Lung

Mesenchymal tumors

Diffuse pulmonary lymphangiomatosis



Last author update: 1 August 2015
Last staff update: 9 May 2024

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PubMed Search: Diffuse pulmonary lymphangiomatosis [title]

Roseann I. Wu, M.D., M.P.H.
Cite this page: Wu R. Diffuse pulmonary lymphangiomatosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lungtumordiffusepulm.html. Accessed December 25th, 2024.
Definition / general
  • Diffuse proliferation of abnormal, complex lymphatic channels (lymphangiomas) that may involve lung or other organs (Lymphat Res Biol 2011;9:191)
  • Pulmonary involvement often accompanied by chylous pleural effusions
  • May be progressive and fatal from respiratory failure
Terminology
  • Lymphangioma if proliferation is focal
Epidemiology
  • Rare condition, typically presents in children and young adults
  • No sex predilection
Sites
  • Localized to lung / chest or can also involve multiple organs, including bone, spleen, soft tissue, liver
Pathophysiology / etiology
  • Progressive disease with recurrent effusions and respiratory failure secondary to infections and chylous accumulation
  • Congenital, possibly from abnormal lymphatic development
Clinical features
  • Generally presents with dyspnea, wheezing, cough and may be confused with asthma
  • Occasionally with chyloptysis or hemoptysis
Diagnosis
  • Clinical presentation and imaging findings may suggest diagnosis, particularly if bone involvement is noted
  • Most cases diagnosed with open lung biopsy
  • Transbronchial biopsy may confirm disease if vesicles seen on bronchoscopy (Clin Radiol 2005;60:921)
Laboratory
  • Thoracocentesis may reveal chylous effusion (elevated triglycerides)
Radiology images
  • Xray: nonspecific findings, including pleural effusion, diffuse pulmonary opacities, interstitial thickening
  • CT: bilateral ground glass opacities, smooth thickening of interlobular septa, bronchovascular bundles, pleura; may show infiltration of the mediastinal soft tissue by cystic fluid densities
Radiology images

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Lower lung heterogeneous opacities

Lower lung heterogeneous opacities

Thickening with effusions

Thickening with effusions

Prognostic factors
Case reports
Treatment
Clinical images

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Subpleural lymphatic vessels

Subpleural lymphatic vessels

Gross description
  • Subpleural and septal thickening
Microscopic (histologic) description
  • Diffuse proliferation of complex, anastomotic lymphatic channels without significant dilatation, lined by benign appearing, flattened endothelial cells
  • Prominence of lymphatic channels in visceral pleura, interlobular septa, and bronchovascular bundles with surrounding bundles of spindle cells, interspersed collagen, vessels
  • Lymphatic channels may contain acellular, eosinophilic, proteinaceous material
  • May show hemorrhagic kaposiform component, with compressed vascular channels, plump spindle cells, hemosiderin
Microscopic (histologic) images

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D2-40

D2-40

Native lung

Native lung

Multiple proliferating vascular spaces

Multiple proliferating vascular spaces

Positive stains
Negative stains
Differential diagnosis
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