title: Extrapulmonary lymphangioleiomyomatosis and lymphangiomatous cysts in tuberous sclerosis complex.
abstract: OBJECTIVE
  To describe the clinical manifestations, imaging findings, and histologic features of extrapulmonary lymphangioleiomyomatosis (LAM) in the tuberous sclerosis complex (TSC).
  
  
  METHODS
  We retrospectively reviewed institutional medical records since 1940 to identify patients with TSC and extrapulmonary LAM.
  
  
  METHODS
  Of 403 patients with TSC, 3 had pulmonary and extrapulmonary LAM and retroperitoneal lymphangiomatous cysts. The clinical, imaging, and histologic features of these three patients were summarized, including analysis of biopsy specimens by conventional histology, immunohistology, radiolabeled ligand-binding assays, and tissue culture.
  
  
  RESULTS
  The three young women had characteristic dermatologic findings of TSC and pulmonary LAM. Two patients were of normal intelligence, and one had a recent history of contraceptive use. All three patients had intra-abdominal lymphangiomatous cysts, uterine LAM, and renal angiomyolipomas. Renal and uterine biopsy specimens demonstrated positive immunostaining for melanoma-related antigens and expression of estrogen and progesterone receptors by ligand-binding assay and immunohistology. Cells cultured from LAM tissue of one of the patients exhibited a mitogenic response to estradiol.
  
  
  CONCLUSIONS
  Clinically significant extrapulmonary LAM is a rare manifestation of TSC and may occur in women with this disease who also have pulmonary LAM. The clinical features of these patients confirm the importance of sex steroids in the development of these lesions. Immunohistochemical findings suggest that LAM and angiomyolipomas have a neuroectodermal origin. The development of lymphangiomatous cysts in these patients is probably due to smooth muscle proliferation in lymph vessels, which can result in lymphatic obstruction.
authors.affiliation: Division of Nephrology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
authors.forename: V E
authors.initials: VE
authors.lastname: Torres
authors.forename: J
authors.initials: J
authors.lastname: Björnsson
authors.forename: B F
authors.initials: BF
authors.lastname: King
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.forename: H
authors.initials: H
authors.lastname: Zincke
authors.forename: E S
authors.initials: ES
authors.lastname: Edell
authors.forename: T O
authors.initials: TO
authors.lastname: Wilson
authors.forename: R R
authors.initials: RR
authors.lastname: Hattery
authors.forename: M R
authors.initials: MR
authors.lastname: Gomez
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications* / Q000209:etiology / Q000473:pathology; D000328:Adult; D005260:Female; D006801:Humans; D018192:Lymphangioleiomyomatosis / Q000150:complications* / Q000209:etiology / Q000473:pathology; D018191:Lymphangioma, Cystic / Q000150:complications* / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D014402:Tuberous Sclerosis / Q000150:complications* / Q000209:etiology / Q000473:pathology