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Kaposiform Lymphangiomatosis, a Newly Characterized Vascular Anomaly Presenting with Hemoptysis in an Adult Woman.
[lymphangioleiomyomatosis]
Disorders
of
the
pulmonary
lymphatic
system
include
macro
and
microcystic
lymphatic
malformations
,
primary
or
secondary
lymphangiectasias
,
generalized
lymphatic
anomalies
(
GLA
)
,
diffuse
pulmonary
lymphangiomatosis
(
DPL
)
,
and
combinations
of
lymphatic
and
other
tissue
anomalies
including
lymphangioleiomyomatosis
(
LAM
)
.
We
report
a
case
of
a
patient
with
a
newly
defined
entity
classified
as
kaposiform
lymphangiomatosis
(
KLA
)
.
A
50
year
old
nonsmoking
Hispanic
female
presented
with
a
20
year
history
of
cough
,
hemoptysis
,
chyloptysis
,
and
pleuritic
chest
pain
.
Laboratory
evaluation
demonstrated
a
low
normal
platelet
count
,
elevated
D-Dimer
,
low
normal
fibrinogen
and
elevated
fibrin
split
products
.
Chest
computerized
tomography
scan
showed
enlarged
hypodense
lymph
nodes
in
the
mediastinum
and
hila
,
and
peribronchovascular
thickening
,
without
evidence
of
cystic
parenchymal
lesions
.
MRI
of
the
chest
showed
a
cystic
,
septated
appearance
of
the
mediastinal
lymph
nodes
with
heterogeneously
increased
T
2
and
decreased
T
1
signal
intensity
.
Fiberoptic
bronchoscopy
revealed
hyperemic
mucosa
with
granular
appearance
secondary
to
submucosal
infiltrative
process
.
Pathological
specimens
revealed
dilated
,
malformed
lymphatic
channels
within
the
pleura
,
pulmonary
septa
,
and
bronchovascular
bundles
,
and
foci
of
perilymphatic
and
intralymphatic
spindle
cells
which
reacted
with
the
PROX-
1
immunostain
.
The
morphology
and
immunohistochemistry
results
were
consistent
with
a
diagnosis
of
KLA
.
KLA
is
a
recently
described
entity
amongst
lymphatic
anomalies
.
Clinically
,
patients
have
a
generalized
dysplastic
lymphatic
process
with
involvement
of
the
mediastinum
,
lungs
,
retroperitoneum
,
spleen
,
bones
,
soft
tissue
,
and
skin
.
Mortality
is
associated
with
progressive
pulmonary
disease
and
serosal
hemorrhage
.
Medical
treatments
reported
include
Sirolimus
,
and
anti-angiogenic
agents
.
Our
patient
received
Sirolimus
and
will
be
followed
in
our
clinic
.
Diseases
Validation
Diseases presenting
"generalized lymphatic anomalies"
symptom
lymphangioleiomyomatosis
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