Case Presentation

Internship Program

By
 Patient Identity
• Name : By. A
• Sex : Girl
• Age : 1 day old
• Address : Kebun Sirih
• Date : 16 Dec 2017 (through ER)
 Anamnesis
• Chief Complaint : lumps in left hemithorax
• History :
– New born baby with lumps in hemithorax sinistra
– No short of breathness, no fever
– Normal urinary and defecation
– The patient can drink breast milk and has normal
sucking reflex
History of pregnancy and childbirth
• The patient’s mother did ANC at puskesmas and
didn’t have any sickness during pregnancy.
• The patient was born at Puskesmas, spontan
delivery, birth weight 3000 gram, body length 48 cm.
Apgar score 8/9.
 General Examination
• KU : compos mentis
• Vital sign :
– HR : 140x/m ;
– RR : 40x/m;
– Temp : 36⁰C
– SpO2 : 98%
Head : Conjungtiva Anemis -/- ; Sklera Ikterik -/-
Thorak : vesikuler, ronkhi -/-, wheezing -/-
Abdomen : supel, bowel sound (+), tenderness (-)
Extremity : warm , crt < 2 seconds
mammae sinistra region :
lumps size 8x11 cm, mobile, semi solid consistency
And there is solid lumps inside with strict lines size 5x5 cm
dolor (-), kalor (-)
• Assesment :
– Lymphangioma hemithorax sinistra

• Planning :
– MRS KBB
– Umbilical cord management
 Follow up
17 December 2017 (SURGERY)
• Discharge, control to surgery polyclinic
• Education to the parent

17 December 2017(PEDIATRIC)
• S : can drink breast milk, fever (-)
• O : compos mentis; NPAT 0; weight 2700 gr
Hr 150 x; Rr 52x; Temp 37,3; SpO2 : 95%
• A : New born baby day 2, normal birth weight +
lymphangioma hemithorax sinistra
• P : from pediatric, discharge
control to pediatric polyclinic for immunization
21 december 2017 (Pediatric Polyclinic)
• S : umbilical cord still intact, breast feeding +, lumps in left
hemithorax
• O : Thorax region: mass (12 cm in diameter), tenderness (-),
cystic.
• A : new born baby day 5, normal birth weight +
lymphangioma hemithorax sinistra
• P : Polio and BCG Immunization
21 december 2017 (Surgery Polyclinic)
• S : Lumps in left hemithorax since birth, pain (-), fever (-),
breastfeeding (+)
• O : mamae sinistra region: there is 2 mass
– 1. semi solid consistency, size 11x8 cm, tenderness (-)
– 2. solid consistency, size 5 cm in diameter, tenderness (-)
• A : Lymphangioma
• P : advise from dr. Ais, SpB
Education for excision byopsi consistent with ‘Rule of
Ten’
(weight >5 kg, age >10 minggu, Hb≥ 10 g/dl)
6 Febuary 2018 (Surgery Polyclinic)
• S : the lumps is getting bigger
• O :hemithorax sinistra region :
Mass size 15x10x10 cm, Cystic Consistency
• A : Lymphangioma hemithorax sinistra
• P : CT scan thorax
: Excision biopsy at 8/2/2018
: Consultation anestesi and pediatric
: IVFD and premed from anestesi
: Ceftriakson 125 mg/IV (skin test)
: Do a complete blood test
Radiology
7 Febuary 2018
PPT 9,3
Complete Blood Count
INR 0,86
WBC 10.34
HB 10
control 11,9
PLT 515 APTT 21,4
NEUT 48,5% control 21,3
8 Febuary 2018, 09.00 (Surgery)
• S : Lumps in left thorax
• O : thorax region: Mass size 15 x 12 x 10 cm, Cystic
Consistency
• Ass : Lymphangioma hemithorax sinistra
• P : pro excision and biopsy today
 Operation Report
• Preoperation Diagnosis : Lymphangioma hemithorax
sinistra
• Post Operation Diagnosis : Lymphangioma hemithorax
sinistra
• Action : Lymph Drainage
– Patient lie down in supine position on GA-Mask
– Disinfection and drapping
– Incision in cystic hemithorak sinistra area -> there is serous
liquid ± 60 cc out from the lumps-> sitologi PA liquid
– Put in NGT 12, fixation NGT
– Operation finish
 Instruction post operation
Surgery
• IVFD from pediatric
• Paracetamol 40 mg/ 8 hour/ IV
• Ampicilin 150 mg/ 12 hour/ IV
Anestesi
• IVFD DS ¼ NS 10 cc/jam
• Paracetamol drips 75 mg every 8 hour
8 Febuary 2018 ; 14.00 (Pediatric)
• S : Post drainage
• O :
– CM
– HR :161x/m; RR : 50x/m; Temp 36,4; NIPS 2
• Ass : Post incision drainage ec lymphangioma day 0
good nutrition
• P :
– IVFD D¼S 480 ml / 24 hour
– Cek DL, HJ, Elektrolit, albumin
– Other therapy from surgery
– Breast feeding
– Inj ampicilin 240 mg / 6 hour
8 Feb 2018; 15.17
Complete blood count
Albumin 3,73 (3,4-4,8)
• WBC 11,11
• HB 9,5
• PLT 540
• NEU 80,5

ELECTROLYTE
• Na 133,5 (135-146)
• K 5,12 (3,4-5,4)
• Cl 105,6 (95-108)
9 Feb 2018; 08.00 (Surgery)
• S : Cough (+)
• O:
– Compos Mentis
– Hr : 124 x/m; RR 44x/m; Temp : 36,7; NIPS 0
– Localic State : mass (+), the size is smaller
– Drainage : minimum production in the NGT
• Ass : Post op Drainage ec lymphangioma day 1
• P :
– Observation the dranaige
– IVFD from pediatric
– Paracetamol 400 mg/8 hour/iv
– Ampicilin 150 mg/6 hour/iv
– Wound toilet every 2 day
9 Feb 2018; 08.45 (Pediatric)
• S : fever (-), short of breathness (-)
• O : in normal range
• Ass : post incision drainage ec lymphangioma day 1;
good nutrition
• P:
– IVFD D¼NS 480 ml per 24 hour
– Ampicilin IV day 3
– Breast feeding
 Pathologic Test Result
9 febuary 2018 Kimia
Macroscopic • Total protein : 3,4 g/dl
• Color : reddish yellow • Albumin : 2,9 g/dl
• The fluid is clear • Globulin : 0,5 g/dl
• Clot : positif • Glucose : 62 mg/dl
Microscopic
• Cel count : 18 sel/mm Tes mikrobiologi
• Differential : • BTA Negatif
– PMN : 28%
– MN : 72%
10 feb 2018; 08.05 (pediatric)
• S : short of breathness (-), fever (-)
• O : in normal range
• Ass : post incision drainage ec lymphangioma
hemithorax sinistra day 2
• P:
– IVFD D¼NS 480 ml per 24 hour
– Ampicilin IV day 4
– Breast feeding
10 feb 2018; 08.30 (surgery)
• S : short of breathness (-), fever (-)
• O:
– Localis : hemithorak sinistra region: drain (-), mass (+)
• Ass : Post op drainage ec lymphangioma day 2; good
nutrition
• P:
– Other therapy from pediatric
– Paracetamol 400 mg/8 hour/iv
– Ampicilin 150 mg/6 hour/iv
– Wound toilet per day
11 Feb 2018 (Surgery)
• S : fever (-)
• O : NIPS 0; HR 120 x/m; RR : 40 x/m; Temp : 36,9
hemithorax sinistra region: drain (-)
• A : Post op drainage ec lymphangioma day 3
good nutrition
• P : discharge with drain
: control on tuesday (13/2/18)
: give education for reffered to Makassar
: Paracetamol syr 3x 5 mg (2 cc)
: Amoxicilin 3 x 75 mg (3 cc)
13 Feb 2018 (Surgery Polyclinic)
• S : control post op drainage
• O :
hemithorax sinistra region: solid mass size 15x10x10 cm,
drain (+).
• A : post drainage lymph ec lymphangioma
• P : Aff drain
: reffered to Makassar, to Pediatric Surgical Specialist
LYMPHANGIOMA
 Definition
• Lymphangioma are uncommon, hamartomatous,
congenital malformations of lymphatic system that
involve the skin and subcutaneous tissues.
 Classification
• Most frequently used divides these lesions
into 2 major groups based on the depth and
the size of these abnormal lymph vessels.
• The superficial vesicles are called
lymphangioma circumscriptum.
• The more deep-seated group includes
cavernous lymphangioma and cystic Hygroma.
 Lymphangioma Circumscriptum
• the common form of cutaneous lymphangioma, is
characterized by persistent, multiple clusters of
translucent vesicles that usually contain clear lymph
fluid (often compared with frog spawn).
• Usually, lesions are asymptomatic but occasionally,
patients may have spontaneous episodes of minor
bleeding and copious drainage of clear fluid from
ruptured vesicles.
• In this type lymphangioma, the underlying lesions
constitute abnormal dilated lymph vessels involving
the upper part of the dermis.
• Lymphangioma circumscriptum has a high recurrence
rate after excision because of its deep component
 Cavernous Lymphangioma
• Cavernous lymphangioma are also uncommon
and usually arise during infancy.
• a solitary rubbery nodule with no skin changes
becomes evident in a single location, such as
the face, trunk, or extremity.
• These lesions are seated deep in the dermis,
forming a painless swelling or thickening of
the skin, mucous membranes, and
subcutaneous tissue.
 Cystic Hygroma
• Soon after birth, the infant is noted to have a
deep subcutaneous cystic swelling, usually in
the axilla, base of the neck, or groin.
• If these lesions are drained, they tend to fill up
rapidly with lymph fluid.
• The lesions tend to grow and increase to a
large size if they are not completely excised at
surgery.
 Epidemiology
• Lymphangiomas are rare. They account for 4%
of all vascular tumors and approximately 25%
of all benign vascular tumors in children.
• Lymphangioma can become evident at any
age, but the greatest incidence occurs at birth
or early in life. About 50% of lymphangiomas
are seen at birth
 Lymphatic System
• The lymphatic system is unique, in that it is a 1-
way system that returns lymph fluid via vessels to
the cardiovascular system for eventual
elimination of toxic byproducts by end organs,
such as the kidney, liver, colon, skin, and lungs.
• The lymphatic system consists of the following
(see Table 1 below):
– Fluid, known as lymph
– Vessels that transport lymph
– Organs that contain lymphoid tissue (eg, lymph nodes,
spleen, and thymus)
• The lymphatic system’s main functions are as
follows:
– Restoration of excess interstitial fluid and proteins
to the blood
– Absorption of fats and fat-soluble vitamins from
the digestive system and transport of these
elements to the venous circulation
– Defense against invading organisms
 Lymph
• Lymph is a fluid derived from blood plasma.
• It is pushed out through the capillary wall by pressure
exerted by the heart or by osmotic pressure at the
cellular level.
• Lymph contains nutrients, oxygen, and hormones, as
well as toxins and cellular waste products generated by
the cells.
• As the interstitial fluid accumulates, it is picked up and
removed by lymphatic vessels that pass through lymph
nodes, which return the fluid to the venous system.
• As the lymph passes through the lymph nodes,
lymphocytes and monocytes enter it.
• Lymphatic capillaries are blind-ended tubes with thin
endothelial walls (only a single cell in thickness).
• The lymphatic capillaries coalesce to form larger
meshlike networks of tubes that are located deeper in
the body; these are known as lymphatic vessels.
• The lymphatic vessels grow progressively larger and
form 2 lymphatic ducts:
– the right lymphatic duct, which drains the upper right
quadrant
– and the thoracic duct, which drains the remaining
lymphatic tributaries.
• Like veins, lymphatic vessels have 1-way valves to
prevent any backflow
 Lymph nodes
• Lymph nodes are bean-shaped structures that
are widely distributed throughout the
lymphatic pathway, providing a filtration
mechanism for the lymph before it rejoins the
blood stream.
• Lymph nodes constitute a main line of defense
by hosting 2 types of immunoprotective cell
lines, T lymphocytes and B lymphocytes.
 Sistem limfatik
• adalah suatu jalur untuk mengembalikan protein,
lipid dan air dari interstitium ke intravaskular.
• Cairan interstitial normalnya berkontribusi untuk
memberi nutrisi bagi jaringan.
• Sekitar 90% cairan kembali melalui vena. Sekitar 10%
sisanya terdiri dari protein yang terlalu besar
sehingga harus melewati kapiler limfatik.
• Protein tersebut melewati nodus yang berfungsi
sebagai filter sebelum memasuki vena.
Sistem limfatik meliputi :
• Kapiler limfatik
• Pembuluh limfatik pengumpul
• Nodus limfatik / kelenjar getah bening/ kelenjar limfe
• Trunkus limfatikus
• Duktus limfatikus
• Organ seperti limpa dan timus
 Kapiler limfatik
• Adalah pembuluh limfatik terkecil yang
berfungsi sebagai penerima cairan limfe
pertama kalinya.
 Pembuluh limfatik pengumpul
• Sebagai penerima cairan limfe yang berasal
dari kapiler limfatik
 Nodus limfatik
• Berbentuk bulat-oval, bean shape dan berada
di sepanjang pembuluh limfe yang berfungsi
untuk menerima cairan limfe.
• Kemudian di saring, menghancurkan bakteri,
parasit dan mikroorganisme yang berbahaya
bagi tubuh.
 Trunkus limfatikus
Ada 5 trunkus besar di tubuh :
• Intestinal trunk
• Lumbar trunk
• Bronchomediastinal trunk
• Jugularis trunk
• Subclavian trunk
 Ductus limfaticus
• Trunkus yang ada kemudian terhubung dengan vena
besar yg berada di daerah thorak dan bergabung di
ductus limfaticus.
– Sisterna cycle : ductus daerah lumbar trunk dan
Intestinal trunk berbentuk gelembung kaya lemak.
– Thoracic duct : berjalan sepanjang vertebra.
Fungsi untuk mengosongkan cairan limfe ke
pembuluh vena
– Duktus limfatikus dextra : bergabung dgn vena
thoracica dan menyuplai kepala, ekstremitas dan
thorak kanan.
 Organ limfatik
Dibagi 2 :
1. Organ limfatik primer
– Sum2 tulang dan thymus
2. Organ limfatik sekunder
– Limpa, KGB, tonsil dan adenoid, appendiks, payer’s patch
 Etiology
• The reason that these embryonic lymph sacs
remain disconnected from the rest of the
lymphatic system is not known
• Fetal lymphangioma is presumably a result of
failure in lymphatic drainage, documented on
routine prenatal ultrasonographic studies. [6]
Vulva lymphangioma circumscriptum may be
secondary to pelvic lymphatic obstruction, linked
in some patients to rectal adenocarcinoma,
cervical carcinoma, or endometrial carcinoma. [7]
 Etiologi
• Penyebab terjadinya limfangioma dikarenakan oleh malformasi
congenital dari sistem limfatik.
• Faktor genetik, paparan tembakau, konsumsi alkohol dan virus
juga dapat menjadi penyebab terjadinya limfangioma.
• Menurut Grasso et al, asal terbentuknya lesi ini dapat berupa
hipotesis berikut ini:
– Tersumbatnya atau berhentinya pertumbuhan normal dari
saluran limfatik primitif selama embriogenesis
– Proliferasi dari jaringan limfatik sac primitif yang tidak
mencapai sistem vena
– Tumbuhya jaringan limfatik di lokasi yang salah selama
embriogenesis.
 Pathophisiology
• In 1976, Whimster [4] studied the pathogenesis of
lymphangioma circumscriptum.
• According to Whimster, the basic pathologic
process is the collection of lymphatic cisterns in
the deep subcutaneous plane.
• These cisterns are separated from the normal
network of lymph vessels, but they communicate
with the superficial lymph vesicles through
vertical, dilated lymph channels.
• Whimster postulated that these cisterns might
arise from a primitive lymph sac that fails to
connect with the rest of the lymphatic system
during its embryonic development
• A thick coat of muscle fibers that cause rhythmic
contractions line these sequestered primitive
sacs.
• Rhythmic contractions increase the intramural
pressure, causing dilated channels to protrude
from the walls of the cisterns toward the skin.
• Whimster's observations are supported by those
of lymphangiographic and radiographic studies.
• These studies revealed that large multilobulated
cisterns extend deep in the dermis and laterally
beyond the obvious clinical lesions.
• These deep lymphangiomas show no evidence of
communication with the adjacent normal
lymphatics.
• The cause for the failure of these primitive lymph
sacs to connect to the rest of the lymphatic
system is not known.
• Some lymphangiomas may represent vascular
malformations during embryonic development rather
than as true neoplasms. [5] Vascular endothelial growth
factor (VEGF)–C and VEGF receptor-3 are active in the
formation of lymphangiomas.
• Based upon their expression, superficial
lymphangiomas more likely result from peripheral
lymphatic dilatation than from a growth factor.
• Fetal lymphangioma is presumably a result of failure in
lymphatic drainage. [
 KLASIFIKASI
• Limfangioma sirkumskripta, yang
superfisial, lesi cutaneus.
• Limfangioma Kavernosa (Kistik Higroma)
yang lebi dalam.
Limfangioma Simple/sirkumskripta
• Lesi ini biasa timbul saat bayi, berupa
bercak soliter, kecil, dengan diameter
kurang dari l cm, terdiri dari vesikel-vesikel
berdinding tebal, berisi cairan limfe, dan
menyerupai telur katak. Bila tercampur
darah, lesi dapat berwarna keunguan
Limfangioma Kavernosa
(Kistik Higroma)
• Kistik Higroma adalah
limfangioma yang luas,
makrokistik yang berisi
cairan kaya protein
• Limfangioma kistik terdiri
dari rongga limfatik yang
besar dan makroskopik
yang dikelilingi oleh
jaringan fibrovascular dan
otot halus
• Lymphangioma kavernosa terjadi di daerah
dengan jaringan ikat longgar dan terbanyak di
diagnosis saat umur 2 tahun.
• Sering berlokasi di kepala, leher dan axilla.
 Imaging studies
• MRI can help define the degree of
involvement and the entire anatomy of the
lymphangioma lesion.
• MRI can help prevent unnecessary extensive,
incomplete surgical resection, because of the
association with a high recurrence rate.
• Other Tests
• Immunohistochemical study is useful in
differentiating lymphangiomas from
hemangiomas in difficult cases.
• Test results with factor VIII – related antigen
are positive for hemangiomas but negative or
weakly positive in the endothelium of
lymphangiomas.
 radiology
• The diagnosis of lymphangioma in these patients was
made on the basis of clinical examination and imaging
findings [4], mainly ultrasound (USG) and computed
tomography (CT), and in some cases magnetic
resonance imaging (MRI). Ultrasonographic assessment
was performed on all patients.
• Ultrasound was used mainly to confirm the diagnosis
and to classify the type of lymphangioma. The tumours
were classified based on the ultrasonographic
appearance into three different subtypes: macrocystic,
mixed and microcystic lymphangiomas
 Macrocystic lymphangioma
that is completely cystic
(arrows).

Mixed type of lymphangioma with

cysts (white arrows) and
echogenic areas representing
microcysts (black arrows).
Microcystic lymphangioma that is
echogenic (arrows). The echogenic
appearance of the mass is due to
multiple interfaces from the walls of
tiny cysts.
• CT or MRI was performed to ensure that the lesion was not
a haemangioma, which is known to produce negative
Doppler flow but will be enhanced on CT and MRI.
• The other role was to visualise the extent of a lesion that
had involved the parapharyngeal space and mediastinum.
• The choice of CT or MRI depended on availability. The
authors preferred CT because it is fast and could be done
with sedation.
• MRI has the advantage of not using ionising radiation but
the long procedure required general anaesthesia in the
younger children.
 RADIOLOGIS
• Fasilitas imaging yang sering diperlukan adalah
– xray
– Computed Tomography (CT) scan
– Magnetic Resonance Imaging (MRI)
– USG, dan
• Foto thoraks membantu mendeteksi adanya
metastasis jauh (diperkirakan 15% pasien) atau
adanya tumor primer kedua (second primary, 5-
10%)
• Foto panoramik membantu mendeteksi adanya
keterlibatan mandibula
RADIOLOGIS

Kistik Higroma:
potongan axial dengan
pemberian kontras
pada gambaran CT
tampak gambaran
sedikit redup yang
menyerupai massa
kistik (tanda panah) di
segitiga posterior sisi
kiri leher pada anak
usia 3 tahun
 Therapy
• The preferred treatment for lymphangiomas is complete
surgical excision. On the basis of the Whimster hypothesis,
the large subcutaneous cisterns should be removed to
prevent the lesion from resurfacing.
• Adequate excision of lymphangiomas can be difficult and, at
times, unfeasible. This problem is the main reason for the
high recurrence rate. Tumors that are confined to the
superficial dermis are more amenable to surgical excision,
which is associated with a high rate of success.
• The use of other treatment modalities has been advocated;
these include cryotherapy, sclerotherapy, and cautery

medscape
 therapy
• PURPOSE:
– The aim of this study is to investigate the optimal treatment for
lymphangioma in children by analyzing the effectiveness and
complications of treatment modalities.
• METHODS:
– We reviewed 128 patients with lymphangioma treated at our
institution
– patients were grouped into 4 types: single cystic (SI; n = 23),
macrocystic (MA; n = 11), microcystic (MI; n = 69), and cavernous (CA;
n = 25).
• Result
– primary surgical excision (69/78 patients, 88.5%) was significantly
more successful than sclerotherapy (32/50, 64.0%) (P < .01).
– The effectiveness of sclerotherapy in SI, MA, MI, and CA types was
90.9%, 100%, 68.0%, and 10.0%,
• CONCLUSION:
– Sclerotherapy with OK-432 was not as effective as reported in the
literature. We recommend OK-432 injection therapy alone for SI and
MA types and surgical excision after pretreatment with OK-432 for MI
and CA types.
 Therapy
• Intralesional sclerotherapy has become an acceptable
method of treatment for lymphangiomas in children.
• It involves the use of a sclerosing agent that causes
irritation of the endothelial lining of the
lymphangioma, which leads to inflammation, fibrosis
and involution [2].
• Other modes of treatment such as surgical resection,
incision and drainage, and radiation therapy have
produced unsatisfactory results.
• Surgical resection for complete removal in many cases
is impossible due to the nature of the lesion, which has
a propensity to infiltrate tissue planes and encircle
important neurovascular structures.
• Tumour recurrences and nerve injuries are common
complications following surgery.
 therapy
• Under the effect of sedation (oral chloral hydrate with IV pethidine
added when necessary) and local anaesthetic and with strict aseptic
precaution, the cystic components of the tumour were aspirated
with a hypodermic syringe and 23G needle using ultrasonographic
guidance.
• While keeping the tip of aspiration needle within a cyst lumen, 0.5
mg per kg body weight of bleomycin aqueous solution (1.5 mg/ml
water) was injected (Figure 4).
• When more than one cyst was aspirated, the calculated dose was
divided by the number of cysts aspirated and the divided dose was
injected into each cyst [3]. This procedure was repeated after 4
weeks if the cystic component persisted and measured at least 1 cm
in diameter. The maximum cumulative dose of bleomycin allowed
was 5 mg/kg body weight. The same paediatric radiologist at the
two centres conducted the procedures.
 • (A) Ultrasound assessment
before injection.
• (B) Aspiration of cyst content
reveals clear serous fluid
(arrow).
• (C) Ultrasound image showing
the tip of aspirating needle
(arrow) within the cyst, and
• (D), while keeping the tip of the
needle within the cyst,
bleomycin aqueous solution is
administered.

While keeping the tip of aspiration needle within a cyst lumen, 0.5 mg per kg
body weight of bleomycin aqueous solution (1.5 mg/ml water) was injected
 complication
• Complications
• Lymphangioma circumscriptum may occur. Lymphangiomas
circumscriptum is associated with minor bleeding, recurrent
cellulitis, and lymph fluid leakage. Two cases of lymphangiosarcoma
arising from lymphangioma circumscriptum have been reported.
However, in both of the patients, the preexisting lesion was
exposed to extensive x-ray therapy. Therefore, radiation therapy
should be avoided in lymphangiomas.
• In cystic hygroma, large cysts can cause dysphagia, respiratory
problems, and serious infection if they involve the neck.
• A cystic lymphangioma of the scrotum may present as an acute
scrotum, owing to the rare complication of hemorrhage. [12]
LYMPHEDEMA
 Lymphedema
• Lymphedema
• Lymphedema results when the lymphatic system cannot adequately
drain lymph, resulting in an accumulation of fluid that causes
swelling. It may be either primary or secondary.
• Primary lymphedema is an inherited condition that occurs as a
result of impaired or missing lymphatic vessels; it may be present at
birth, may develop with the onset of puberty, or may occur in
adulthood, with no apparent causes
• Secondary lymphedema is basically acquired regional lymphatic
insufficiency, which may occur as a consequence of any trauma,
infection, or surgical procedure that disrupts the lymphatic vessels
or results in the loss of lymph nodes [8]
• Treatment consists of compression bandages or pneumatic
stockings to alleviate the swelling after appropriate diagnosis is
made.
 Definisi
• Adalah pengumpulan cairan kaya protein di
inerstitium yang disebabkan obstruksi drainase
limfatik.
• Obstruksi limfatik menyebabkan peningkatan protein
pada jaringan ekstravaskular, yg membuat retensi
cairan dan bengkak pada soft tissue.
• Peningkatan protein di ekstravaskular menstimulasi
proliferasi fibroblas, terkumpul cairan dan terjadi
nonpitting edema pada ekstremitas.
 Etiologi
• Limfangitis rekuren
• Malignancy
• Obesitas
• Pembedahan
 Patogenesis
• Obstruksi pada sistem limfatik → terkumpulnya
cairan dan protein → reaksi inflamasi → makrofag →
destruksi jaringan elastis dan produksi jaringan
fibrosclerotic.
• Fibroblas migrasi ke ruang interstitium dan deposit
kolagen → non pitting edema.
• Pada akhirnya local imunologi turun →
lymphangiosarcoma
1. Normal lymphatic flow
2. lymphedema
Terapi
 Lymphoma
• Lymphoma is a medical term used for a group of
cancers that originate in the lymphatic system.
Lymphomas usually begin with malignant
transformation of the lymphocytes in lymph
nodes or bunches of lymphatic tissue in organs
like the stomach or intestines. Hodgkin
lymphoma and non-Hodgkin lymphoma are the 2
major categories of lymphoma, characterized by
enlargement of lymph nodes, usually present in
the neck. Symptoms of lymphoma include
chronic fatigue, weak immune function, weight
loss, and night sweats.
• Lymphadenopathy
• Lymphadenopathy is a lymphatic disorder in which the
lymph nodes become swollen or enlarged as a
consequence of an infection. For example, swollen
lymph nodes in the neck may occur as a result of a
throat infection or sinus infection. [3]
• Lymphadenitis
• Lymphadenitis is an inflammation of the lymph node
that is due to a bacterial infection of the tissue in the
node, which causes swelling, reddening, and
tenderness of the skin overlying the lymph node. [3]