Search Results (233)

Background: Lymphatic malformations of the parotid gland and of the adjacent parotideo-masseteric region are rare and technically demanding, because the malformation infiltrates the glandular parenchyma and grows around the branches of the facial nerve rather than displacing them, and published experience consists almost entirely of isolated case reports. Case Presentation: A 16-year-old boy was treated for an extensive lymphatic malformation of the left parotid and parotideo-masseteric region, present since childhood and progressive over three years, with facial asymmetry, no pain and normal facial nerve function. Magnetic resonance imaging showed a mixed lesion of 47 × 20 × 55 mm involving the superficial and deep lobe with parapharyngeal extension. Facial nerve-preserving partial parotidectomy of European Salivary Gland Society levels I, II and IV was performed under continuous nerve monitoring. Histology confirmed a cavernous lymphangioma (CD31 and D2-40 positive). A postoperative sialocele was managed after a single revision. Conclusions: Level-classified nerve-preserving parotidectomy with monitoring was associated with stable residual disease and preserved facial nerve function during 19 months of follow-up. The radial resection margin was focally involved and a thin residual lesion persisted on imaging. Stability at follow-up does not establish the absence of future progression, and longer follow-up is required. Full article

Background: Secondary lymphedema is a chronic complication of oncologic surgery and radiotherapy for which effective disease-modifying therapies remain lacking. While mesenchymal stem cells (MSCs) have shown partial benefit in experimental models, direct functional comparison with lineage-committed lymphatic endothelial progenitor cells (LEPCs) remains limited. Methods: Secondary lymphedema was induced in C57BL/6J mice by circumferential tail skin excision with disruption of superficial lymphatics. Animals received intradermal phosphate-buffered saline (PBS), MSCs, or adipose-derived LEPCs on postoperative days 1 and 7. Lymphatic function was longitudinally quantified using IVIS-based near-infrared indocyanine green (ICG) imaging with standardized region-of-interest analysis. Tail diameter was measured serially throughout follow-up as a complementary morphometric parameter. Tissue remodeling was assessed by Picrosirius Red staining and qualitative LYVE-1 immunofluorescence. Statistical analysis incorporated mixed-effects modeling to evaluate treatment group, sex, time, and their interaction terms, with estimation of effect sizes and 95% confidence intervals. Results: LEPC-treated mice demonstrated higher IVIS signal intensity than MSC- and PBS-treated animals, consistent with improved lymphatic transport at the injury site. Longitudinal tail diameter analysis showed a more favorable temporal profile in the LEPC group relative to controls, with exploratory analysis suggesting potential variations in temporal profiles between sexes that warrant further investigation in larger cohorts. Histologic analysis showed reduced non-tissue/void area and a more favorable qualitative pattern of LYVE-1 staining in LEPC-treated tissue. Conclusions: LEPC administration enhanced functional and structural recovery in a murine model of secondary lymphedema. These findings support further translational evaluation of LEPC-based approaches as a regenerative strategy for secondary lymphedema. Full article

Introduction: Mediastinal lymphangiomas are rare, benign vascular malformations of the lymphatic system that are seldom diagnosed in adults. Due to their varied clinical presentation and heterogeneous imaging characteristics, they pose a significant preoperative diagnostic challenge, frequently mimicking other mediastinal masses. Materials and Methods: We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. We included articles from 2000 to 2026. Our search yielded 150 articles, out of which we selected 45 articles. Inclusion criteria were strictly limited to adult patients with a solitary mediastinal lymphangioma. Cases involving diffuse systemic lymphangiomatosis, mixed histological features such as lymphangiomyomas or hemangiolymphangioma or studies on pediatric populations were explicitly excluded from the analysis. We also reported a case of mediastinal lymphangioma in a 42-year-old patient, which was surgically resected at the “Marius Nasta” National Institute of Pneumology in Bucharest, Romania. Case Description: An asymptomatic 42-year-old male presenting with exertional chest discomfort following minor trauma demonstrated a lower left hemithorax opacity on chest X-ray. Imagistic studies revealed a 13 × 9 × 6 cm cystic mass in the left supradiaphragmatic costophrenic recess. The patient underwent a complete radical excision. The postoperative recovery was uneventful. Histopathology confirmed a benign cystic mediastinal lymphangioma. Conclusions: Adult mediastinal lymphangiomas are rare entities that require a high index of clinical suspicion. While advanced cross-sectional imaging is invaluable for delineating their characteristics, definitive diagnosis relies on histopathological confirmation. Complete surgical resection, increasingly performed via minimally invasive approaches or standard thoracotomy, remains the therapeutic gold standard, offering an excellent long-term prognosis with virtually no risk of recurrence. For inoperable cases, several non-surgical approaches are available. Full article

Background and Clinical Significance: Encephalitis is a rare neurological complication associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. In rare cases, focal neuroinflammation can manifest as a mass-like parenchymal lesion, creating profound diagnostic and treatment dilemmas by mimicking primary central nervous system neoplasms. Case Presentation: A 34-year-old female presented with cephalalgia, nausea, confusion, facial palsy, and a new onset of focal impaired awareness seizures (FIAS). Brain magnetic resonance imaging (MRI) revealed a prominent hyperintense lesion within the left temporal lobe with associated vasogenic edema and focal leptomeningeal enhancement highly suspicious of a low-grade glial neoplasm. Although nasopharyngeal RT-PCT was negative, the presence of serum anti-SARS-CoV-2 IgM and IgG suggested recent subclinical SARS-CoV-2 infection. To resolve diagnostic ambiguity and avoid empiric oncological overtreatment, a stereotactic brain biopsy was performed. Histopathology revealed acute neuroinflammation characterized by reactive gliosis, microglial hyperplasia, and perivascular lymphatic cuffing, with no evidence of neoplastic presence. Quantitative tissue RT-PCR confirmed the presence of SARS-CoV-2 (Ct33). Follow-up imaging demonstrated complete resolution of the abnormalities following conservative treatment with corticosteroids and antiepileptics, though mild clinical symptoms persisted for 12 months thereafter. Conclusions: Encephalitis presents a rare yet critical manifestation of SARS-CoV-2. Establishing definitive etiology remains challenging. Stereotactic biopsy is a valuable tool to guide appropriate treatment in cases of ambiguous imaging and clinical findings. Radiographic resolution may precede complete clinical recovery. Full article

Resveratrol (RES) is a natural polyphenolic compound characterized by poor aqueous solubility and significant first-pass metabolism, resulting in extremely low oral bioavailability. Although resveratrol-loaded nanostructured lipid carriers (RES-NLCs) have shown potential in enhancing oral absorption, direct experimental evidence for their intestinal lymphatic transport mechanism remains limited, and existing explanations is largely based on indirect inference. RES-NLCs were prepared, and their pharmacokinetics and lymphatic transport characteristics were evaluated using a laboratory-established mesenteric lymph duct–jugular vein assisted reflux model in rats. Simultaneously, a 28-day repeated-dose toxicity study was conducted in ICR mice. Pharmacokinetic results showed that compared with RES-Sol, RES-NLCs increased Cmax by approximately 2.3-fold, improved relative bioavailability by 7-fold, and achieved an absolute bioavailability of 176%. The lymphatic transport model confirmed that RES-NLCs are absorbed via the intestinal lymphatic pathway. In the 28-day repeated-dose toxicity study, no mortality or obvious clinical symptoms were observed at a dose of 10 mg/kg. The RES-NLCs group exhibited increased liver coefficient and decreased spleen coefficient. Hematological analysis showed a mild increase in red blood cell count, along with decreases in mean corpuscular volume and red blood cell distribution width coefficient of variation. Serum biochemistry revealed significant elevations in aspartate aminotransferase and alanine aminotransferase (p = 9 × 10⁻⁵ and p = 4.02 × 10⁻⁷, respectively). However, no significant differences were observed in the organ coefficients of the heart, lungs, kidneys, or brain. Body composition and magnetic resonance imaging showed no abnormalities, and histopathological examination of major organs including the liver, stomach, and intestines revealed no structural damage. These findings provide direct evidence that RES-NLCs enhance the oral bioavailability by promoting intestinal lymphatic uptake, suggesting that this system may serve as an effective delivery platform for poorly soluble hydrophobic drugs. Full article

Chylothorax is a rare condition caused by damage to the thoracic duct, leading to chyle from the lymphatic system leaking into the pleural cavity. The diagnosis is based on triglyceride and cholesterol levels in the pleural fluid. Various imaging methods, including computed tomography scans and lymphatic-specific investigations, may be utilized to identify the site of a chyle leak. The management of chylothorax requires a multidisciplinary approach employing conventional therapy and possibly thoraco-surgical intervention for patients who do not respond to standard treatment. Complications include malnutrition, immunosuppression, and respiratory distress. We present the case of a 57-year-old female patient who presented with chylothorax after an apparently minor car accident, illustrating problems with delayed recognition of trauma and difficulty in localizing the lymphatic leak. Full article

Sentinel lymph node (SLN) mapping plays a pivotal role in oncological staging in veterinary medicine. However, conventional techniques often depend on radioactive tracers or specialized imaging equipment that is unavailable in many clinical settings. This brief report describes the use of indirect radiographic lymphography with the non-ionic iodinated contrast agent iohexol for SLN identification in a dog with auricular melanoma. A 12-year-old spayed female mixed-breed dog presented with an ulcerated cutaneous mass affecting the left auricle. Cytological evaluation was consistent with a melanocytic neoplasm. Immediately before surgery, iohexol was administered intradermally at four peritumoral sites (0.75 mL per cm²). Radiographic images acquired 3 and 4.5 min after injection demonstrated lymphatic drainage to the superficial ventral and superficial dorsal cervical lymph nodes, which were identified as sentinel lymph nodes. The patient underwent vertical ear canal ablation, conchectomy, partial auriculectomy, and excision of the mapped sentinel lymph nodes. Histopathological examination confirmed a mixed-type cutaneous melanoma with macrometastatic involvement of the superficial ventral cervical sentinel node and micrometastatic deposits in both the superficial dorsal cervical and left parotid lymph nodes. Although the parotid lymph node was not enlarged radiographically, afferent lymphatic channels indicated contrast uptake, and histopathology confirmed metastatic involvement. This finding supports considering elective regional lymphadenectomy alongside sentinel lymph node biopsy in similar cases. An incidental cutaneous hemangiosarcoma was identified at a distant abdominal site, excised with complete margins, and was unrelated to the primary tumor. No systemic adverse effects associated with iohexol administration were observed, and only transient mild-to-moderate localized edema developed at the injection site, resolving spontaneously without treatment. These findings suggest that iohexol-based indirect radiographic lymphography is a practical, safe, and accessible technique for sentinel lymph node identification and may represent a promising, though not yet validated, alternative for lymphatic staging in veterinary oncology, although further prospective studies are needed to establish its diagnostic accuracy. Full article

Copper-deficient copper selenide (Cu_2−xSe) nanocrystals possess strong near-infrared (NIR) absorption and efficient photothermal conversion, making them attractive candidates for photoacoustic imaging. In this study, Cu_2−xSe nanocrystals with distinct morphologies were synthesized using different selenium precursors and evaluated as photoacoustic contrast agents. Se–oleylamine precursors produced predominantly disk-shaped nanocrystals with average dimensions of approximately 20 nm in diameter and 5 nm in thickness, while Se–TOP/TOPO precursors yielded smaller spherical nanocrystals. Structural characterization by transmission electron microscopy, high-resolution TEM, and selected-area electron diffraction confirmed the formation of highly crystalline copper-deficient Cu_2−xSe nanocrystals with a face-centered cubic crystal structure. UV–Vis–NIR spectroscopy revealed broad optical absorption extending into the NIR region, with morphology-dependent spectral characteristics. Multispectral optoacoustic tomography demonstrated strong photoacoustic signal generation from both nanodisks and nanospheres over a broad wavelength range. In vivo studies using PEGylated Cu_2−xSe nanospheres showed successful lymphatic uptake following hind paw injection and enabled visualization of the draining popliteal lymph node through spectral unmixing of nanoparticle and hemoglobin signals. These results demonstrate that Cu_2−xSe nanocrystals are promising photoacoustic contrast agents for lymphatic imaging and other biomedical imaging applications. Full article

Background: The Martini and Melamed criteria for diagnosing multiple primary lung cancers (MPLCs) have remained in use for half a century despite substantial changes in lung cancer epidemiology, risk factors, imaging technologies, and treatment approaches. Correspondingly, the landscape of MPLC has likely changed, necessitating revisions to their diagnostic guidelines. Research Question: What are the clinicopathologic profiles of modern-day MPLC patients, and can these features be used to identify a subset of patients classified as MPLC that may warrant additional investigation as intrapulmonary metastasis (IPM)? Study Design and Methods: We conducted a retrospective cohort study using electronic medical record data from patients who underwent multiple lung cancer resections at Mount Sinai Hospital. Patient demographics, tumor characteristics, and surgical treatments were compared with those reported in the original Martini and Melamed series. We then proposed a reclassification framework incorporating a CT-based assessment of synchronous versus metachronous tumors and contemporary clinicopathologic features documented in imaging and pathology reports. Results: Ninety-one patients underwent successive lung cancer resections. Among first nodules treated with surgical resection, 46% exhibited pathologic features suggestive of metastasis within the lung, including visceral pleural invasion (18%), vascular invasion (24%), lymphatic invasion (36%), and/or lymph node positivity (3%). In contrast, among second nodules (second temporal surgery), 45% demonstrated ground-glass opacity (GGO) supportive of a diagnosis of MPLC. Using the original criteria, 83 patients (91%) were classified as having MPLC; this proportion decreased to 53 patients (58%) under the reclassification criteria. Regardless of the criteria applied, contemporary MPLCs were more likely to occur in older patients, women, those with adenocarcinoma histology, and treated with sublobar resections compared with MPLCs described in the Martini and Melamed era. Conclusions: MPLCs are increasingly recognized, and their clinical presentation has changed substantially over time. Modern imaging and pathologic assessment may be useful tools for diagnosing MPLCs, but this requires future validation. This has important implications for staging and treatment decision-making, as patients may be undertreated by not being offered multimodal treatments or over-treated with systemic therapy when surgery alone may be sufficient. Full article

Mismatch repair–deficient (dMMR) or microsatellite instability-high (MSI-H) colorectal cancers exhibit high mutational burden and abundant neoantigen formation, generating a highly immunogenic tumour microenvironment characterised by dense lymphocytic infiltration and strong sensitivity to immune checkpoint inhibition. In metastatic colorectal cancer, PD-1 blockade produces durable responses almost exclusively in dMMR tumours, establishing mismatch repair status as a predictive biomarker for immunotherapy responsiveness. Recent studies extending immune checkpoint inhibitors (ICIs) into the neoadjuvant setting for localised dMMR colorectal cancer have produced major pathological response rates exceeding 90%, with pathological complete response (pCR) rates frequently surpassing 60%, challenging traditional oncologic staging frameworks, particularly with respect to lymph node assessment. Baseline clinical nodal staging in dMMR tumours is complicated by immune-mediated lymphadenopathy. Reactive lymphoid hyperplasia driven by tumour antigen exposure frequently produces enlarged lymph nodes that mimic metastatic disease on cross-sectional imaging. Following neoadjuvant immunotherapy, treatment-related immune activation may further increase nodal size or metabolic activity, while pathological examination often reveals sterilised nodes or immune infiltration without viable tumour. Consequently, conventional radiologic criteria for nodal metastasis demonstrate limited specificity in this context. The discordance between imaging findings and pathological outcomes raises important implications for staging accuracy, response assessment, and treatment planning. This review examines the biological basis of lymphatic involvement in dMMR colorectal cancer, evaluates the performance of current imaging modalities for nodal staging, and summarises emerging evidence from neoadjuvant immunotherapy trials. Particular emphasis is placed on the interpretation of lymph node findings in the era of immune checkpoint blockade and the implications for surgical decision-making, organ preservation, and future staging paradigms. Full article

Colorectal cancer (CRC) remains the third most common malignancy worldwide and a leading cause of cancer mortality, largely driven by metastatic dissemination. Among metastatic routes, lymphatic spread is crucial to determine the prognosis and establish an adequate therapeutic strategy. Lymph node metastasis (LNM) defines stage III disease in the TNM classification, guiding adjuvant chemotherapy and surgical planning. However, nodal staging based on lymphadenectomy and histopathology is invasive, time-consuming, and may lead to overtreatment. Conventional imaging modalities, including computed tomography, magnetic resonance imaging, and endorectal ultrasound, show limited sensitivity and specificity for small or micro-metastatic nodes. Despite multimodal progress, no non-invasive technique reliably identifies malignant nodes in real time. PET–MRI, contrast-enhanced ultrasound, photoacoustic and fluorescence approaches, ICG mapping, and sentinel node biopsy improve detection but remain limited by specificity, cost, or availability. Extranodal extension (ENE) and tumor deposits (TDs) carry major prognostic value, reflecting aggressive biology and association with distant spread. Meanwhile, phylogenetic studies challenge linear dissemination models, indicating that some metastases arise directly from the primary tumor or TDs rather than LNMs. These data support refinement of staging and surgical strategies according to tumor biology rather than purely anatomical criteria. High-frequency quantitative ultrasound (HF-QUS) enables real-time, operator-independent, three-dimensional nodal assessment with reported sensitivity and specificity exceeding 85%. Combined with artificial intelligence and molecular profiling, it may support biologically informed staging, reduce unnecessary surgery, and foster precision oncology. Lymphatic dissemination in CRC offers a platform to merge tumor biology with technological innovation, where advanced imaging, molecular insight, and artificial intelligence may redefine nodal staging toward precision, non-invasive care. Full article

Background/Objectives: Systematic lymphadenectomy is recommended in apparent early-stage epithelial ovarian cancer (EOC) to assess nodal status, but it is associated with significant morbidity and lacks survival benefit. Sentinel lymph node (SLN) mapping may offer a less invasive alternative, although evidence remains limited due to the complexity of ovarian lymphatic drainage and methodological heterogeneity across studies. This prospective study evaluates the feasibility and diagnostic accuracy of a true hybrid ^99mTc–indocyanine green (ICG) tracer for SLN mapping in apparent early-stage EOC. Methods: A prospective observational study was conducted at a tertiary oncology center between 2021 and 2026. Patients presenting with a suspicious ovarian mass (Group A) or requiring restaging after adnexectomy for confirmed EOC (Group B) underwent SLN mapping using a hybrid ^99mTc–ICG tracer injected into the infundibulopelvic (IPL) and/or utero-ovarian ligament (UOL). SLNs were identified using gamma detection and near-infrared fluorescence imaging. All malignant cases underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy. SLNs were ultrastaged and compared with the final nodal status. Results: Forty patients were included; 20 (50%) had malignant tumors. The overall SLN detection rate was 92.5% (37/40), with 100% in malignant cases. Among malignant tumors, 3/20 (15%) had metastatic SLNs, all accurately detected (false-negative rate 0%). Sensitivity and negative predictive value were 100%. Combined pelvic and para-aortic drainage was the most frequent pattern (75%). Conclusions: SLN mapping may represent a feasible and potentially accurate staging strategy in apparent early-stage EOC. In the present study, a hybrid ^99mTc–ICG tracer was associated with high detection rates and complete concordance with final nodal status. These findings support further multicenter validation to define its potential role as an alternative to systematic lymphadenectomy. Full article

Background/Objectives: Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to systematic lymphadenectomy for endometrial cancer staging. However, optimization of SLN identification during robot-assisted surgery remains an important clinical issue. This prospective exploratory study evaluated the feasibility and mapping characteristics of dual-tracer SLN mapping combining radioisotope (RI) and indocyanine green (ICG) in robot-assisted surgery for clinical stage IA endometrial cancer. Methods: Ten patients with clinical stage IA endometrioid carcinoma (grade 1 or 2) who underwent robot-assisted surgery at our institution between June 2025 and March 2026 were prospectively enrolled. Technetium-99m phytate was injected cervically the day before surgery, followed by SPECT-CT imaging. ICG was administered intraoperatively. SLNs were identified using both RI mapping and near-infrared fluorescence imaging. All patients subsequently underwent pelvic lymphadenectomy. SLN detection rates, concordance between tracers, intraoperative findings, and perioperative outcomes were evaluated. Results: The SLN detection rate with the dual-tracer method was 100% (10/10). RI mapping alone achieved bilateral detection in 30% (3/10), whereas ICG fluorescence imaging identified SLNs in all patients (100%). All RI-positive SLNs were also identified by ICG fluorescence imaging. In several cases, multiple fluorescent lymph nodes were observed, and gamma-probe assessment aided intraoperative SLN selection. No lymph node metastases were identified. One Clavien–Dindo grade IIIa complication (pelvic hematoma requiring intervention) occurred. No adverse events related to ICG were observed. Conclusions: Dual-tracer SLN mapping using RI and ICG was feasible in robot-assisted surgery for clinical stage IA endometrial cancer. ICG fluorescence imaging provided sensitive lymphatic visualization, whereas RI mapping offered complementary information for intraoperative SLN identification in selected cases. Further prospective studies with larger cohorts are required to clarify the clinical utility of the dual-tracer approach. Full article

Lymphatic malformations (LMs) are rare congenital low-flow vascular anomalies that frequently involve the head and neck and may be managed with surgery, laser therapy, sclerotherapy, or multimodal approaches depending on lesion type, size, depth, and relationship with adjacent structures. Ultrasound-guided sclerotherapy with doxycycline is an established treatment option for macrocystic lesions, whereas the practical role of high-frequency superficial ultrasound as a technical adjunct has been less specifically discussed. We report the case of a 32-year-old man presenting with a painless left submandibular swelling of approximately two years’ duration. Magnetic resonance imaging showed a well-encapsulated cystic lesion measuring 56 × 35 mm in the left submandibular region, extending into the internal paralaryngeal space and causing mild compression of the laryngeal wall. Previous fine-needle aspiration cytology had not conclusively established the lymphatic nature of the lesion; therefore, an incisional biopsy was performed and confirmed a macrocystic LM. The patient underwent day-surgery intralesional doxycycline sclerotherapy under real-time high-frequency ultrasound guidance using an 18 MHz hockey-stick transducer. After aspiration of the main cystic compartment through a 25-gauge needle, 100 mg of doxycycline diluted to 10 mg/mL in normal saline was slowly injected under continuous visualization. The procedure was well tolerated under topical local anesthesia, without pain, complications, or adverse effects. A partial clinical reduction was observed after the first session; the treatment was repeated after three months, resulting in apparent complete clinical resolution at one-year follow-up; no post-treatment imaging was available to confirm radiological resolution. This case highlights the potential technical value of high-frequency superficial ultrasonography, particularly for needle positioning, improved delineation of superficial locules, and real-time monitoring of sclerosant distribution. Full article

Lipedema is a chronic adipose tissue disorder characterized by disproportionate and often painful enlargement of the extremities, occurring predominantly in women. Despite increasing clinical recognition, the underlying pathophysiology remains incompletely understood and is likely multifactorial. Existing evidence suggests contributions from vascular alterations, adipose tissue remodeling, inflammatory activation, hormonal influences, and lymphatic dysfunction. This review proposes a hypothesis-generating integrative framework in which lipedema may reflect a regenerative imbalance of subcutaneous adipose tissue. Within this model, genetically and hormonally modulated endothelial permeability could promote activation of perivascular adipose-derived stromal/stem-cell niches and stromal vascular fraction signaling pathways, thereby facilitating coupled angiogenesis and adipogenesis. Progressive adipocyte hyperplasia and hypertrophy may subsequently contribute to inflammatory remodeling, pain generation, and secondary impairment of dermal and subdermal lymphatic drainage. The proposed framework attempts to integrate clinical, histological, imaging, molecular, and endocrine observations into a biologically coherent conceptual model. At the same time, the review emphasizes the current limitations of the available evidence, the heterogeneity of lipedema phenotypes, and the ongoing controversies regarding disease progression, obesity overlap, and the relative role of lymphatic dysfunction. Finally, the potential mechanistic rationale of lymphatic-sparing liposuction is discussed in the context of tissue decompression, restoration of lymphatic transport, and interruption of persistent adipose remodeling. The model presented here should be interpreted as a hypothesis-generating conceptual scaffold requiring prospective validation. Importantly, the present framework should be interpreted as a biologically plausible and hypothesis-generating conceptual model rather than a definitive mechanistic doctrine. Several proposed interactions remain associative and require prospective biological validation. Full article