Stewart‑Treves syndrome: Magnetic resonance imaging data compared with pathological results from a single center

Li,Bin; Wang,Zhenchang

doi:10.3892/ol.2017.7363

Stewart‑Treves syndrome: Magnetic resonance imaging data compared with pathological results from a single center

Authors:
- Bin Li
- Zhenchang Wang
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Affiliations: Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
Published online on: November 8, 2017 https://doi.org/10.3892/ol.2017.7363
Pages: 1113-1118

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Abstract

The aim of the present study was to evaluate the magnetic resonance imaging (MRI) data of patients with Stewart‑Treves Syndrome (STS), and to compare them with the corresponding pathological data. A total of 4,289 cases of secondary upper limb lymphedema (LE) from a single center, including 5 female cases of STS who underwent modified‑radical post mastectomy, were included in the study. All cases were diagnosed pathologically, and by conventional and contrast‑enhanced (ce)MRI scans. A total of 43 tumor nodules (Φ ≥4 mm) were examined. According to the immunohistochemical results, the 5 cases of STS were divided into 2 types; 4 patients exhibited STS type I [angiosarcoma (AS)] and 1 patient exhibited STS type 2 [mixed lymphangiosarcoma (mLAS)]. The MRI signal intensity (SI) of all the nodules was compared with the pathological results. In the T1WI sequences, all nodules showed isointensity compared with normal muscle tissues in the same image. However, in the T2WI sequences, there were the visually recognizable differences in the SI compared with the LE tissues in the two STS types. The SI of mLAS was more markedly decreased compared with that of AS. The SI of mLAS was closer to that of normal muscle tissues compared with the SI of AS. In the ceMRI, the SI of the tumor nodules was markedly increased in the two STS types, compared with non‑enhancement imaging. Overall, MRI is a useful tool for the evaluation and diagnosis of STS. A chronic case of LE, in which MRI examination demonstrates nodules within the LE, may suggest a diagnosis of STS.

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1	Stewart FW and Treves N: Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer. 1:64–81. 1948. View Article : Google Scholar : PubMed/NCBI
2	Fitzpatrick PJ: Lymphangiosarcoma and breast cancer. Can J Surg. 12:172–177. 1969.PubMed/NCBI
3	Maldonado-Fernández N, López-Espada C, Sánchez-Rodriguez J, Rodríguez-Morata A, Fernández-Quesada F, Martínez-Gámez J, Moreno-Escobar J and García-Róspide V: Síndrome de Stewart-Treves: Linfangiosarcoma en linfedema crónico posmastectomía. Angiología. 54:467–471. 2002. View Article : Google Scholar
4	Young RJ, Brown NJ, Reed MW, Hughes D and Woll PJ: Angiosarcoma. Lancet Oncol. 11:983–991. 2010. View Article : Google Scholar : PubMed/NCBI
5	Sordillo PP, Chapman R, Hajdu SI, Magill GB and Golbey RB: Lymphangiosarcoma. Cancer. 48:1674–1679. 1981. View Article : Google Scholar : PubMed/NCBI
6	Woodward AH, Ivins JC and Soule EH: Lymphangiosarcoma arising in chronic lymphedematous extremities. Cancer. 30:562–572. 1972. View Article : Google Scholar : PubMed/NCBI
7	Grobmyer SR, Daly JM, Glotzbach RE and Grobmyer AJ III: Role of surgery in the management of postmastectomy extremity angiosarcoma (Stewart-Treves syndrome). J Surg Oncol. 73:182–188. 2000. View Article : Google Scholar : PubMed/NCBI
8	Kerchner K, Fleischer A and Yosipovitch G: Lower extremity lymphedema update: Pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol. 59:324–331. 2008. View Article : Google Scholar : PubMed/NCBI
9	Borel Rinkes IH and de Jongste AB: Lymphangiosarcoma in chronic lymphedema. Reports of 3 cases and review of the literature. Acta Chir Scand. 152:227–230. 1986.PubMed/NCBI
10	Peyron N, Dandurand M and Guillot B: Malignant tumors as complications of lymphedema. J Mal Vasc. 18:293–298. 1993.(In French). PubMed/NCBI
11	Martin MB, Kon ND, Kawamoto EH, Myers RT and Sterchi JM: Postmastectomy angiosarcoma. Am Surg. 50:541–545. 1984.PubMed/NCBI
12	Nascimento AF, Raut CP and Fletcher CD: Primary angiosarcoma of the breast: Clinicopathologic analysis of 49 cases, suggesting that grade is not prognostic. Am J Surg Pathol. 32:1896–1904. 2008. View Article : Google Scholar : PubMed/NCBI
13	Futrell J and Meyers GH Jr: The regional lymphatics and cancer immunity. Ann Surg. 177:1–7. 1973. View Article : Google Scholar : PubMed/NCBI
14	Ruocco V, Brunetti G, Puca RV and Ruocco E: The immunocompromised district: A unifying concept for lymphoedematous, herpes-infected and otherwise damaged sites. J Eur Acad Dermatol Venereol. 23:1364–1373. 2009. View Article : Google Scholar : PubMed/NCBI
15	Ruocco V, Schwartz RA and Ruocco E: Lymphedema: An immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol. 47:124–127. 2002. View Article : Google Scholar : PubMed/NCBI
16	Ruocco V, Ruocco E, Schwartz RA and Janniger CK: Kaposi sarcoma and quinine: A potentially overlooked triggering factor in millions of Africans. J Am Acad Dermatol. 64:434–436. 2011. View Article : Google Scholar : PubMed/NCBI
17	Yu L and Yang SJ: Lymphangiosarcoma of the vocal cord: A rare entity defined by a D2-40 immunohistochemical and ultrastructural study. J Clin Oncol. 29:e57–e61. 2011. View Article : Google Scholar : PubMed/NCBI
18	Kahn HJ, Bailey D and Marks A: Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi's sarcoma and a subset of angiosarcomas. Mod Pathol. 15:434–440. 2002. View Article : Google Scholar : PubMed/NCBI
19	Fukunaga M: Expression of D2-40 in lymphatic endothelium of normal tissues and in vascular tumours. Histopathology. 46:396–402. 2005. View Article : Google Scholar : PubMed/NCBI
20	Mankey CC, McHugh JB, Thomas DG and Lucas DR: Can lymphangiosarcoma be resurrected? A clinicopathological and immunohistochemical study of lymphatic differentiation in 49 angiosarcomas. Histopathology. 56:364–371. 2010. View Article : Google Scholar : PubMed/NCBI
21	Ohsawa M, Naka N, Tomita Y, Kawamori D, Kanno H and Aozasa K: Use of immunohistochemical procedures in diagnosing angiosarcoma. Evaluation of 98 cases. Cancer. 75:2867–2874. 1995. View Article : Google Scholar : PubMed/NCBI
22	Schindera ST, Streit M, Kaelin U, Stauffer E, Steinbach L and Anderson SE: Stewart-Treves syndrome: MR imaging of a postmastectomy upper-limb chronic lymphedema with angiosarcoma. Skeletal Radiol. 34:156–160. 2005. View Article : Google Scholar : PubMed/NCBI
23	Nakazono T, Kudo S, Matsuo Y, Matsubayashi R, Ehara S, Narisawa H and Yonemitsu N: Angiosarcoma associated with chronic lymphedema (Stewart-Treves syndrome) of the leg: MR imaging. Skeletal Radiol. 29:413–416. 2000. View Article : Google Scholar : PubMed/NCBI