CLT Lymphedema Pathology & Staging 2 — Questions and Answers
Question 1: Which tissue change in chronic lymphedema results from macrophage activity digesting accumulated proteins?
- Acanthosis
- Fibrosis from chronic inflammatory response and protein degradation (Correct answer)
- Papillomatosis
- Hyperkeratosis
Correct answer: Fibrosis from chronic inflammatory response and protein degradation
Chronic protein accumulation triggers macrophages and inflammatory cells that stimulate fibroblasts, leading to progressive fibrosis that hardens the tissue.
Question 2: The Stemmer sign is a clinical test for lymphedema that involves what assessment?
- Measuring circumference of the affected limb
- Attempting to pinch and lift a fold of skin at the base of the second toe (or finger) (Correct answer)
- Palpating for pitting along the shin
- Assessing range of motion of the affected joint
Correct answer: Attempting to pinch and lift a fold of skin at the base of the second toe (or finger)
A positive Stemmer sign occurs when skin at the base of the second digit cannot be lifted into a fold due to subcutaneous fibrotic changes, indicating lymphedema.
Question 3: Cancer-related secondary lymphedema most commonly occurs after treatment for which cancer in the US?
- Lung cancer
- Colorectal cancer
- Breast cancer (Correct answer)
- Prostate cancer
Correct answer: Breast cancer
Breast cancer treatment, particularly axillary lymph node dissection and radiation, is the most common cause of secondary lymphedema in the United States.
Question 4: What is the estimated lifetime risk of lymphedema for breast cancer survivors who undergo axillary lymph node dissection (ALND)?
- Less than 5%
- 5–10%
- 20–40% (Correct answer)
- Over 70%
Correct answer: 20–40%
Studies report approximately 20–40% of breast cancer survivors who undergo ALND will develop lymphedema, with risk increasing when radiation is added.
Question 5: Lipedema differs from lymphedema in that lipedema involves what primary tissue change?
- Accumulation of protein-rich lymph fluid
- Symmetrical, painful pathological fat deposition, predominantly in women (Correct answer)
- Fibrosis secondary to inflammation
- Pitting from venous insufficiency
Correct answer: Symmetrical, painful pathological fat deposition, predominantly in women
Lipedema is a chronic disease of abnormal fat deposition that is symmetrical, affects women almost exclusively, spares the feet, and is painful to palpation.
Question 6: Which condition, when coexisting with lymphedema, is called 'lipolymphedema'?
- Obesity alone
- Lipedema that has progressed to involve secondary lymphatic dysfunction (Correct answer)
- Venous insufficiency with lymphedema
- Diabetes with edema
Correct answer: Lipedema that has progressed to involve secondary lymphatic dysfunction
Lipolymphedema occurs when advanced lipedema mechanically impairs lymphatic drainage, adding a true lymphedema component to the existing lipedema.
CLT Lymphedema Pathology & Staging 2
Which tissue change in chronic lymphedema results from macrophage activity digesting accumulated proteins?