Lymphangioleiomyomatosis
From Wikipedia, the free encyclopedia
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| CT scan of a lung with LAM. | |
| OMIM | 606690 |
| DiseasesDB | ddb30755 |
| eMedicine | med/1348 radio/415 |
| MeSH | D018192 |
Lymphangioleiomyomatosis (LAM) is the result of disorderly smooth muscle proliferation throughout the bronchioles, alveolar septa, perivascular spaces, and lymphatics, resulting in the obstruction of small airways (leading to pulmonary cyst formation and pneumothorax) and lymphatics (leading to chylous pleural effusion). LAM occurs in a sporadic form, which only affects females, who are usually of childbearing age. LAM also occurs in patients who have tuberous sclerosis.
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[edit] Cause
Sporadic LAM only affects women.
The proliferating smooth muscle that occurs in the type of LAM seen in patients with tuberous sclerosis (TSC-LAM) has been shown to represent clones of the smooth muscle in those patients' renal angiomyolipomas. Thus it is believed to represent metastases of this "benign" tumor. There is a female preponderance to TSC-LAM. (reference: Henske EP. Metastasis of benign tumor cells in tuberous sclerosis complex. Genes, Chromosomes & Cancer. Dec. 2003. 38(4):376-81)
[edit] Radiography
With LAM, there is diffuse replacement of the pulmonary parenchyma by thin-walled cysts measuring 2-20 mm in diameter, with equal involvement of upper and lower lung zones. On chest X-rays, superimposition of the cysts gives a reticulonodular pattern of interstitial lung disease. High-resolution CT of the chest is both more specific for the diagnosis, as well as better able to assess the degree of pulmonary involvement.
[edit] Prognosis
Without lung transplant, there is a 50-80% 5-year survival rate.
[edit] Complications
- Worsening pulmonary insufficiency
- Pneumothorax, secondary to rupture of a cyst into the pleural space
- Chylous pleural effusions
[edit] Treatment
The association of LAM with women of childbearing age suggests that hormonal stimulation plays a role in the disease process, and several approaches to treatment involve diminishing the effect of estrogen. At one time or another, therapeutic approaches have included
- progesterone
- oophorectomy
- tamoxifen
- gonadotropin-releasing hormone (GnRH) agonists
- androgen therapy
No therapy is clearly efficacious, and all have undesirable side-effects. There is some evidence which shows that tamoxifen may actually cause worsening of LAM in some patients.[1][2]
When pulmonary function deteriorates to the point where oxygenation is inadequate, lung transplantation is usually performed. Following lung transplant (usually unilateral), LAM patients have survival curves similar to other lung transplant patients.
Doxycycline has been proposed as a treatment with minimal side-effects.[3]
An FDA-approved drug called sirolimus (or rapamycin) is being tested for the treatment of LAM. The MILES Trial (Multicenter International LAM Efficacy of Sirolimus Trial) is now underway. The first site, the University of Cincinnati, is open for enrollment. The National Institutes of Health will open enrollment soon. The MILES Trial is randomized, double-blinded, and placebo-controlled. The objective of the Trial is to determine if sirolimus has a beneficial effect on lung function in LAM patients. For more information contact The LAM Foundation at info@thelamfoundation.org.
[edit] Research
[edit] Support
[edit] References
- ^ Clemm C, Jehn U, Wolf-Hornung B, Siemon G, and Walter G (1987). "Lymphangiomyomatosis: a report of three cases treated with tamoxifen". Klin Wochenschr 65: 391-393.
- ^ Yu J, Astrinidis A, Howard S, and Henske E (2004). "Estradiol and tamoxifen stimulate LAM-associated angiomyolipoma cell growth and activate both genomic and nongenomic signaling pathways". Am J Physiol Lung Cell Mol Physiol 286: L694-L700.
- ^ Moses MA, Harper J, Folkman J (2006). "Doxycycline Treatment for Lymphangioleiomyomatosis with Urinary Monitoring for MMPs". New Engl J Med 354 (24): 2621–22.
