title: Multifocal lymphangioendotheliomatosis with thrombocytopenia: a newly recognized clinicopathological entity.
abstract: BACKGROUND
  Severe thrombocytopenic coagulopathy may complicate platelet-trapping vascular tumors such as kaposiform hemangioendothelioma and tufted angioma. Low-grade, chronic consumptive coagulopathy may occur with extensive venous and lymphatic malformations. We have also observed patients with rare multifocal, congenital skin and gastrointestinal (GI) tract vascular anomalies of distinctive and remarkably similar appearance, all associated with coagulopathy. We studied the clinical and histopathologic features of 3 patients demonstrating this previously uninvestigated phenomenon.
  
  
  METHODS
  All 3 patients presented with hundreds of congenital red-brown skin plaques as large as a few centimeters, with similar lesions throughout the GI tract and severe GI tract bleeding. One patient had synovial involvement. All had significant thrombocytopenia, with prothrombin and partial thromboplastin times and fibrinogen levels near the reference range. Corticosteroids and/or interferon alfa treatment resulted in equivocal or no improvement. Skin lesions from all 3 patients were histologically distinctive and similar, including dilated, thin-walled vessels in the dermis and subcutis lined by hobnailed, proliferative endothelial cells (10%-15% immunoreactive for Ki-67), most displaying intraluminal papillary projections. Immunoreaction for the lymphatic marker LYVE-1 was uniformly present.
  
  
  CONCLUSIONS
  We propose the term multifocal lymphangioendotheliomatosis with thrombocytopenia to distinguish this newly recognized clinicopathological entity. These congenital lesions, like tufted angioma and kaposiform hemangioendothelioma, show lymphatic differentiation, strengthening the association between abnormal lymphatic endothelium and coagulopathy.
authors.affiliation: Departments of Pathology and Otolaryngology, the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202, USA.
authors.forename: Paula E
authors.initials: PE
authors.lastname: North
authors.forename: Teri
authors.initials: T
authors.lastname: Kahn
authors.forename: Maria R
authors.initials: MR
authors.lastname: Cordisco
authors.forename: Soheil S
authors.initials: SS
authors.lastname: Dadras
authors.forename: Michael
authors.initials: M
authors.lastname: Detmar
authors.forename: Ilona J
authors.initials: IJ
authors.lastname: Frieden
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006023:Glycoproteins; D006390:Hemangioendothelioma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D008297:Male; D012878:Skin Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D013921:Thrombocytopenia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D033921:Vesicular Transport Proteins
chemical_list: D006023:Glycoproteins; C119248:LYVE1 protein, human; D033921:Vesicular Transport Proteins