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NEAR-INFRA-RED (NIR) FLUORESCENCE IMAGING OF LYMPHATIC VESSELS AFTER SUBCUTANEOUS (SC) INJECTION OF FREE INDOCYANINE GREEN (ICG): WHAT DO WE SEE? PRELIMINARY RESULTS
PIERRE BOURGEOIS 1, ROMAIN BARBIEUX 2, GUIDO GIACALONE 3, PHILIPPE MERSCH 4, OLIVIER LEDUC 2, SOPHIE V ANKERCKHOVE 1, GHANEM GHANEM 4 (Group R&D Clinical Applications of Fluorescence Imagings)
1 Department of Nuclear Medicine and Clinic-Unit of Lymphology,
4 Laboratoire d’Oncologie et Chirurgie Expérimentale,
Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
2 Lympho-phlebology Unit, Department of Occupational and Environmental Physiology, Haute Ecole P. H. Spaak, Brussels Belgium, 3 University of Hasselt, Belgium
Introduction: Stewart-Treves syndrome (STS) is a rare, but a life-threatening complication of lymphedema, consisting of vascular malignancies and long-standing chronic lymphedema. The first case of angiosarcoma arising secondary to lymphedema was reported by Lowenstein in 1906, and Stewart and Treves reported collective 6 cases of angiosarcoma in postmastectomy lymphedema in 1948.
Materials and Methods: Review of the literatures related to STS, and immunohistochemical study of the tumor tissue obtained from a case of STS (60 years old Japanese male) who suffered from primary lymphedema of the lower extremities.
Results and Discussion: Regarding the tumor cells of the vascular malignancy observed in the case of STS, some of the tumor cells were CD34(+)/podoplanin(–) and others revealed CD34(–)/podoplanin(+). The vascular malignancies of STS have been called angiosarcoma, lymphangiosarcoma, or hemangiosarcoma depending on the literatures. Since, there are both types of tumor cells showing phenotypes for hemangiosarcoma and lymphangiosarcoma, the term angiosarcoma is thought to be appropriate to call the malignancy.
Regarding the process of the oncogenesis taking place in the syndrome, the local immunodeficiency caused by lymphedema has been regarded as the sole oncogenic factor. However, immune deficiency is thought to be a promoting factor for the oncogenesis, not an initiating. We reported that there is an increase in contents of lipid peroxide in the tissue of lymphedema. An increase in lipid peroxide is the evidence for generation of oxygen radicals. DNA-injury caused by oxygen radicals may play an initiating role in the process of the oncogenesis
Conclusions: The vascular malignancy in STS should be called angiosarcoma. Oncogenesis of the angiosarcoma in STS is thought to be initiated by the oxygen radicals and promoted by the local immunodeficiency.
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015