PRESENCE OF FUNCTIONAL AXILLARY LYMPH NODES AND LYMPH DRAINAGE WITHIN ARMS IN WOMEN WITH AND WITHOUT BREAST CANCER-RELATED LYMPHEDEMA

This pilot study was designed to investigatelymphatic transport in the arms of womenafter breast cancer treatment withoutlymphedema and with mild and severe armlymphedema. Nineteen breast cancer survivors[6 without (Group 1), 6 with mild (Group 2)and 7 with severe (Group 3) lymphedema]were examined. Lymphatic transport in thearm and to axillary lymph nodes wereevaluated using quantitative radionuclidelymphscintigraphy. The radioactivity ratiobetween the operated and unoperated axillae(axillary ratio), and both lymphatic transportand tracer disappearance rates (TDR) fromthe injection sites were calculated. We foundthat axillary ratio and lymphatic transportwere significantly higher in Groups 1 and 2compared to 3 and that TDR was not affectedin any Group. Additionally, lymphscintigraphyrevealed presence of functional axillary lymphnodes within the operated axilla in womenwithout or with mild lymphedema, while inwomen with severe lymphedema, no axillarylymph nodes were visualized. We concludefrom our subjects that breast cancer survivorswho did not develop or had mild arm lymphedemahave functional lymphatic transportand lymph nodes in the axillary area on theoperated side. This suggests that efficientcollateral circulation and/or peripherallymphovenous communications has developedin these subjects which may be preventativefor the development of severe lymphedema

MELKERSSON-ROSENTHAL SYNDROME: LYMPHOSCINTIGRAPHY-DOCUMENTED IMPAIRMENT AND RESTORATION OF FACIAL LYMPHATIC DRAINAGE IN THE COURSE OF DISEASE

Melkersson-Rosenthal syndrome (MRS)is an idiopathic, rare disorder manifested byfacial swelling, congenital plicated tongue andrecurrent peripheral facial nerve palsy. Labialinvolvement alone is referred to as cheilitisgranulomatosa. Differential diagnosis of MRSincludes allergic angioedema, bacterial, viralor filarial infections as well as autoimmunologicalinflammation in the course of systemiclupus erythematosus, dermatomyositis, andothers. We present 4 patients who experiencedperiodically painless edema of the face and/orlips. Lesions were diagnosed as recurrentQuincke’s edema and were treated withantihistamine agents and glucocorticoidswithout improvement.In all four cases of MRS, we were able todocument impaired lymphatic drainage fromthe swollen area using lymphoscintigraphy.We also documented in follow-up lymphoscintigraphya restoration of lymphatic flow inthree of the four patients with MRS and theseresults corresponded with clinical improvement.We have demonstrated that lymphaticpathology plays an important role in pathophysiologyof chronic facial swelling inpatients with Melkersson-Rosenthal syndrom