Abstract
Chronic lymphedema is a progressive pathological condition of the lymphatic system often leading to a clinical picture of disfigurement and decreased mobility and function. The authors discuss clinical presentation with diagnosis and stages and traditional treatment.
Typically, a clinical history and physical examination are sufficient to provide a clear diagnosis of chronic lymphedema, but in obscure cases lymphoscintigraphy and/or magnetic resonance imaging will lead to a diagnosis. Most innovative regenerative medicine paradigms are related to cell processing and culturing, but combined autologous lymph node fragments and biodegradable scaffolds are particularly promising.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59:464–72.
Clodius L. Lymphatics, lymphodynamics, lymphedema: an update. Plast Surg Outlook. 1990;4(1):2–3.
Smeltzer DM, Stickler GB, Schirger A. Primary lymphedema in children and adolescents—a follow-up-study and review. Pediatrics. 1985;76(2):206–18.
Karkkainen MJ, Ferrell RE, Lawrence EC, Kimak MA, Levinson KL, McTigue MA, Alitalo K, Finegold DN. Missense mutations interfere with VEGFR-3 signalling in primary lymphoedema. Nat Genet. 2000;25(2):153–9.
Irrthum A, Karkkainen MJ, Devriendt K, Alitalo K, Vikkula M. Congenital hereditary lymphedema caused by a mutation that inactivates VEGFR3 tyrosine kinase. Am J Hum Genet. 2000;67(2):295–301.
Wheeler ES, Chan V, Wassman R, Rimoin DL, Lesavoy MA. Familial lymphedema praecox—Meiges disease. Plast Reconstr Surg. 1981;67(3):362–4.
Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44(1):43–57.
Soran A, D'Angelo G, Begovic M, Ardic F, Harlak A, Wieand HS, Vogel VG, Johnson RR. Breast cancer-related lymphedema—what are the significant predictors and how they affect the severity of lymphedema? Breast J. 2006;12(6):536–43.
Lulay G. Lymphödem. Chirurg. 2013;84(7):607–18.
Schünemann H, carcinoma WNL a b. A study of 5868 cases. Deutsche Med Wochensch (1946). 1997;122(17):536–41.
Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92(6):1368–77.
della Rovere GQ, Ahmad I, Singh P, Ashley S, Daniels IR, Mortimer P. An audit of the incidence of arm lymphoedema after prophylactic level I/II axillary dissection without division of the pectoralis minor muscle. Ann Roy Coll Surg. 2003;85(3):158–61.
Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer. Am J Surg. 2004;187(1):69–72.
Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd T, Fassl KA, Edge SB. Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11(6):573–80.
Coen JJ, Taghin AG, Kachnic LA, Assaad SI, Powell SN. Risk of lymphedema after regional nodal irradiation with breast conservation therapy. Int J Radiat Oncol. 2003;55(5):1209–15.
Werner RS, Mccormick B, Petrek J, Cox L, Cirrincione C, Gray JR, Yahalom J. Arm edema in conservatively managed breast-cancer - obesity is a major predictive factor. Radiology. 1991;180(1):177–84.
Schijven MP, Vingerhoets AJJM, Rutten HJT, Nieuwenhuijzen GAP, Roumen RMH, van Bussel ME, Voogd AC. Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. Eur J Surg Oncol. 2003;29(4):341–50.
Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst. 2001;93(2):96–111.
Christensen SB, Lundgren E. Sequelae of axillary dissection vs axillary sampling with or without irradiation for breast-cancer—a randomized trial. Acta Chir Scand. 1989;155(10):515–9.
Kissin M, Della Rovere GQ, Easton D, Westbury G. Risk of lymphoedema following the treatment of breast cancer. Brit J Surg. 1986;73(7):580–4.
Langer S, Guenther JM, Haigh PI, DiFronzo LA. Lymphatic mapping improves staging and reduces morbidity in women undergoing total mastectomy for breast carcinoma. Am Surg. 2004;70(10):881–5.
Armer J, Fu M, Wainstock J, Zagar E, Jacobs L. Lymphedema following breast cancer treatment, including sentinel lymph node biopsy. Lymphology. 2004;37(2):73–91.
Leidenius M, Leivonen M, Vironen J, Von Smitten K. The consequences of long-time arm morbidity in node-negative breast cancer patients with sentinel node biopsy or axillary clearance. J Surg Oncol. 2005;92(1):23–31.
Purushotham AD, Upponi S, Klevesath MB, Bobrow L, Millar K, Myles JP, Duffy SW. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol. 2005;23(19):4312–21.
Soran A, Aydin C, Harlak A, Vogel VG, Johnson R. Impact of sentinel lymph node biopsy on lymphedema following breast cancer treatment. Breast J. 2005;11(5):370–1.
Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furnival CM. Physiotherapy after breast cancer surgery: results of a randomised controlled study to minimise lymphoedema. Breast Cancer Res Treat. 2002;75(1):51–64.
Kocak Z, Overgaard J. Risk factors of arm lymphedema in breast cancer patients. Acta Oncol. 2000;39(3):389–92.
Smahel J. Adipose-tissue in plastic-surgery. Ann Plas Surg. 1986;16(5):444–53.
Ryan TJ. Lymphatics and adipose tissue. Clin Dermatol. 1995;13(5):493–8.
Gaffney RM, Casleysmith JR. Excess plasma-proteins as a cause of chronic inflammation and lymphoedema - biochemical estimations. J Pathol. 1981;133(3):229–42.
International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema—consensus document of the lymphology. Lymphology. 2003;36(2):84–91.
Mortimer PS. ABC of arterial and venous disease - swollen lower limb-2: lymphoedema. Brit Med J. 2000;320(7248):1527–9.
Ruocco V, Schwartz RA, Ruocco E. Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol. 2002;47(1):124–7.
Offori T, Platt C, Stephens M, Hopkinson G. Angiosarcoma in congenital hereditary lymphoedema (Milroy's disease)—diagnostic beacons and a review of the literature. Clin Exp Dermatol. 1993;18(2):174–7.
Kirchmann TTT, Smoller BR, McGuire J. Cutaneous angiosarcoma as a second malignancy in a lymphedematous leg in a Hodgkin’s disease survivor. J Am Acad Dermatol. 1994;31(5):861–6.
Sinclair SA, Sviland L, Natarajan S. Angiosarcoma arising in a chronically lymphoedematous leg. Brit J Dermatol. 1998;138(4):692–4.
Azurdia RM, Guerin DM, Verbov JL. Chronic lymphoedema and angiosarcoma. Clin Exp Dermatol. 1999;24(4):270–2.
Woodward AH, Soule EH, Ivins JC. Lymphangiosarcoma arising in chronic lymphedematous extremities. Cancer. 1972;30(2):562.
Rockson SG. Lymphedema. Am J Med. 2001;110(4):288–95.
Stemmer R. A clinical symptom for the early and differential diagnosis of lymphedema. Vasa. 1976;5(3):261–2.
Bagheri S, Ohlin K, Olsson G, Brorson H. Tissue tonometry before and after liposuction of arm lymphedema following breast cancer. Lymphat Res Biol. 2005;3(2):66–80.
Moseley A, Piller N, Carati C. Combined opto-electronic perometry and bioimpedance to measure objectively the effectiveness of a new treatment intervention for chronic secondary leg lymphedema. Lymphology. 2002;35(4):136–43.
Ward LC. Bioelectrical impedance analysis: proven utility in lymphedema risk assessment and therapeutic monitoring. Lymphat Res Biol. 2006;4(1):51–6.
Cornish B. Bioimpedance analysis: scientific background. Lymphat Res Biol. 2006;4(1):47–50.
Watanabe R, Miura A, Inoue K, Haeno M, Sakamoto K, Kanai H. Evaluation of leg edema using a multifrequency impedance meter in patients with lymphatic obstruction. Lymphology. 1989;22(2):85–92.
Mikes DM, Cha BA, Dym CL, Baumgaertner J, Hartzog AG, Tacey AD, Calabria MR. Bioelectrical impedance analysis revisited. Lymphology. 1999;32(4):157–65.
Hayes S, Cornish B, Newman B. Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6-month follow-up. Breast Cancer Res Treat. 2005;89(3):221–6.
Ward L, Bunce I, Cornish B, Mirolo B, Thomas B, Jones L. MuIti-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients. Eur J Clin Inv. 1992;22(11):751–4.
Cornish BH, Chapman M, Thomas BJ, Ward LC, Bunce IH, Hirst C. Early diagnosis of lymphedema in postsurgery breast cancer patients. Ann N Y Acad Sci. 2000;904:571–5.
Weissleder H, Weissleder R. Lymphedema—evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology. 1988;167(3):729–35.
Mcneill GC, Witte MH, Witte CL, Williams WH, Hall JN, Patton DD, Pond GD, Woolfenden JM. Whole-body lymphangioscintigraphy—preferred method for initial assessment of the peripheral lymphatic-system. Radiology. 1989;172(2):495–502.
Witte CL, Witte MH, Unger EC, Williams WH, Bernas MJ, McNeill GC, Stazzone AM. Advances in imaging of lymph flow disorders. Radiographics. 2000;20(6):1697–719.
Monnin-Delhom ED, Gallix BP, Achard C, Bruel JM, Janbon C. High resolution unenhanced computed tomography in patients with swollen legs. Lymphology. 2002;35(3):121–8.
Case TC, Witte CL, Witte MH, Unger EC, Williams WH. Magnetic-resonance-imaging in human lymphedema - comparison with lymphangioscintigraphy. Magn Reson Imaging. 1992;10(4):549–58.
Földi E. Therapie des LymphödemsTherapy of lymphedema. Hautarzt. 2012;63(8):627–33.
Brorson H, Ohlin K, Olsson G, Svensson B, Svensson H. Controlled compression and liposuction treatment for lower extremity lymphedema. Lymphology. 2008;41(2):52–63.
Baumeister RGH, Mayo W, Notohamiprodjo M, Wallmichrath J, Springer S, Frick A. Microsurgical lymphatic vessel transplantation. J Reconstr Microsurg. 2016;32(1):34–41.
Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg. 2003;19(4):209–15.
Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg. 2013;132(5):1305–14.
Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema—long-term results following microsurgical lymph node transplantation. Ann Surg. 2006;243(3):313–5.
Schindewolffs L. Die Transplantation autologer Lymphknotenfragmente als Therapiemöglichkeit des sekundären Lymphödems: Einfluss der VEGF-C-Applikationsparameter auf die Regeneration und den Wiederanschluss der Transplantate. Bibliothek der Tierärztlichen Hochschule, Hannover 2012.
Honkonen KM, Visuri MT, Tervala TV, Halonen PJ, Koivisto M, Lahteenvuo MT, Alitalo KK, Ylä-Herttuala S, Saaristo AM. Lymph node transfer and perinodal lymphatic growth factor treatment for lymphedema. Ann Surg. 2013;257(5):961–7.
Yan A, Avraham T, Zampell JC, Aschen SZ, Mehrara BJ. Mechanisms of lymphatic regeneration after tissue transfer. PLoS One. 2011;6(2):e17201.
Hutmacher DW, Goh JCH, Teoh SH. An introduction to biodegradable materials for tissue engineering applications. Ann Acad Med Singap. 2001;30(2):183–91.
Atala A. Engineering organs. Curr Opin Biotechnol. 2009;20(5):575–92.
Hutmacher DW, Schantz T, Zein I, Ng KW, Teoh SH, Tan KC. Mechanical properties and cell cultural response of polycaprolactone scaffolds designed and fabricated via fused deposition modeling. J Biomed Mater Res. 2001;55(2):203–16.
Weitman E, Cuzzone D, Mehrara BJ. Tissue engineering and regeneration of lymphatic structures. Future Oncol. 2013;9(9):1365–74.
Jaffe HL, Richter MN. The regeneration of autoplastic lymph node transplants. J Exp Med. 1928;47(6):977–U154.
Pabst R, Rothkotter HJ. Regeneration of autotransplanted lymph-node fragments. Cell Tissue Res. 1988;251(3):597–601.
Pabst R, Westermann J, Rothkotter HJ. Immunoarchitecture of regenerated splenic and lymph-node transplants. Int Rev Cytol. 1991;128:215–60.
Rothkotter HJ, Pabst R. Autotransplantation of lymph-node fragments-structure and function of regenerated tissue. Scand J Plast Recons. 1990;24(2):101–5.
Cupedo T, Stroock A, Coles M. Application of tissue engineering to the immune system: development of artificial lymph nodes. Front Immunol. 2012;3:343.
Herbert L. Lehrbuch Anatomie. Fischer, Auflage-München-Jena; 2000.
Suematsu S, Watanabe T. Generation of a synthetic lymphoid tissue-like organoid in mice. Nat Biotechnol. 2004;22(12):1539–45.
Okamoto N, Chihara R, Shimizu C, Nishimoto S, Watanabe T. Artificial lymph nodes induce potent secondary immune responses in naive and immunodeficient mice. J Clin Invest. 2007;117(4):997–1007.
Tomei AA, Siegert S, Britschgi MR, Luther SA, Swartz MA. Fluid flow regulates stromal cell organization and ccl21 expression in a tissue-engineered lymph node microenvironment. J Immunol. 2009;183(7):4273–83.
Forster R, Davalos-Misslitz AC, Rot A. CCR7 and its ligands: balancing immunity and tolerance. Nat Rev Immunol. 2008;8(5):362–71.
Cyster JG. Chemokines, sphingosine-1-phosphate, and cell migration in secondary lymphoid organs. Annu Rev Immunol. 2005;23:127–59.
von Andrian UH, Mempel TR. Homing and cellular traffic in lymph nodes. Nat Rev Immunol. 2003;3(11):867–78.
Hadamitzky C, Zaitseva TS, Bazalova-Carter M, Paukshto MV, Hou L, Strassberg Z, Ferguson J, Matsuura Y, Dash R, Yang PC, Kretchetov S, Vogt PM, Rockson SG, Cooke JP, Huang NF. Aligned nanofibrillar collagen scaffolds e Guiding lymphangiogenesis for treatment of acquired lymphedema. Biomaterials. 2016;102:259–67.
Kwak MS, Balmayor ER, Chhaya M, Hutmacher DW, Schulz T, Müller D, et al. Bioartificial lymph nodes—a new innovative concept for the treatment of chronic lymphedema patients. Lymphe Gesundheit. 2016:1.
Kwak MS, Balmayor ER, Schantz JT, Chhaya M, Hutmacher DW, Poh PSP, Machens HG, Muller DF. Implantation of tissue-engineered lymph nodes using polycaprolactone scaffolds in immunodeficient nude mice. Lymphol Forsch Prax. 2017;21(2):68–73.
Szolnoky G, Dobozy A, Kemeny L. Towards an effective management of chronic lymphedema. Clin Dermatol. 2014;32(5):685–91.
Becker C. Autologous lymph node transfers. J Reconstr Microsurg. 2016;32(1):28–33.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Neßbach, P., Aitzetmüller, M.M. (2019). Translational Challenges: Lymph Node Tissue Engineering. In: Duscher, D., Shiffman, M.A. (eds) Regenerative Medicine and Plastic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19958-6_25
Download citation
DOI: https://doi.org/10.1007/978-3-030-19958-6_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-19957-9
Online ISBN: 978-3-030-19958-6
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)