PMID- 22911751
OWN - NLM
STAT- MEDLINE
DCOM- 20130419
LR  - 20220316
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 7
IP  - 7
DP  - 2012
TI  - Pathological steps of cancer-related lymphedema: histological changes in the 
      collecting lymphatic vessels after lymphadenectomy.
PG  - e41126
LID - 10.1371/journal.pone.0041126 [doi]
LID - e41126
AB  - INTRODUCTION: To date, an electron microscopy study of the collecting lymphatic 
      vessels has not been conducted to examine the early stages of lymphedema. 
      However, such histological studies could be useful for elucidating the mechanism 
      of lymphedema onset. The aim of this study was to clarify the changes occurring 
      in collecting lymphatic vessels after lymphadenectomy. METHODS: The study was 
      conducted on 114 specimens from 37 patients who developed lymphedema of the lower 
      limbs after receiving surgical treatment for gynecologic cancers and who 
      consulted the University of Tokyo Hospital and affiliated hospitals from April 
      2009 to March 2011. Lymphatic vessels that were not needed for lymphatico venous 
      anastomosis surgery were trimmed and subsequently examined using electron 
      microscopy and light microscopy. RESULTS: Based on macroscopic findings, the 
      histochemical changes in the collecting lymphatic vessels were defined as 
      follows: normal, ectasis, contraction, and sclerosis type (NECST). In the ectasis 
      type, an increase in endolymphatic pressure was accompanied by a flattening of 
      the lymphatic vessel endothelial cells. In the contraction type, smooth muscle 
      cells were transformed into synthetic cells and promoted the growth of collagen 
      fibers. In the sclerosis type, fibrous elements accounted for the majority of the 
      components, the lymphatic vessels lost their transport and concentrating 
      abilities, and the lumen was either narrowed or completely obstructed. 
      CONCLUSIONS: The increase in pressure inside the collecting lymphatic vessels 
      after lymphadenectomy was accompanied by histological changes that began before 
      the onset of lymphedema.
FAU - Mihara, Makoto
AU  - Mihara M
AD  - Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, 
      Japan. mihara@keiseigeka.name
FAU - Hara, Hisako
AU  - Hara H
FAU - Hayashi, Yohei
AU  - Hayashi Y
FAU - Narushima, Mitsunaga
AU  - Narushima M
FAU - Yamamoto, Takumi
AU  - Yamamoto T
FAU - Todokoro, Takeshi
AU  - Todokoro T
FAU - Iida, Takuya
AU  - Iida T
FAU - Sawamoto, Naoya
AU  - Sawamoto N
FAU - Araki, Jun
AU  - Araki J
FAU - Kikuchi, Kazuki
AU  - Kikuchi K
FAU - Murai, Noriyuki
AU  - Murai N
FAU - Okitsu, Taro
AU  - Okitsu T
FAU - Kisu, Iori
AU  - Kisu I
FAU - Koshima, Isao
AU  - Koshima I
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120724
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Fibrillar Collagens)
SB  - IM
EIN - PLoS One. 2013;8(5). doi: 10.1371/annotation/6fff4d28-3f99-44eb-82d6-ccd885a1ba11
MH  - Adult
MH  - Aged
MH  - Desmosomes/pathology/ultrastructure
MH  - Endothelial Cells/pathology/ultrastructure
MH  - Female
MH  - Fibrillar Collagens/ultrastructure
MH  - Humans
MH  - Lymph Node Excision
MH  - Lymphatic Vessels/*pathology
MH  - Lymphedema/*etiology/*pathology
MH  - Middle Aged
MH  - Myocytes, Smooth Muscle/pathology/ultrastructure
MH  - Neoplasms/*complications/surgery
PMC - PMC3404077
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2012/08/23 06:00
MHDA- 2013/04/23 06:00
PMCR- 2012/07/24
CRDT- 2012/08/23 06:00
PHST- 2012/01/02 00:00 [received]
PHST- 2012/06/19 00:00 [accepted]
PHST- 2012/08/23 06:00 [entrez]
PHST- 2012/08/23 06:00 [pubmed]
PHST- 2013/04/23 06:00 [medline]
PHST- 2012/07/24 00:00 [pmc-release]
AID - PONE-D-11-08927 [pii]
AID - 10.1371/journal.pone.0041126 [doi]
PST - ppublish
SO  - PLoS One. 2012;7(7):e41126. doi: 10.1371/journal.pone.0041126. Epub 2012 Jul 24.