Lymphangioma fleshy tumor is an extremely rare tumor that almost always occurs on the basis of chronic lymphatic edema, with the vast majority located in the upper limbs. It is often associated with long-term chronic lymphatic edema of the upper limb secondary to radical mastectomy for carcinoma of the breast.

bubble_chart Pathological Changes

1. Macroscopic findings: The skin surface appears purplish-red, forming small purplish-red nodules that may coalesce to form large ulcerated hemorrhagic masses. The deeper lesions of the tumor present as traumatic ecchymoses or a cellulitis-like appearance.

2. Microscopic findings: Most tumor cells are spindle-shaped, with a few being irregularly oval or round, larger than typical endothelial cells. Irregular and anastomosing lumens or clefts can be observed, which are often empty or contain small amounts of lymph fluid.

bubble_chart Clinical Manifestations

This disease is commonly seen in elderly individuals with upper limb lymphedema after radical mastectomy for breast carcinoma, or in patients with long-term chronic lower limb edema following penile carcinoma surgery or caused by filariasis. The edema worsens, with local tenderness, followed by the appearance of multiple erythematous patches on the skin, which further develop into well-demarcated purplish-red papules or blisters. The tumor grows rapidly, often spreading along subcutaneous tissue or deep fascia, and may invade deep muscles.

bubble_chart Treatment Measures

Due to the high malignancy of this tumor, which can invade deep muscles and makes local resection difficult, amputation is often performed immediately upon diagnosis. This tumor frequently metastasizes to the lungs and bones via lymphatic and hematogenous routes. Most patients die within one year of onset.

The main differential diagnosis for this tumor is malignant hemangioendothelioma, primarily based on whether the patient has a history of chronic lymphedema.