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Pathogenesis of lymphangiomas

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Abstract

Based on various hypotheses concerning lymphangiogenesis published in the literature, different putative mechanisms of lymphangioma development are discussed including failure of the lymphatic system to connect with or separate from the venous system, abnormal budding of the lymphatic system from the cardinal vein, or acquired processes such as traumata, infections, chronic inflammations, and obstructions. Increasingly, the possible influence of lymphangiogenic growth factors on the development of lymphangiomas is discussed. The proved expression of different growth factors in the endothelium of lymphangiomas leads to new hypotheses regarding the pathogenesis of lymphangiomas. Thus, further studies on the lymphangiogenesis and the development of lymphangiomas will have to clarify as to whether lymphangiomas are true malformations or neoplastic in nature.

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References

  1. Alitalo K (2007) Inhibition of VEGF-C/VEGFR-3 mediated angiogenesis, lymphangiogenesis and metastasis. 2nd International Symposium on Cancer and the lymphovascular System: Basis for rational therapy, San Francisco

  2. Alqahtani A, Nguyen LT, Flageole H, Shaw K, Laberge JM (1999) 25 years’ experience with lymphangiomas in children. J Pediatr Surg 34:1456–1463

    Article  Google Scholar 

  3. Asellius G (1627) De lactibus sive lacteis venis. Milan, J.B. Bidellium, Mediolani

    Google Scholar 

  4. Bloom DC, Perkins JA, Manning SC (2004) Management of lymphatic malformations. Curr Opin Otolaryngol Head Neck Surg 12:500–504

    Article  PubMed  Google Scholar 

  5. Brandrup F (1976) Lymphangioma circumscriptum of the tongue. Plast Reconstr Surg 153:191

    CAS  Google Scholar 

  6. Detmar M (2007) Tumor and lymph node lymphangiogenesis: Impact on metastasis. 2nd International Symposium on Cancer and the Lymphovascular System: Basis for Rational Therapy, San Francisco

  7. Enzinger FM, Weiss SW (1995) Tumors of lymph vessels. In: Enzinger FM, Weiss SW (eds) Soft tissue tumors. Mosby-Year Book, St. Louis, pp 679–688

    Google Scholar 

  8. Faul JL, Berry GJ, Colby TV, Ruoss SJ, Walter MB, Rosen GD, Raffin TA (2000) Thoracic lymphangiomas, lymphangiectasis, lymphangiomatosis, and lymphatic dysplasia syndrome. Am J Respir Crit Care Med 161:1037–1046

    PubMed  CAS  Google Scholar 

  9. Heether J, Whalen T, Doolin E (1994) Follow-up of complex unresectable lymphangiomas. Am Surg 60:840–841

    PubMed  CAS  Google Scholar 

  10. Hong YK, Harvey N, Noh YH, Schacht V, Hirakawa S, Detmar M, Oliver G (2002) Prox1 is a master control gene in the program specifying lymphatic endothelial cell fate. Dev Dyn 225:351–357

    Article  PubMed  CAS  Google Scholar 

  11. Huang HY, Ho CC, Huang PH, Hsu SM (2001) Co-expression of VEGF and its receptors, VEGFR-2 and VEGFR-3, in endothelial cells of lymphangioma. Implication in autocrine or paracrine regulation of lymphangioma. Lab Invest 81:1729–1734

    PubMed  CAS  Google Scholar 

  12. Huntington GS, McClure CFW (1908) The anatomy and development of the jugular lymph sac in the domestic cat. Anat Rec 2:1–19

    Article  Google Scholar 

  13. Irrthum A, Karkkainen MJ, Devriendt K, Alitalo K, Vikkula M (2000) Congenital hereditary lymphedema caused by a mutation that inactivates VEGFR-3 tyrosine kinase. Am J Hum Genet 67:295–301

    Article  PubMed  CAS  Google Scholar 

  14. Jackowski S, Janusch M, Fiedler E, Marsch WC, Ulbrich EJ, Gaisbauer G, Dunst J, Kerjaschki D, Helmbold P (2007) Radiogenic lymphangiogenesis in the skin. Am J Pathol 171:338–348

    Article  PubMed  Google Scholar 

  15. Jain RK, Padera TP (2003) Lymphatics make the break. Science 299:209–210

    Article  PubMed  CAS  Google Scholar 

  16. Joukov V, Pajusola K, Kaipainen A, Chilov D, Lahtinen I, Kukk E, Saksela O, Kalkkinen N, Alitalo K (1996) A novel vascular endothelial growth factor, VEGF-C, is a ligand for the Flt4 (VEGFR-3) and KDR (VEGFR-2) receptor tyrosine kinases. EMBO J 15:290–298

    PubMed  CAS  Google Scholar 

  17. Kaipainen A, Korhonen J, Mustonen T, Van Hinsberg V, Fang G, Dumont D, Breitman M, Alitalo K (1995) Expression of the fms-like tyrosine kinase 4 gene becomes restricted to lymphatic endothelium during development. Proc Natl Acad Sci U S A 92:3566–3570

    Article  PubMed  CAS  Google Scholar 

  18. Kampmeier OF (1912) The value of the injection method in the study of the lymphatic development. Anat Rec 6:223–233

    Article  Google Scholar 

  19. Karkkainen MJ, Haiko P, Sainio K, Partanen J, Taipale J, Petrova TV, Jeltsch M, Jackson DG, Talikka M, Rauvala H, Bersholtz C, Alialo K (2004) Vascular endothelial growth factor C is required for sprouting of the first lymphatic vessels from embryonic veins. Nat. Immun 5:74–80

    Article  CAS  Google Scholar 

  20. Kerjaschki D (2005) The crucial role of macrophages in lymphangiogenesis. J Clin Invest 115:2316–2319

    Article  PubMed  CAS  Google Scholar 

  21. Kuo AH, Hoshida T, Isaka N, Hagendoorn J, di Tomaso E, Chen Y, Pytowski B, Fukumura D, Padera TP, Jain RK (2007) Vascular endothelial growth factor receptor-3 signaling via vascular endothelial growth factor-C increases lymphatic metastasis by influencing tumor cell entry into lymphatic vessels. 2nd International Symposium on Cancer and the Lymphovascular System: Basis for Rational Therapy, San Francisco

  22. Kutsuna M (1933) Beiträge zur Kenntnis der Entwicklung des Lymphgefäßsystems der Vögel. Acta Sch Med Kyoto 16:16–25

    Google Scholar 

  23. Laurence KM (1955) Congenital cystic pulmonary lymphangioectasis. J Pathol Bacteriol 70:325–333

    Article  PubMed  CAS  Google Scholar 

  24. Lawley LP, Cerimele F, Weiss W, North P, Cohen C, Kozakewich HPW, Mulliken JB, Arbiser JL (2005) Expression of Wilms tumor 1 gene distinguishes vascular malformations from proliferative endothelial lesions. Arch Dermatol 141:1297–1300

    Article  PubMed  Google Scholar 

  25. Lee KJ, Klein TR (1980) Surgery of cysts and tumors of the neck. In: Paparella MM, Shumrick DA (eds) Otolaryngology. 2nd ed. WB Saunders, Philadelphia, PA, pp 2987–2989

    Google Scholar 

  26. Lymboussaki A, Partanen TA, Oloffson B, Thomas-Crusells J, Fletcher CDM, de Waal RMW, Kaipainen A, Alitalo K (1998) Expression of vascular endothelial growth factor receptor VEGFR-3 in lymphatic endothelium of the skin and in vascular tumors. Am J Pathol 153:395–493

    PubMed  CAS  Google Scholar 

  27. Maddalozzo J, Hughes CA, Huang L, Mu Y, Ludemann J, Crawfort S (1999) High angiogenic activity in cells isolated from cystic hygroma: role of bFGF. Arch Otolaryngol Head Neck Surg 125:45–48

    PubMed  CAS  Google Scholar 

  28. Madriota SJ, Jussila L, Jeltsch M, Compagni A, Baetens D, Prevo R, Banerji S, Quarte J, Montesano R, Jackson DG, Orci L, Alitalo K, Christofori G, Pepper MS (2001) Vascular endothelial growth factor-C-mediated lymphangiogenesis promotes tumour metastasis. EMBO J 20:672–682

    Article  Google Scholar 

  29. Marler J, Mulliken J (2005) Current management of hemangiomas and vascular malformations. Clin Plastic Surg 32:99–116

    Article  Google Scholar 

  30. Maruyama K, Ii M, Cursiefen C, Jackson DG, Keino H, Tomita M, Van Rooijen N, Takenaka H, Dámore PA, Stein-Streilein J, Losordo DW, Streilein JW (2005) Inflammation-induced lymphangiogenesis in the cornea arises from CD11b-positive macrophages. J Clin Invest 115:2363–2372

    Article  PubMed  CAS  Google Scholar 

  31. McClure CFW, Silvester CF (1909) A comparative study of the lymphatic-venous communication in adult mammals. Anat Rec 3:534–553

    Article  Google Scholar 

  32. Mentzel T, Kutzner H (2002) Tumors of the lymphatic vessels of the skin and soft tissue. Pathologe 23:118–127

    Article  PubMed  CAS  Google Scholar 

  33. Mentzel T, Kutzner H (2003) Benign and malign lymphatic tumours of skin and soft tissue. In: Browse N, Burnand KG, Mortimer PS (eds) Diseases of the lymphatics. Arnold, London, pp 85–101

    Google Scholar 

  34. North PE, Kahn T, Cordisco MR, Dadras SS, Detmar M, Frieden IJ (2004) Multifocal lymphangioendotheliomatosis with thrombocytopenia. Arch Dermatol 140:599–606

    Article  PubMed  Google Scholar 

  35. Paik AS, Lee PHA, O’Grady TC (2007) Acquired progressive lymphangioma in an HIV-positive patient. J Cutan Pathol 34:882–885

    Article  PubMed  Google Scholar 

  36. Petrova TV, Mäkinen T, Mäkela TP, Saarela J, Virtanen I, Ferrell RE, Finegold DN, Kerjaschki D, Ylä-Herttuala S, Alitalo K (2002) Lymphatic endothelial reprogramming of vascular endothelial cells by the Prox-1 homeobox transcription factor. EMBO J 21:4593–4599

    Article  PubMed  CAS  Google Scholar 

  37. Phillips HE, McGahan JP (1981) Intrauterine fetal cystic hygroma: sonographic detection. Am J Roentgenol 136:799–802

    CAS  Google Scholar 

  38. Reis RM, Reis-Filho JS, Longatto Filho A, Tomarev S, Silva P, Lopes JM (2005) Differential Prox-1 and CD 31 expression in mucousae, cutaneous and soft tissue vascular lesions and tumors. Pathol Res Pract 201:771–776

    Article  PubMed  CAS  Google Scholar 

  39. Sabin FR (1909) The lymphatic system in human embryos with a consideration of the system as a whole. Am J Anat 9:43–91

    Article  Google Scholar 

  40. Schneider M, Othman-Hassan K, Christ B, Wilting J (1999) Lymphangioblasts in the avian wing bud. Dev Dyn 216:311–319

    Article  PubMed  CAS  Google Scholar 

  41. Schoppmann SF, Birner P, Stockl J, Kalt R, Ullrich R, Caucig C, Kriehuber E, Nagy K, Alital K, Kerjaschki D (2002) Tumor-associated macrophages express lymphatic endothelial growth factors and are related to peritumoral lymphangiogenesis. Am J Pathol 161:947–956

    PubMed  CAS  Google Scholar 

  42. Sidle DM, Maddalozzo J, Meier JD, Cornwell M, Stellmach V, Crawfort SE (2005) Altered pigment epithelium-derived factor and vascular endothelial growth factor levels in lymphangioma pathogenesis and clinical recurrence. Arch Otolaryngol Head Neck Surg 131:990–995

    Article  PubMed  Google Scholar 

  43. Skobe M, Hawighorst T, Jackson DG, Prevo R, Janes L, Velasco P, Riccardi L, Alialo K, Claffey K, Detmar M (2001) Induction of tumor lymphangiogenesis by VEGF-C promotes breast cancer metastasis. Nat Med 7:192–198

    Article  PubMed  CAS  Google Scholar 

  44. Song TB, Kim CH, Kim SM, Kim YH, Byun JS, Kim EK (2002) Fetal axillary cystic hygroma detected by prenatal ultrasonography: a case report. J Korean Med Sci 17:400–402

    PubMed  Google Scholar 

  45. Suk S, Sheridan M, Saenger JS (1997) Adult lymphangioma: a case report. Ear Nose Throat J 76:881–883

    PubMed  CAS  Google Scholar 

  46. Teymoortash A, Schrader C, Shimoda H, Kato S, Werner JA (2007) Evidence of lymphangiogenesis in Warthin`s tumor of the parotid gland. Oral Oncol 43:614–618

    Article  PubMed  CAS  Google Scholar 

  47. Van der Jagt ER (1932) The origin and development of the anterior lymph sacs in the sea turtle. Q J Microbiol Sci 75:151–165

    Google Scholar 

  48. Van der Putte SCJ (1977) Lymphatic malformation in human fetuses. Virchows Arch 376:233–246

    Article  Google Scholar 

  49. Weingast GR (1988) Congenital lymphangiectasia with fetal cystic hygroma: report of two cases with co-existent Down’s syndrome. JCU 16:553–668

    Google Scholar 

  50. Werner JA, Dünne AA, Folz BJ, Rochels R, Bien S, Ramaswamy A, Lippert BM (2001) Current concepts in the classification, diagnosis and treatment of hemangiomas and vascular malformations of the head and neck. Eur Arch Otorhinolaryngol 258:141–149

    Article  PubMed  CAS  Google Scholar 

  51. Werner JA, Eivazi B, Folz BJ, Dünne AA (2006) State of the art of classification, diagnostics and therapy for cervicofacial hemangiomas and vascular malformations. Laryngorhinootologie 85:883–889

    Article  PubMed  CAS  Google Scholar 

  52. Wiggs WJ Jr, Sismanis A (1994) Cystic hygroma in the adult: two case reports. Otolaryngol Head Neck Surg 110:239–241

    PubMed  Google Scholar 

  53. Wigle JT, Harvey N, Detmar M, Lagutina I, Grosveld G, Gunn MD, Jackson DG, Oliver G (2002) An essential role for Prox1 in induction of the lymphatic endothelial cell phenotype. EMBO J 21:1505–1513

    Article  PubMed  CAS  Google Scholar 

  54. Wigle JT, Oliver G (1999) Prox1 function is required for the development of the murine lymphatic system. Cell 98:769–778

    Article  PubMed  CAS  Google Scholar 

  55. Williams HB (1982) Hemangiomas and lymphangiomas. Adv Surg 15:317–349

    Google Scholar 

  56. Wilting J, Kasten P, Schöning G, Bergmann A, Papoutsi M, Weich HA (2007) Model system to study lymphangiogenesis and angiogenesis: lessons for tumor biology. 2nd International Symposium on Cancer and the Lymphovascular System: Basis for Rational Therapy, San Francisco

  57. Wilting J, Papoutsi M, Christ B, Nicolaides KH, von Kaisenberg CS, Borges J, Stark GB, Alitalo K, Tomarev SI, Niemeyer C, Rossler J (2002) The transcription factor Prox1 is a marker for lymphatic endothelial cells in normal and diseased human tissues. FASEB J 16:1271–1273

    PubMed  CAS  Google Scholar 

  58. Zadvinskis DP, Benson MT, Kerr HH, Mancuso AA, Cacciarelli AA, Madrazo BL, Mafee MF, Dalen K (1992) Congenital malformations of the cervicothoracic lymphatic system: embryology and pathogenesis. Radiographics 12:1175–1189

    PubMed  CAS  Google Scholar 

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Wiegand, S., Eivazi, B., Barth, P.J. et al. Pathogenesis of lymphangiomas. Virchows Arch 453, 1–8 (2008). https://doi.org/10.1007/s00428-008-0611-z

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