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Multifocal lymphangioendotheliomatosis, also known as congenital cutaneovisceral angiomatosis with thrombocytopenia and multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT), is a skin condition that presents at birth with hundreds of red-brown plaques as large as several centimeters.

Signs and symptoms

This disease presents as diffuse reddish-brown, congenital cutaneous papules and plaques. Important additional findings include vascular lesions in the GI tract and possibly other organ systems. Severe gastrointestinal bleeding resulting from these lesions is likely and requires repeated blood transfusions. Serious cases of associated thrombocytopenia are frequently caused by localized intralesional platelet consumption.

Patients with multifocal lymphangioendotheliomatosis typically have GI and cutaneous involvement, although there have also been reports of cases with no GI involvement as well as mild or delayed cutaneous involvement. Furthermore, reports of instances with normal platelet counts have been made.

Diagnosis

Given the phenotypic variability, there are no established diagnostic criteria. Instead, the diagnosis is made based on clinical evidence and supporting histopathology that demonstrates the presence of positive lymphatic markers, such as podoplanin (D2-40) or lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1), as well as negative glucose transporter 1 (GLUT-1).

Treatment

For multifocal lymphangioendotheliomatosis, there is no accepted course of care. Most cases of anemia and severe thrombocytopenia require numerous transfusions. In terms of medical therapy, corticosteroids, thalidomide, vincristine, propranolol, octreotide, aminocaproic acid,  bevacizumab, and/or sirolimus are available.

See also

• Skin lesion
• List of cutaneous conditions

References

1. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
2. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
3. Yeung, Jensen; Somers, Gino; Viero, Sandra; Pope, Elena (2006). "Multifocal lymphangioendotheliomatosis with thrombocytopenia". Journal of the American Academy of Dermatology. 54 (5). Elsevier BV: S214–S217. doi:10.1016/j.jaad.2005.07.029. ISSN 0190-9622. PMID 16631943.
4. Huang, Christina; Rizk, Elias; Iantosca, Mark; Zaenglein, Andrea L.; Helm, Klaus F.; Choudhary, Arabinda K.; Dias, Mark S. (2013). "Multifocal lymphangioendotheliomatosis with devastating intracranial hemorrhage". Journal of Neurosurgery: Pediatrics. 12 (5). Journal of Neurosurgery Publishing Group (JNSPG): 517–520. doi:10.3171/2013.8.peds12604. ISSN 1933-0707. PMID 24053595.
5. Esparza, Edward M.; Deutsch, Gail; Stanescu, Luana; Weinberger, Edward; Brandling-Bennett, Heather A.; Sidbury, Robert (2012). "Multifocal lymphangioendotheliomatosis with thrombocytopenia: Phenotypic variant and course with propranolol, corticosteroids, and aminocaproic acid". Journal of the American Academy of Dermatology. 67 (1). Elsevier BV: e62–e64. doi:10.1016/j.jaad.2011.08.020. ISSN 0190-9622. PMID 22703922.
6. Shakir, Asiya K.; Yu, Zhongxin; Altaf, Muhammad Adnan (2019). "Long-term Complications and Management of Gastrointestinal Bleeding in Multifocal Lymphangioendotheliomatosis". Journal of Pediatric Hematology/Oncology. 41 (8). Ovid Technologies (Wolters Kluwer Health): e534–e537. doi:10.1097/mph.0000000000001324. ISSN 1077-4114. PMID 30334900.
7. Com, Gulnur; Awad, Samah; Trenor, Cameron C. (2017). "Delayed Appearance of Cutaneous Lesions of Cutaneovisceral Angiomatosis (CAT) Leading to Misdiagnosis of Immune Thrombocytopenia". Journal of Pediatric Hematology/Oncology. 39 (4). Ovid Technologies (Wolters Kluwer Health): e236–e239. doi:10.1097/mph.0000000000000800. ISSN 1077-4114. PMID 28234740.
8. Peña Merino, Lander; López Almaraz, Ricardo; Fernández de Larrinoa, Aitor; Rubio Lombraña, Marta; González-Hermosa, Maria Rosario (2019-08-25). "Multifocal lymphangioendotheliomatosis without thrombocytopenia or clinical signs of systemic bleeding". Pediatric Dermatology. 36 (6). Wiley: 965–966. doi:10.1111/pde.13959. ISSN 0736-8046. PMID 31448439.
9. ^ Manor, Joshua; Patel, Kalyani; Iacobas, Ionela; Margolin, Judith F.; Mahajan, Priya (2021-02-27). "Clinical variability in multifocal lymphangioendotheliomatosis with thrombocytopenia: a review of the literature". Pediatric Hematology and Oncology. 38 (4). Informa UK Limited: 367–377. doi:10.1080/08880018.2020.1871135. ISSN 0888-0018. PMID 33641614.
10. Smith, Angela R.; Hennessy, Jane M.; Kurth, Margaret A. Heisel; Nelson, Stephen C. (2008-05-20). "Reversible skeletal changes after treatment with bevacizumab in a child with cutaneovisceral angiomatosis with thrombocytopenia syndrome". Pediatric Blood & Cancer. 51 (3). Wiley: 418–420. doi:10.1002/pbc.21597. ISSN 1545-5009. PMID 18493993.
11. Droitcourt, Catherine; Boccara, Olivia; Fraitag, Sylvie; Favrais, Géraldine; Dupuy, Alain; Maruani, Annabel (2015-08-01). "Multifocal Lymphangioendotheliomatosis With Thrombocytopenia: Clinical Features and Response to Sirolimus". Pediatrics. 136 (2). American Academy of Pediatrics (AAP): e517–e522. doi:10.1542/peds.2014-2410. ISSN 0031-4005. PMID 26148948.

Further reading

• Khamaysi, Ziad; Bergman, Reuven (2010). "Multifocal Congenital Lymphangioendotheliomatosis Without Gastrointestinal Bleeding and/or Thrombocytopenia". The American Journal of Dermatopathology. 32 (8). Ovid Technologies (Wolters Kluwer Health): 804–808. doi:10.1097/dad.0b013e3181dfd100. ISSN 0193-1091.
• Nagao, Daiki; Ozeki, Michio; Nozawa, Akifumi; Yasue, Shiho; Sasai, Hideo; Endo, Saori; Kato, Takazumi; Hori, Yumiko; Ohnishi, Hidenori (2023). "A Case of Multifocal Lymphangioendotheliomatosis With Thrombocytopenia and Changes in Coagulopathy". Journal of Pediatric Hematology/Oncology. 45 (3): e384–e388. doi:10.1097/MPH.0000000000002597. ISSN 1077-4114. PMID 36730448.

External links

• Children's Wisconsin

• Dermal and subcutaneous growths