From Big Medical Encyclopedia

STYUARTA-TRIVSA SYNDROME (F. W. Stewart, sovr. amer. pathologist; N. Treves, amer. surgeon, sort. in 1894; syndrome; synonym: lymphangiosarcoma, limfangioendotelioma, a limfangioblastoma, a limfangioendotelioblastoma, Stewart's tumor — Trivsa) — the rare and special kind of an angioendotelioma developing against the background of it is long the existing lymphostasis of an upper extremity after a radical mastectomy concerning a breast cancer.

For the first time this tumor is in details described in 1948 by Stewart and Triv-som, obrativshikhm attention to its emergence against the background of hron. a lymphostasis of an upper extremity after a radical mastectomy (see), especially in the cases combined with radiation therapy (see). Similar tumors in the subsequent were found in sites hron. a lymphostasis (see) both upper, and the lower extremity, caused by other reasons.

Page — T. the page meets seldom; by 1972 it was published apprx. 200 observations. Page — T. the page arises more often in 5 — 10 years after a radical mastectomy.

The tumoral centers are localized preferential superficially, in skin and hypodermic cellulose. In the beginning they have an appearance of flat bagrovosinyushny spots or slightly towering plaques, then gain knotty character, often ulcerate and bleed. During this period they can be mistakenly taken for a hematoma (see), angioma (see), Kaposha's sarcoma (see. Kaposha sarcoma ). The tumoral centers can carry both solitary, and multiple character. Their sizes fluctuate from 1 cm in the diameter to huge, the growing brownish-red masses having an appearance ekzofitno. Within several months the tumor extends up to an extremity, passes to a chest wall, metastasizes in a pleura and lungs.

Microscopically the tumor is characterized by growth of atypical endothelial cells with hyperchromic kernels, the covering various size and a form the vascular cracks of capillary type anastomosing among themselves. The hyalinosis of perivascular spaces and vascular walls is characteristic. In a stroma considerable limfoplazmotsitarny infiltration is defined. On the periphery a large number of the expanded vessels with not changed endothelium containing a lymph, and in a stroma — accumulations of haemo siderophages is visible. Such angiomatosis connected with reorganization of vessels because of a lymphostasis, not svoystven another to angioendotelioma (see).

Treatment consists in an early wide operative measure, with removal of all zone of a lymphostasis — amputations (see) or an exarticulation of an extremity (see. Exarticulation ).

The forecast adverse — more than 50% of patients perish in the first 2 years after S.'s emergence — T. page. Five-year survival (after treatment), according to Vudvord (A. N. of Woodward) et al., makes 8,5%.

Bibliography: Dvorakovskaya I. V. A. V. Limfangioendoteliom's isanchakova of a shoulder which developed against the background of long hypostasis after a mastectomy concerning a breast cancer, Vopr. onkol., t. 10, No. 9, page 115, 1964; International histologic classification of tumors of soft tissues, page 37, Geneva, WHO, 1969; Oshmyanskaya A. I., Zele-ner S. V. iporoshin K. K. Diagnosis and treatment of lymphangiosarcomas against the background of a lymphostasis of an upper extremity after a mastectomy, Surgery, No. 2, page 23, 1975; Stewart F. W. a. Treves N. Lym-phangiosarcoma in postmastectomy limphe-dema, Cancer, v. 1, p. 64, 1948; Woodward A. H., Ivins J. C. a. Soule E. H. Lymphangiosarcoma arising in chronic lymphedematous extremities, ibid., v. 30, p. 562, 1972.

V. M. Blinov.