Changes in adipose tissue in secondary lymphedema
Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, and can lead to irreversible tissue changes. The pathophysiology of lymphedema is poorly understood. Current treatment options include compression therapy, manual lymphatic drainage (MLD), resection, liposuction, and lymphatic microsurgery, but determining the optimal treatment approach for each patient remains challenging. The objective of this study was to evaluate morphologic and histopathologic tissue alterations by ultrasound, lymphography and flow cytometry. It was conducted in 26 women with gyneacological cancer.
Macroscopic and ultrasound findings revealed that lymphedema adipose tissue had larger cells, and larger lobules of adipose tissue, with these lobules surrounded by thick collagen fibers and interstitial lymphatic fluid, leading to fibrosis of the skin. Other findings were a decrease stromal cells (important in tissue regeneration) and a dysbalance between M1 and M2 macrophages, contributing to immunological changes and cellulitis.
Long-term lymphatic volume overload can induce chronic tissue inflammation, progressive fibrosis, impaired homeostasis, altered remodeling of adipose tissue and the skin, impaired regenerative capacity, and immunologic dysfunction. Although the knowledge derived from the current study might not be directly relevant in the treatment setting, knowledge about pathophysiological changes is crucial to applying correct treatment choices. Early recognition of lymphedema and adequate expert treatment are extremely important to prevent irreversible tissue changes.
> From: Tashiro et al., Br J Dermatol (2017) (Epub ahead of print). All rights reserved to British Association of Dermatologists. Click here for the online summary.