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lymphangiomatosis : ウィキペディア英語版
lymphangiomatosis
In medical terminology lymphangiomatosis means: lymphatic system (lymph) vessel (angi) tumor or cyst (oma) condition (tosis). Lymphatic vessels reach every part of the body except the central nervous system (the brain and spinal cord), which has its own specialized system. The lymphatic system has three main functions:
* to maintain fluid balance,
* to defend the body against disease by producing lymphocytes, and
* to absorb fats and fat soluble vitamins (A, D, E, and K) from the small intestine and transport them to the blood, bypassing the liver.
Lymphangiomatosis, like other lymphatic malformations, is thought to be the result of congenital errors of lymphatic development occurring prior to the 20th week of gestation.〔Faul, J.L., Berry, G.J., Colby, T.V., Ruoss, S.J., Walter, M.B, Rosen, G.D., and Raffin, T.A. Thoracic Lymphangiomas, Lymphangiectasis, Lymphangiomatosis, and Lymphatic Dysplasia Syndrome. Am. J. Respir. Crit. Care Med., Volume 161, Number 3, March 2000, 1037-1046.〕 Lymphangiomatosis is a condition marked by the presence of cysts that result from an increase both in the size and number of thin-walled lymphatic channels that are abnormally interconnected and dilated.〔〔Pernick, Nat. "Soft Tissue Tumors Part 3 Muscle, Vascular, Nerve, Other Lymphangiomatosis." PathologyOutlines.com. PathologyOutlines.com, Inc., 10/17/2009. Web. 6 Sep 2011. .〕〔Tazelaar HD, Kerr D, Yousem SA, Saldana MJ, Langston C, Colby TV. Diffuse pulmonary lymphangiomatosis. Hum Pathol. 1993 Dec;24(12):1313-22.〕 The condition may involve a single organ system; 75% of cases involve multiple organs.〔 It typically presents by age 20 and, although it is technically benign, these deranged lymphatics tend to invade surrounding tissues and cause problems due to invasion and/or compression of adjacent structures.〔〔Huaringa, A.J., Chittari, L.M., Herzog, C.E., Fanning, C.V., Haro, M. & Eftekhari, F. Pleuro-Pulmonary Lymphangiomatosis: Malignant Behavior Of A Benign Disease . The Internet Journal of Pulmonary Medicine. 2005; 5(2).〕 The condition is most common in the bones and lungs〔〔 and shares some characteristics with Gorham’s disease. Up to 75% of patients with lymphangiomatosis have bone involvement, leading some to conclude that lymphangiomatosis and Gorham’s disease should be considered as a spectrum of disease rather than separate diseases.〔〔Aviv RI, McHugh K, Hunt J. Angiomatosis of bone and soft tissue: a spectrum of disease from diffuse lymphangiomatosis to vanishing bone disease in young patients. Clin Radiol. 2001 Mar;56(3):184-90.〕 When it occurs in the lungs, lymphangiomatosis has serious consequences and is most aggressive in the youngest children.〔〔 When the condition extends into the chest it commonly results in the accumulation of chyle in the linings of the heart and/or lungs.〔〔 Chyle is composed of lymph fluid and fats that are absorbed from the small intestine by specialized lymphatic vessels called lacteals during digestion. The accumulations are described based on location: chylothorax is chyle in the chest; chylopericardium is chyle trapped inside the sack surrounding the heart; chyloascites is chyle trapped in the linings of the abdomen and abdominal organs. The presence of chyle in these places accounts for many of the symptoms and complications associated with both lymphangiomatosis and Gorham’s disease.〔〔Duffy B, Manon R, Patel R, Welsh JS, et al. A case of Gorham’s disease with chylothorax treated curatively with radiation therapy. Clin Med Res. 2005;3:83–〕 The incidence of lymphangiomatosis is unknown and it is often misdiagnosed. It is separate and distinct from lymphangiectasis, lymphangioleiomyomatosis (LAM), pulmonary capillary hemangiomatosis, Kaposi’s sarcoma, and kaposiform hemangioendothelioma.〔 Its unusual nature makes lymphangiomatosis (and Gorham’s disease) a diagnostic and therapeutic challenge.〔〔Yeager ND, Hammond S, Mahan J, Davis JT, Adler B. Unique diagnostic features and successful management of a patient with disseminated lymphangiomatosis and chylothorax. J Pediatr Hematol Oncol. 2008 Jan;30(1):66-9.〕 A multidisciplinary approach is generally necessary for optimal diagnosis and symptom management.
==Signs and symptoms==
Lymphangiomatosis is a multi-system disorder. Symptoms depend on the organ system involved and, to varying degrees, the extent of the disease. Early in the course of the disease patients are usually asymptomatic, but over time the abnormally proliferating lymphatic channels that constitute lymphangiomatosis are capable of massive expansion and infiltration into surrounding tissues, bone, and organs.〔〔 Because of its slow course and often vague symptoms, the condition is frequently under-recognized or misdiagnosed.〔Venkatramani R, Ma NS, Pitukcheewanont P, Malogolowkin MH, Mascarenhas L. Gorham’s disease and diffuse lymphangiomatosis in children and adolescents. Pediatr Blood Cancer. 2011 Apr;56(4):667-70〕
Early signs of disease in the chest include wheezing, cough, and feeling short of breath, which is often misdiagnosed as asthma.〔 The pain that accompanies bone involvement may be attributed to "growing pains" in younger children. With bone involvement the first indication for disease may be a pathological fracture. Symptoms may not raise concern, or even be noted, until the disease process has advanced to a point where it causes restrictive compression of vital structures.〔 Further, the occurrence of chylous effusions seems to be unrelated to the pathologic "burden" of the disease, the extent of involvement in any particular tissue or organ, or the age of the patient.〔Zisis C, Spiliotopoulos K, Patronis M, Filippakis G, Stratakos G, Tzelepis G, Bellenis I. Diffuse lymphangiomatosis: are there any clinical or therapeutic standards? J Thorac Cardiovasc Surg. 2007 Jun;133(6):1664-5.〕 This offers one explanation as to why, unfortunately, the appearance of chylous effusions in the chest or abdomen may be the first evidence of the disease.
Following are some of the commonly reported symptoms of lymphangiomatosis, divided into the regions/systems in which the disease occurs:

抄文引用元・出典: フリー百科事典『 ウィキペディア(Wikipedia)
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