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Gluteal lymphoedema associated with lower extremity lymphoedema: A preliminary study with indocyanine green lymphography and magnetic resonance imaging

  • T. Karlsson
    Affiliations
    Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia

    Department of Clinical Sciences, Lund University, Malmö, Sweden
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  • H. Mackie
    Affiliations
    Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
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  • K. Ho-Shon
    Affiliations
    Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
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  • R. Blackwell
    Affiliations
    Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
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  • A. Heydon-White
    Affiliations
    Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
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  • L. Koelmeyer
    Affiliations
    Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
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  • H. Suami
    Correspondence
    Corresponding author.
    Affiliations
    Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, Australia
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Published:October 18, 2022DOI:https://doi.org/10.1016/j.bjps.2022.10.029

      Summary

      Introduction

      Indocyanine green (ICG) lymphography studies have identified that one in three to five patients with cancer-related lower extremity lymphoedema (LEL) demonstrated dermal backflow extending to the gluteal region. This study aimed to further characterize gluteal lymphoedema using contemporaneous magnetic resonance imaging (MRI).

      Patients and methods

      Twenty-eight patients with unilateral advanced LEL who underwent both ICG lymphography and MRI prior to any surgical procedure were included in this study. The patients were divided into two groups with/without gluteal lymphoedema by the presence of dermal backflow on ICG lymphography. MRI was used to evaluate tissue changes.

      Results

      Ten patients demonstrated gluteal lymphoedema on ICG lymphography and had a higher incidence of skin hypertrophy in the gluteal region. However, no difference in excess leg volume was found between the two groups. A trend of increasing gluteal subcutaneous tissue in the affected side was identified in patients with gluteal lymphoedema with a median increase of 20% compared with an 11% increase in the non-gluteal lymphoedema group. The excess gluteal subcutaneous tissue was positively correlated to ipsilateral excess leg volume.

      Conclusion

      The gluteal lymphoedema group on ICG lymphography had skin thickening in the gluteal region and was likely identified in the secondary cancer-related group. Surgical and conservative management options for gluteal lymphoedema need to be considered in advanced LEL.

      Keywords

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      References

        • Cormier J.N.
        • Askew R.L.
        • Mungovan K.S.
        • et al.
        Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema.
        Cancer. 2010; 116: 5138-5149
        • Schook C.C.
        • Mulliken J.B.
        • Fishman S.J.
        • et al.
        Primary lymphedema: clinical features and management in 138 pediatric patients.
        Plast Reconstr Surg. 2011; 127: 2419-2431
        • Zampell J.C.
        • Aschen S.
        • Weitman E.S.
        • et al.
        Regulation of adipogenesis by lymphatic fluid stasis: part I. Adipogenesis, fibrosis, and inflammation.
        Plast Reconstr Surg. 2012; 129: 825-834
        • Aschen S.
        • Zampell J.C.
        • Elhadad S.
        • et al.
        Regulation of adipogenesis by lymphatic fluid stasis: part II. Expression of adipose differentiation genes.
        Plast Reconstr Surg. 2012; 129: 838-847
        • Szuba A.
        • Rockson S.G.
        Lymphedema: anatomy, physiology and pathogenesis.
        Vasc Med. 1997; 2: 321-326
        • Mihara M.
        • Hara H.
        • Hayashi Y.
        • et al.
        Pathological steps of cancer-related lymphedema: histological changes in the collecting lymphatic vessels after lymphadenectomy.
        PLoS ONE. 2012; 7: e41126
        • Pappalardo M.
        • Cheng M.H.
        Lymphoscintigraphy for the diagnosis of extremity lymphedema: current controversies regarding protocol, interpretation, and clinical application.
        J Surg Oncol. 2020; 121: 37-47
        • Mihara M.
        • Hara H.
        • Narushima M.
        • et al.
        Indocyanine green lymphography is superior to lymphoscintigraphy in imaging diagnosis of secondary lymphedema of the lower limbs.
        J Vasc Surg Venous Lymphat Disord. 2013; 1: 194-201
        • Koelmeyer L.A.
        • Thompson B.M.
        • Mackie H.
        • et al.
        Personalizing conservative lymphedema management using indocyanine green-guided manual lymphatic drainage.
        Lymphat Res Biol. 2021; 19: 56-65
        • Case T.C.
        • Witte C.L.
        • Witte M.H.
        • et al.
        Magnetic resonance imaging in human lymphedema: comparison with lymphangioscintigraphy.
        Magn Reson Imaging. 1992; 10: 549-558
        • Bourgeois P.
        • Leduc O.
        Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas.
        PLoS ONE. 2021; 16e0253900
        • Mascagni P.
        Vasorum lymphaticorum corporis humani historia et ichonographia.
        Pazzini Carli, Siena1787
        • Sappey M.P.C.
        Anatomie, physiologie, pathologie des vaisseaux lymphatiques considérés chez l'homme et les vertébratés.
        Adrien Delahaye, 1874
        • Micieli R.
        • Alavi A.
        Lymphedema in patients with hidradenitis suppurativa: a systematic review of published literature.
        Int J Dermatol. 2018; 57: 1471-1480
        • Hoshika Y.
        • Hamamoto T.
        • Sato K.
        • et al.
        Prevalence and clinical features of lymphedema in patients with lymphangioleiomyomatosis.
        Respir Med. 2013; 107: 1253-1259
        • Bhattacharjea S.K.
        An unusual case of elephantiasis buttocks.
        Ind Med Gaz. 1950; 85: 158
        • Dai M.
        • Nakagami G.
        • Sugama J.
        • et al.
        The prevalence and functional impact of chronic edema and lymphedema in Japan: LIMPRINT study.
        Lymphat Res Biol. 2019; 17: 195-201
        • Executive Committee of the International Society of Lymphology
        The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology.
        Lymphology. 2020; 53: 3-19
        • Sen Y.
        • Qian Y.
        • Koelmeyer L.
        • et al.
        Breast cancer-related lymphedema: differentiating fat from fluid using magnetic resonance imaging segmentation.
        Lymphat Res Biol. 2018; 16: 20-27
        • Nguyen A.T.
        • Suami H.
        • Hanasono M.M.
        • et al.
        Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema.
        J Surg Oncol. 2017; 115: 84-89
        • Brorson H.
        • Hoijer P.
        Standardised measurements used to order compression garments can be used to calculate arm volumes to evaluate lymphoedema treatment.
        J Plast Surg Hand Surg. 2012; 46: 410-415
        • Soga S.
        • Onishi F.
        • Jinzaki M.
        • et al.
        Analysis of collateral lymphatic circulation in patients with lower limb lymphedema using magnetic resonance lymphangiography.
        J Vasc Surg Venous Lymphat Disord. 2021; 9 (471-81.e1)
        • Brorson H.
        • Ohlin K.
        • Olsson G.
        • et al.
        Controlled compression and liposuction treatment for lower extremity lymphedema.
        Lymphology. 2008; 41: 52-63
        • Gennaro P.
        • Borghini A.
        • Chisci G.
        • et al.
        Could MRI visualize the invisible? An Italian single center study comparing magnetic resonance lymphography (MRL), super microsurgery and histology in the identification of lymphatic vessels.
        Eur Rev Med Pharmacol Sci. 2017; 21: 687-694

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