Lympho-nodal fibrosclerosis in primary lymphedema. Part one: Considerations on lympho-nodal fibrosclerosis in primary lymphedema.

Segments of an inferior inguinal ganglion and of an external iliac (upper inguinal) ganglion were microscopically examined in 46 cases of bilateral primary lymphedema and 26 cases of unilateral primary lymphedema. The examination was performed bilaterally and comparatively to a set of ganglions unaffected by lymphedema, during the years 1974-1978. In all the lymph nodes originating from the patients with lymphedema important morphopathological alternations were noticed, chiefly consisting in fibrosis, fibrosclerosis, fat loading, hyalinization processes, giganto-cellular responses, etc., leading even to an aspect of cirrhosis, lympho-nodal pseudo-cirrhosis. These alterations were also found on the healthy side of the patients with unilateral primary lymphedema at the time of the microscopical examination. In the same patient clinical edema appeared in the following years. The degree of the morphopathological alterations was greater in the side of the greater edema and more peculiar in the cases of bulkier edema.

Lympho-nodal fibrosclerosis in primary lymphedema. Part two: Consequences of lympho-nodal fibrosclerosis on lymph stasis in primary lymphedema.

The inguinal-iliac lympho-nodal fibrosclerotic processes appearing in female patients with primary lymphedema bring about an obvious tendency of reduction of the circulatory flux in the afferent lymphatics at some distance from the lympho-nodal area: at the foot or at the shank. The inguinal lympho-nodal morphopathological alterations (examined in 72 cases of primary lymph-edema) were followed, by distal lymph stasis at the level of the foot and of the leg, without sensibly affecting the lymph flow in the thigh. These aspects of the lymph stasis adjacent to the lympho-nodal areas are striking in the patients with secondary lymphedema.