With the recent posts about Mondor's and the scientific literature describing it as venous and rare, I did a pubmed search, and found it's also commonly found on the penis (go figure) and I reviewed the lecture notes I had from Jodi Winicour, and they have started to do biopsies of it using special staining to differentiate veins and lymphatics and the biopsies showed some sclerosed lymphatics, which are the same pathology as axillary web, and some cases of phlebitic veins:

http://www.ncbi.nlm.nih.gov/pubmed?term=Mera%20mondor%27s%20disease

Dear Editor,

Mondor's disease, first described by Mondor in 1939,1 is an inflammatory vascular disorder characterized clinically by a linear subcutaneous nodule most commonly affecting the thoracoepigastric, lateral thoracic or superior epigastric region. There is currently no consensus whether this disorder is of venous or lymphatic vessel origin.2 We recently encountered a rare case of Mondor's disease developed in a cervical lymphatic vessel.

This 20-year-old man was referred to our department for the evaluation of a subcutaneous induration on his left neck that was resistant to antibiotics prescribed by his internal medicine practitioner. On physical examination, a 5-cm long, Y-shaped, cord-like, moderately tender subcutaneous induration was detected (Fig. 1). Laboratory examinations of his blood including coagulation tests returned normal results. A biopsy specimen revealed that subcutaneous vessels were obstructed by organized thrombi and that the vessel walls were replaced by fibroblasts. Narrow recanalized lumens were seen in the area of organized thrombi (Fig. 2a). Weigert staining detected few elastic fibers in the affected vessels (Fig. 2b). Cells lining recanalized lumens and lymphatic vessels in the stroma were positive for D2-40, a specific marker for lymphatic endothelial cells (Fig. 3).3 Based on our clinical and histopathological findings, we made a diagnosis of Mondor's disease arising from lymphatic vessels.

Figure 1. A rope of Y character type of approximately 5 cm in length subcutaneous tumor with an oppressive pain was admitted of his left neck.
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Figure 2. (a) There were some middle-sized veins or lymph ducts which were blockaded and the walls were replaced by fibroblasts and many re-communicated veins or lymph ducts were observed by the blockaded part. (b) Elastica van Gieson stain, in comparison with the nearby vein, showed a few elastic fibers in the sick part.
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Figure 3. The stain showed that the positive parts of D2-40 were on the endothelial cells of re-communicated veins or lymph ducts.
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Most patients with Mondor's disease present with lesions on the chest wall; for example, the thoracoepigastric, lateral thoracic or superior epigastric region. Our review of the published work detected only two cases of Mondor's disease of the neck.3 Although the etiology of this disorder is unclear, it may reflect the response of the local vasculature to trauma, muscular strain, febrile illness or contact dermatitis around the affected vessel.

As our patient is a carpenter who regularly carries heavy loads on his left shoulder that put strong pressure on the affected site on his neck, we posit that this occupational factor may underlie his development of Mondor's disease at this unusual site.

Whether Mondor's disease arises from veins or lymphatic vessels remains unclear. In our case, immunohistochemical study showed positive staining for D2-40, a specific lymphatic marker, and the absence of elastic fibers in the vessel wall. These findings clearly demonstrate that the lesion arose from lymphatic vessels. To the best of our knowledge, this is the first report of Mondor's disease in which the lesion stained positive for D2-40.

We presented a case of Mondor's disease with several peculiar features. First, the lesion was on the neck, a very rare site in patients with Mondor's disease. Second, occupational factors were involved in disease development and, third, there was immunohistochemical evidence that the disease was of lymphatic origin. To clarify the histogenesis of this disorder, other cases should be subjected to immunohistochemical study using D2-40 staining.

Another study of the penis, stated it was lymphatic and yet another study of the breast, showed that in 14 patients, the cord was a vein or artery:

http://www.ncbi.nlm.nih.gov/pubmed/19548938

J Eur Acad Dermatol Venereol. 2008 Feb;22(2):168-73.

Objective recognition of vascular lesions in Mondor's disease by immunohistochemistry.

Ichinose A, Fukunaga A, Terashi H, Nishigori C, Tanemura A, Nakajima T, Akishima-Fukasawa Y, Ishikawa Y, Ishii T.

Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan. ichise@med.kobe-u.ac.jp