Lymph Node Fibrosis in a Case of Primary Lymphoedema- A Report of Two Cases

Abstract

Lymphoedema can be classified into primary and secondary. Primary lymphoedema arise in patients where the cause is not known. Secondary lymphoedema are those in which the lymph system has been damaged by some well recognised pathological process, such as extensive malignancy, filariasis, radiation etc. The changes may occur either in the lymph node, or in lymph vessels or both. The clinical evolution and the prognosis of the oedema in the limb involved will depend on the extension and evolution of these lesions. The degree of fibrosis and its distribution in lymph node play an important role on the prognosis, clinical course and treatment of the patient. Hence pathologist should be aware of the microscopic distribution and patterns of lymph node fibrosis in primary lymphoedema. We hereby report two cases- a 50-year-old male diabetic patient and a 35-year-old male patient presenting with varicose veins, lymphoedema showing lymph node fibrosis.

Keywords: Lymph node fibrosis; Lymphodema; Varicose veins.

[Table/Fig-1]:

Gross picture of both lymph nodes. Cut surface of the lymphnodes show homogenous grey white appearance.

[Table/Fig-2]:

Microphotograph showing: a) Cortex and medulla with depletion of lymphoid cells and are replaced by dense masses of hyaline fibrosis (H&E,X40) b) The medulla also shows focal areas of lipomatosis (H&E,X100).

[Table/Fig-3]:

Microphotograph of lymph node of second case showing increased pericapsular fibrosis (H&E,X40).

[Table/Fig-4]:

Microphotograph showing areas of fibrosis: a) Masson’s trichrome stain (MT,X40); b) Van Gieson stain (VG,X40).