Cutaneous lymphatic malformations in disappearing bone (Gorham-Stout) disease: A novel clue to the pathogenesis of a rare syndrome - 12/08/11

Doi : 10.1016/j.jaad.2006.01.063

Daniela Bruch-Gerharz, MD ^a,^⁎ , Claus-Dieter Gerharz, MD ^b, Helger Stege, MD ^a, Jean Krutmann, MD ^c, Michael Pohl, MD ^d, Rainer Koester, MD ^e, Thomas Ruzicka, MD ^a
^a From the Departments of Dermatology
^d Radiology, Heinrich-Heine-University of Duesseldorf
^b Institute of Pathology, Bethesda-Krankenhaus Duisburg
^c Institute for Environmental Medical Research, Duesseldorf
^e Department of Radiology, Lukas-Krankenhaus Neuss

Reprint requests: Daniela Bruch-Gerharz, MD, Department of Dermatology, Heinrich-Heine-University, PO Box 101007, D-40001 Duesseldorf, Germany.

Duesseldorf, Duisburg, and Neuss, Germany

Abstract

Background

Gorham-Stout disease is an unusual, progressive syndrome of unknown etiology characterized by mono- or polyostotic osteolysis most often affecting children and young adults. The onset is insidious and the disease progresses to extensive and potentially disabling osteolysis often unresponsive to therapeutic intervention. Although bone and soft tissue lesions are the most frequent manifestations of Gorham-Stout disease, skin lesions can occur and may provide a clue to the pathogenesis of this rare syndrome.

Objective

Our aim was to describe characteristics of vascular skin lesions of this rare condition using magnetic resonance imaging and histomorphological analysis.

Methods

The case of a 36-year-old man with Gorham-Stout disease of the left leg and foot is reported.

Results

This case was remarkable for its prominent lymphatic vascular malformations involving the skin and soft tissues adjacent to the diseased bone—a previously undescribed abnormality, which preceded osteolysis for several years. Magnetic resonance imaging played a key role in defining the extent of disease in skin and soft tissues.

Limitations

It is difficult to assess the true incidence of hemangiomatosis in the earlier reports on Gorham-Stout disease in which hemangiomatous cutaneous lesions were mentioned but not described or illustrated.

Conclusion

A vascular process with angiomatous histological features is considered to be the pathological hallmark of Gorham-Stout disease, but the specific type of this vascular process is still under debate. Our report highlights a lymphatic malformative nature of Gorham-Stout disease, thereby contributing to a better understanding and characterization of this rare disease entity.

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