Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2015  |  Volume : 60  |  Issue : 2  |  Page : 200
Author's Reply


Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India

Date of Web Publication3-Mar-2015

Correspondence Address:
Angoori Gnaneshwar Rao
Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana
India
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How to cite this article:
Rao AG. Author's Reply. Indian J Dermatol 2015;60:200

How to cite this URL:
Rao AG. Author's Reply. Indian J Dermatol [serial online] 2015 [cited 2020 Mar 30];60:200. Available from: http://www.e-ijd.org/text.asp?2015/60/2/200/152535


Sir,

I appreciate the interest shown [1] by the esteemed reader in the article titled "acquired lymphangiectasis following surgery and radiotherapy of breast cancer." Published in esteemed journal, Indian Journal of Dermatology as E-case report. [2]

The issue of terminology raised by the esteemed reader is pertinent. The terminology used in the article is based on pathological changes consequent to surgery and/or radiotherapy. There is controversy regarding two different pathological changes; lymphangiectasia and benign vascular proliferations.

  1. The origin of the papules in benign lymphangiomatous papules of the skin following radiotherapy is debatable, some observers think they are associated with disruption of the flow of lymphatic fluid with resultant dilation of the existing lymphatic ducts [3] whereas others believe that they are a reactive proliferation of lymphatic vessels after damage by either operation or radiation. [4] It is definite that there is damage to the lymphatics by surgery/radiotherapy but whether consequent dilation or proliferation of lymphatics leads to papule formation is uncertain. In such circumstances the usage of the term acquired lymphangictasia is not incorrect. Furthermore, histopatholiogically absence of plump endothelial cells protruding into the vascular lumen and absence of prominent nuclei of endothelial cells protruding into lumen of vessel in hobnail pattern and absence of dense lymphocytic infiltrate close to the dilated lymphatic vessels in the index case do not substantiate usage of the term benign angiomatous proliferation. [5],[6] Hence, the term acquired lymphangiectasis was used aptly for the index case. Moreover, the term lymphangiomatous papules may be reserved when the above histopathological features are seen.
  2. Regarding the development of angiosarcoma: Acquired lymphangiectasia patients with the chronic lymphedema following mastectomy and/or radiotherapy may develop angiosarcoma. [7]


These angiosarcomas are characterized immunohistochemically by expression and amplification of myelocytomatosis (MYC) gene, which differentiates post radiation angiosarcomas from benign vascular proliferations following radiotherapy. [8] In addition, immunohistochemical staining for MYC not only helps in the diagnosis but also helps in mapping the neoplasm.

It is clear that acquired lymphangiectasia and chronic lymphedema are the pathological process involved (following surgery and/or radiotherapy), which subsequently may develop angiosarcoma which is MYC expressive. Conversely, angiosarcoma from benign vascular proliferations (induced by radiation) is MYC nonexpressive. Lymphangiectasia and benign vascular proliferations are distinct pathological processes and usage of these terms should be based on histopathological findings.

 
   References Top

1.
Madke B. Benign Lymphangiomatous Papules or Plaques after Radiotherapy is the Correct Terminology. Indian J Dermatol 2015:60:199.  Back to cited text no. 1
    
2.
Rao AG. Acquired lymphangiectasis following surgery and radiotherapy of breast cancer. Indian J Dermatol 2015;60:106   Back to cited text no. 2
    
3.
Fineberg S, Rosen PP. Cutaneous angiosarcoma and atypical vascular lesions of the skin and breast after radiation therapy for breast carcinoma. Am J Clin Pathol 1994;102:757-63.  Back to cited text no. 3
    
4.
Rosso R, Gianelli U, Carnevali L. Acquired progressive lymphangioma of the skin following radiotherapy for breast carcinoma. J Cutan Pathol 1995;22:164-7.  Back to cited text no. 4
    
5.
Diaz-Cascajo C, Borghi S, Weyers W, Retzlaff H, Requena L, Metze D. Benign lymphangiomatous papules of the skin following radiotherapy: A report of five new cases and review of the literature. Histopathology 1999;35:319-27.  Back to cited text no. 5
    
6.
Sener SF, Milos S, Feldman JL, Martz CH, Winchester DJ, Dieterich M, et al. The spectrum of vascular lesions in the mammary skin, including angiosarcoma, after breast conservation treatment for breast cancer. J Am Coll Surg 2001;193:22-8.  Back to cited text no. 6
    
7.
Rodríguez-Bujaldón A, Vázquez-Bayo MC, Galán-Gutiérrez M, Jiménez-Puya R, Vélez García-Nieto A, Moreno- Giménez JC, et al. Angiosarcoma in chronic lymphedema. Actas Dermosifiliogr 2006;97:525-8.  Back to cited text no. 7
    
8.
Manner J, Radlwimmer B, Hohenberger P, Mössinger K, Küffer S, Sauer C, et al. MYC high level gene amplification is a distinctive feature of angiosarcomas after irradiation or chronic lymphedema. Am J Pathol 2010;176:34-9.  Back to cited text no. 8
    




 

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