Dizionario

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Although words like lymphocyte, lymph node, lymph, and lymphatic vessels are common in daily medical activities, Lymphology has always been considered as a sort of younger sister to Angiology or Phlebology. Also, apart from few pioneer physicians, it has never been investigated as a discreet, well identified area of research.

Therefore, the following “Dictionary” aims to be a sort of metaphorical “window” on the extensive and still poorly explored world of lymphatic diseases, as well as to provide some useful, basic information for a correct diagnosis of patients affected by lymphatic-lymph node disorders.

Questo “Dizionario” vuole, quindi, rappresentare una sorta di metaforica “finestra” sul vasto ed ancora poco inesplorato mondo della patologia linfatica e fornire utili elementi di conoscenza di base per una corretta diagnosi e gestione del paziente affetto da alterazioni del sistema linfatico-linfonoidale.

LYMPHOSTATIC VERRUCOSIS

Typical manifestation of advanced stage chronic lymphedema. The term verrucosis refers to the macroscopic appearance of esophytic lesions, and it has nothing to do with more common dermatologic verrucoid pictures, which, in the majority of cases, are due to viruses (human papilloma virus). Also in lymphostatic verrucosis, skin hyperplasia is present, which, in this case, is caused by increased pressure of interstitial fluid in the derma, promoting the proliferation of epidermal basal layer cells through the compression of their intercellular joints. Lymphostatic verrucosis is often accompanied by lymph leak (lymphorrhea or lymphorrhagia). 

LYMPHOSCINTIGRAPHY

Diagnostic imaging technique commonly used in lymphology. It features an interdigital injection of Technetium-99m (99mTc) labeled nanocolloids, which, being highly lymphotropic, are only drained through the lymphatic pathways. Then, with the acquisition of serial views from a gamma-camera, the anatomy of lymphatic, both superficial and deep, pathways can be outlined, and their drainage capacity assessed over time. With this simple, moderately invasive examination, requiring only an intradermal subcutaneous or deep injection of radioisotopic tracer, the extent of lymph stasis can be assessed, preferential drainage pathways and lymph node structures detected, and any other parameters defined, that may be useful to begin treatment, as well as for long-term follow-up of applied therapies.

LYMPHORRHEA OR LYMPHORRHAGIA

Leak of lymph outside the body. It frequently occurs through surgical wounds, as a complication of lymphadenectomies or lesions of major lymphatic ducts. It may also occur in cases of acute or chronic lymphedemas, where the interstitial pressure increases so much as to make the lymph seep through the skin. Figure: Lymph leak in a case of acute lymphedema with lymphostatic verrucosis.

LYMPHOLOGY

International scientific journal on lymphology, and the official journal of the International Society of Lymphology.

LYMPHOCELE

Lymph collection in a newly developed cavity. Depending on its anatomic localization and the presence of any associated lesions, some varying chylous component (lymph-chylocele) may also be observed. It is a common complication after lymphadenectomy, but it may also develop as a primary manifestation. Symptoms of lymphocele depend on its size and on whether it presses against surrounding tissues and structures. Lymphocele is treated by surgery with its radical resection associated with concurrent laser “sealing” of any lymphatic vessels, which could give origin to lymphorrhoea or even a recurrency.

LYMPHEDEMA ETIOLOGY

Lymphedema may occur as a primary condition (primary lymphedema) or secondary to a previous pathological condition (secondary lymphedema). Secondary lymphedemas often have a latent congenital component, which becomes clinically overt only after some triggering event. Lymphangiodysplasia with varying severity is the etiological origin of primary lymphedemas, which are distinguished into neonatal or congenital proper (Milroy disease), with early (Meige syndrome) or late onset. Secondary lymphedemas more commonly have a surgical origin, such as for example in the case of lymphadenectomies for oncological control (post-mastectomy lymphedema), but may also be the result of trauma, infection (filaria related or post-lymphangitis lymphedemas), or they may be linked to a loss of neuro-muscular functions (functional or “disuse” Lymphedema).

Lymphedema secondary to trauma with relevant lymphoscintigraphy, which, if superimposed, shows that the tracer is blocked at the level of the scar, with corresponding lymph stagnation in the medial portion of the thigh.

LYMPHEDEMA

Lymphedema is an edema caused by either mechanical or dynamic insufficiency in lymph circulation. Low output lymphedema (mechanical insufficiency) may be caused by congenital lymphatic dysplasia (primary lymphedema), or it may be due to secondary anatomic impairment of lymphatic structures, for example following surgeries or repeated lymphangites, with subsequent diffuse lymphangiosclerosis and functional insufficiency (secondary lymphedema). Conversely, high output lymphedema (dynamic insufficiency) is due to higher lymph production, associated with arteriovenous insufficiency of capillary microcirculation: with this condition, despite regular transport capacity of the lymphatic pathways, lymph stasis is brought about by an abnormal increase in lymphatic load (see), thus leading to edema, which, in turn, may become chronic, if the underlying conditions are maintained over time, for example in case of liver cirrhosis, chronic venous insufficiency of the lower limbs with peripheral edema, and nephrosic syndrome with anasarca. Lymphedema therapy is based on three fundamental principles: physical treatment (manual and mechanical lymphatic drainage, and multilayer functional bandages), pharmacologic treatment (diuretics, benzopyrones, antibiotics, and diet), and surgical treatment, with particular reference to derivative and reconstructive microsurgery. The synergistic application of the above specified treatments has led to treatment outcomes that would have not been achieved if individually applied. This also explains why certain therapeutical methods, even when correctly applied, have failed, since they have not fully benefited from the potentials offered by the so called “combined” medical-physical-surgical therapy, which is by now internationally recognized as the “gold standard” in lymphedema treatment.

LYMPHCHROME

In vivo staining of lymphatic vessels (see: Lymphochromic Test, Lymphography).

LYMPHATIC VALVES

Lymphatic valves are identical to venous valves, but they are many more in number. The peculiar rosary-shape of lymphatic vessels is due to the arrangement of these valves, which consist of endothelial cell laminas in seamless connection with the intima of the lymphatic vessel. They lack smooth muscle cells. Just like in the nervous system, lymphatic valves are arranged to follow the flow direction and are located to allow a quick flow of the lymph through the larger lymphatics, while preventing its back-flow.

LYMPHATIC PRECOLLECTORS

Short and thin lymphatic vessels connecting the absorbing peripheral section with the main lymphatic drainage pathways proper, namely, lymphatic and main lymphatic ducts.

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