{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:05:14Z","timestamp":1791932714164,"version":"4.3.4"},"reference-count":125,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Complex Lymphatic Anomalies (CLA) are lymphatic malformations with idiopathic bone and soft tissue involvement. The extent of the abnormal lymphatic presentation and boney invasion varies between subtypes of CLA. The etiology of these diseases has proven to be extremely elusive due to their rarity and irregular progression. In this review, we compiled literature on each of the four primary CLA subtypes and discuss their clinical presentation, lymphatic invasion, osseous profile, and regulatory pathways associated with abnormal bone loss caused by the lymphatic invasion. We highlight key proliferation and differentiation pathways shared between lymphatics and bone and how these systems may interact with each other to stimulate lymphangiogenesis and cause bone loss.<\/jats:p>","DOI":"10.3390\/ijms23158258","type":"journal-article","created":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T04:59:16Z","timestamp":1658897956000},"page":"8258","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Osteopathy in Complex Lymphatic Anomalies"],"prefix":"10.3390","volume":"23","author":[{"given":"Ernesto","family":"Solorzano","sequence":"first","affiliation":[{"name":"Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-1900","authenticated-orcid":false,"given":"Andrew L.","family":"Alejo","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3595-2485","authenticated-orcid":false,"given":"Hope C.","family":"Ball","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Magoline","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Department of Pediatric Hematology Oncology and Blood, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayez F.","family":"Safadi","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Musculoskeletal Research Group, Northeast Ohio Medical University (NEOMED), Rootstown, OH 44272, USA"},{"name":"Rebecca D. Considine Research Institute, Akron Children\u2019s Hospital, Akron, OH 44308, USA"},{"name":"School of Biomedical Sciences, Kent State University, Kent, OH 44243, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/BF01945110","article-title":"Transendothelial transport of lipids in the absorbing lymphatic vessel","volume":"38","author":"Azzali","year":"1982","journal-title":"Experientia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1172\/JCI71610","article-title":"Lymphatic transport of high-density lipoproteins and chylomicrons","volume":"124","author":"Randolph","year":"2014","journal-title":"J. Clin. 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