title: Multifocal Lymphangioendotheliomatosis With Thrombocytopenia: Clinical Features and Response to Sirolimus.
abstract: Multifocal lymphangioendotheliomatosis with thrombocytopenia (MLT) is a recently described glucose transporter 1-negative multifocal vascular disorder with significant morbidity and mortality. However, data are lacking on the clinical spectrum, long-term prognosis, and treatment of MLT. It is often confused with multifocal infantile hemangioma, but the conditions must be differentiated for appropriate assessment and therapeutic management. Treatments for MLT have been disappointing, and the treatments classically used for infantile hemangioma are often ineffective. We report 3 newborn cases featuring various clinical and biological phenotypes of MLT: 1 patient had severe brain involvement and died early; another had no thrombocytopenia; and the third had nearly no skin involvement. Histologically, all were negative for glucose transporter 1 and positive for the lymphatic marker lymphatic vessel endothelial hyaluronan receptor 1 or D2-40 (∼38-kDa O-linked transmembrane sialoglycoprotein podoplanin). Two cases with severe gastrointestinal bleeding were treated with sirolimus 0.1 mg/k per day, which was efficient after the first month of treatment. MLT clinically presents in various forms, and when complicated by widespread or severe extracutaneous involvement, initial aggressive therapeutic intervention is justified. The pathogenesis of MLT remains unclear, but lymphatic differentiation is widely acknowledged. Because of its antiangiogenic properties, including anti-lymphangiogenesis, sirolimus offers an adequate and targeted therapeutic approach for MLT.
authors.affiliation: University Rennes 1, Department of Dermatology, Inserm CIC 0203 Pharmacoepidemiology Unit, CHU Rennes, Rennes, France; catherine.droitcourt@chu-rennes.fr olivia.boccara@nck.aphp.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Droitcourt
authors.affiliation: Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), University Paris Descartes-Sorbonne Paris Cité, Institute Imagine, University Hospital Necker-Enfants Malades, Paris, France; catherine.droitcourt@chu-rennes.fr olivia.boccara@nck.aphp.fr.
authors.forename: Olivia
authors.initials: O
authors.lastname: Boccara
authors.affiliation: Department of Pathology, University Hospital Necker-Enfants Malades, Paris, France; and.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Fraitag
authors.affiliation: Departments of Neonatalogy and.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Favrais
authors.affiliation: University Rennes 1, Department of Dermatology, Inserm CIC 0203 Pharmacoepidemiology Unit, CHU Rennes, Rennes, France;
authors.forename: Alain
authors.initials: A
authors.lastname: Dupuy
authors.affiliation: Dermatology, University Francois Rabelais Tours, CHRU Tours, Tours, France.
authors.forename: Annabel
authors.initials: A
authors.lastname: Maruani
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D020123:Sirolimus / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D020123:Sirolimus