórax espontáneo bilateral. El diagnóstico se realizó mediante biopsia pulmonar a cielo abierto, donde se encontró proliferación de haces de músculo liso los cuales se disponían preferentemente alrededor de las estructuras vasculares,bronquiales y septo alveolares. Comentamos los principales hallazgos clínicos, radiológicos e histopatológicos.