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A Lethal Complication of Postmastectomy Lymphedema and Regional Immune Deficiency

Helmut Schreiber, MD; Frank M. Barry, MD; W. C. Russell, MD; William L. Macon, IV, MD; Jeffrey L. Ponsky, MD; Walter J. Pories, MD

Arch Surg. 1979;114(1):82-85.

Abstract
• Lymphangiosarcoma is a fatal complication of postmastectomy lymphedema. The pathogenesis of lymphangiosarcoma in chronic lymphedema is a combination of two factors. First, the edematous region responds in a manner similar to "immunologically privileged sites." Second, because of its anatomic and physiologic properties, it is a favorable site for the development of mutant cell populations for reasons that are not fully understood. As a result, these mutant cells, with their genetically nonidentical antigens, escape recognition by the host's impaired immune surveillance mechanism. The failure to promote a sufficient immune response allows unrestricted tumor growth to take place, resulting in the ultimate death of the patient. Available therapeutic measures are equally unsatisfactory. Emphasis is placed on periodic examination of the lymphedematous extremity, aggressive treatment of established lymphedema and infections, and surgical preservation of lymphatic channels during breast cancer surgery.

(Arch Surg 114:82-85, 1979)

Author Affiliations
From the Departments of Surgery, Case Western Reserve University School of Medicine, Cleveland (Drs Schreiber, Barry, Ponsky, Macon, and Pories) and Southwest General Hospital, Middleburg Heights, Ohio (Dr Russell). Dr Macon is presently with St Agnes Hospital, Baltimore. Dr Pories is presently with East Carolina University, Greeneville, NC.

Footnotes
Accepted for publication May 16, 1978.

Reprint requests to 3395 Scranton Rd, Cleveland, OH 44109 (Dr Schreiber).

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