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Axillary Web Syndrome : Evidence for Lymphatic Origin with Thrombosis

Johansson, Karin LU ; Chong, Heung ; Ciornei, Cristina-Daria LU ; Brorson, Håkan LU orcid and Mortimer, Peter S (2020) In Lymphatic Research and Biology 18(4). p.329-332
Abstract


Background:
The axillary web syndrome (AWS) occurs in the axilla and on the frontal side of the upper arm and sometimes along the forearm to the thumb. The cord is painful, particularly on movement, and can therefore be very distressing for the patient. Although the phenomenon has been examined and discussed for decades, no evidence for the origin has been found until now. The aim of this study was to perform a histopathologic analysis of cords taken between 1996 and 1998 in the Surgical Clinic, Skane University Hospital, Lund, Sweden.
Methods and Results:
In seven patients, biopsies of the AWS cords were obtained 4-5 weeks after axillary node surgery for breast cancer and examined with standard hematoxylin and... (More)


Background:
The axillary web syndrome (AWS) occurs in the axilla and on the frontal side of the upper arm and sometimes along the forearm to the thumb. The cord is painful, particularly on movement, and can therefore be very distressing for the patient. Although the phenomenon has been examined and discussed for decades, no evidence for the origin has been found until now. The aim of this study was to perform a histopathologic analysis of cords taken between 1996 and 1998 in the Surgical Clinic, Skane University Hospital, Lund, Sweden.
Methods and Results:
In seven patients, biopsies of the AWS cords were obtained 4-5 weeks after axillary node surgery for breast cancer and examined with standard hematoxylin and eosin and D2-40 (lymphatic endothelial cell) staining. In one biopsy, there was a dilated vessel with a thickened wall, which was confirmed by D2-40 immunostaining to represent a lymphatic vessel. The lumen was occluded by organized thrombus, within which new vessels were being formed, indicating recanalization. In two other biopsies, similar lymphatic vessels with thickened walls were present, although the lumen of the vessels was not visualized in the planes of the section. The other four biopsies do not show specific features.
Conclusion:
Although only one case, this is the first pathological evidence of thrombosis within a confirmed lymphatic vessel from a case of cording. We propose that the axillary cord represents lymphatic vessel thrombosis. Recanalization of the thrombus may eventually restore lymphatic flow consistent with the transient nature of the condition.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Lymphatic Research and Biology
volume
18
issue
4
pages
329 - 332
publisher
Mary Ann Liebert, Inc.
external identifiers
  • scopus:85089801074
  • pmid:31880509
ISSN
1539-6851
DOI
10.1089/lrb.2019.0074
language
English
LU publication?
yes
id
2b43f197-b2fb-42bf-91a0-3838f7473254
date added to LUP
2020-02-17 18:22:57
date last changed
2024-05-01 05:25:44
@article{2b43f197-b2fb-42bf-91a0-3838f7473254,
  abstract     = {{<p><br>
 Background:<br>
 The axillary web syndrome (AWS) occurs in the axilla and on the frontal side of the upper arm and sometimes along the forearm to the thumb. The cord is painful, particularly on movement, and can therefore be very distressing for the patient. Although the phenomenon has been examined and discussed for decades, no evidence for the origin has been found until now. The aim of this study was to perform a histopathologic analysis of cords taken between 1996 and 1998 in the Surgical Clinic, Skane University Hospital, Lund, Sweden. <br>
 Methods and Results:<br>
 In seven patients, biopsies of the AWS cords were obtained 4-5 weeks after axillary node surgery for breast cancer and examined with standard hematoxylin and eosin and D2-40 (lymphatic endothelial cell) staining. In one biopsy, there was a dilated vessel with a thickened wall, which was confirmed by D2-40 immunostaining to represent a lymphatic vessel. The lumen was occluded by organized thrombus, within which new vessels were being formed, indicating recanalization. In two other biopsies, similar lymphatic vessels with thickened walls were present, although the lumen of the vessels was not visualized in the planes of the section. The other four biopsies do not show specific features. <br>
 Conclusion:<br>
 Although only one case, this is the first pathological evidence of thrombosis within a confirmed lymphatic vessel from a case of cording. We propose that the axillary cord represents lymphatic vessel thrombosis. Recanalization of the thrombus may eventually restore lymphatic flow consistent with the transient nature of the condition.</p>}},
  author       = {{Johansson, Karin and Chong, Heung and Ciornei, Cristina-Daria and Brorson, Håkan and Mortimer, Peter S}},
  issn         = {{1539-6851}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{329--332}},
  publisher    = {{Mary Ann Liebert, Inc.}},
  series       = {{Lymphatic Research and Biology}},
  title        = {{Axillary Web Syndrome : Evidence for Lymphatic Origin with Thrombosis}},
  url          = {{http://dx.doi.org/10.1089/lrb.2019.0074}},
  doi          = {{10.1089/lrb.2019.0074}},
  volume       = {{18}},
  year         = {{2020}},
}