{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:16:26Z","timestamp":1777922186127,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Complex lymphatic anomalies (CLA) are a group of conditions that pose diagnostic and therapeutic challenges due to their rarity and overlapping clinical findings. This case series describes the complex pathology and novel combination therapies of three patients diagnosed with various types of CLA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>A retrospective review of medical records was performed for three patients treated for CLA between 2011 and 2019. Diagnostics, imaging, treatment, and follow-up were reviewed in the electronic medical record and combined with the literature review within the analysis. One patient had involvement of her skull base and ear canals, diagnosed after ear canal abnormalities were detected on computed tomography following meningitis. The second patient had involvement of her posterior ribs and T7\u2013T12 vertebral bodies, with thoracic instability requiring a back brace. The third patient had involvement of his left lower extremity and hemipelvis, necessitating a left above the knee amputation. Case 1 progressed on sirolimus and pamidronate but responded to zoledronic acid (ZA). She developed flares of coagulopathy and cellulitis that required reinforcement with vincristine and steroid pulses. Similarly, case 2 progressed on sirolimus and ZA alone, but achieved stable disease with added vincristine. Upon further disease progression, stabilization was obtained by the reinforcement of ZA. Case 3 required a combination of surgery as well as medical management with sirolimus and pamidronate. All three patients now have stable disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case series depicts a multidisciplinary and multiagent approach to the management of CLA with severe bony involvement using sirolimus, bisphosphonates, vincristine, and steroids.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lrb.2021.0011","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T11:38:28Z","timestamp":1629977908000},"page":"118-124","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Multidisciplinary Multiagent Treatment of Complex Lymphatic Anomalies with Severe Bone Disease: A Single-Site Experience"],"prefix":"10.1177","volume":"20","author":[{"given":"Megan D.","family":"Anthony","sequence":"first","affiliation":[{"name":"Departments of Hematology\/Oncology, Pathology, Radiology, University of North Texas Health Science Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aubrey","family":"Swilling","sequence":"additional","affiliation":[{"name":"Departments of Hematology\/Oncology, Pathology, Radiology, University of North Texas Health Science Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahra M.","family":"Jiwani","sequence":"additional","affiliation":[{"name":"Departments of Hematology\/Oncology, Pathology, Radiology, University of North Texas Health Science Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Heym","sequence":"additional","affiliation":[{"name":"Cook Children's Medical Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda R.","family":"Margraf","sequence":"additional","affiliation":[{"name":"Cook Children's Medical Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelby","family":"Fierke","sequence":"additional","affiliation":[{"name":"Cook Children's Medical Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren J.","family":"Akers","sequence":"additional","affiliation":[{"name":"Cook Children's Medical Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anish","family":"Ray","sequence":"additional","affiliation":[{"name":"Cook Children's Medical Center, Fort Worth, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-200402000-00018"},{"key":"e_1_3_4_3_2","first-page":"198","article-title":"An overview of the neurosurgical implications, pathophysiology, diagnosis and recent treatment strategies for Grade IV idiopathic osteolysis, also known as Gorham-Stout or phantom bone disease","volume":"21","author":"Ganau M","year":"2018","unstructured":"Ganau M, , Prasad V, , Ligarotti GKI, , Syrmos NC, , Ellamushi H. An overview of the neurosurgical implications, pathophysiology, diagnosis and recent treatment strategies for Grade IV idiopathic osteolysis, also known as Gorham-Stout or phantom bone disease. Hell J Nucl Med, 2018; 21:198\u2013201.","journal-title":"Hell J Nucl Med"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-195537050-00008"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2014.02.011"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1083\/jcb.144.4.789"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbo.2015.05.001"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.25100\/cm.v47i4.2406"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25886"},{"key":"e_1_3_4_10_2","first-page":"551","article-title":"A case report and literature review","volume":"11","author":"Koto K","year":"2019","unstructured":"Koto K, , Inui K, , Itoi M, , Itoh K, , Gorham-Stout disease in the rib and thoracic spine with spinal injury treated with radiotherapy, zoledronic acid, vitamin D, and propranolol: A case report and literature review. 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