Lymphatic Microvessel Density (LMD) as a Prognostic Marker in Endocervical Adenocarcinoma
RS Saad, M Xu, N Ismiil, S Nofech-Mozes, V Dube, Z Ghorab, MA Khalifa. Sunnybrook Health Science Center/Univ of Toronto, Toronto, ON, Canada
Background: Lymphatic invasion and lymph node metastases serve as prognostic indicators for disease progression in endocervical adenocarcinoma and as a guide for therapeutic decisions. Most studies investigating lymphatic vessel density (LVD) in cervical carcinoma have dealt with squamous cell type. There is limited data evaluating the significance of LVD as a prognostic marker in cervical adenocarcinoma. In this study, we investigated intra- and peritumoral LVD, using the lymphatic marker D2-40, as a prognostic marker in endocervical adenocarcinoma.
Design: Surgical specimens from 45 consecutive patients with endocervical adenocarcinoma treated with total abdominal hysterectomy and surgical staging were reviewed. Selected tumor blocks were immunostained for D2-40 and CD31. Positively stained microvessels (MV) were counted in density vascular/lymphatic foci (hot spots) at x400 field in each specimen (=0.17 mm2) by 2 pathologists. Results were expressed as the highest number of MV count identified within any single field and correlated with other prognostic parameters.
Results: Both CD31 MV and peritumoral D2-40 LVD showed significant correlation with depth of invasion, circumferential involvement, and angiolymphatic invasion (r=0.41 and 0.35; 0.39 and 0.52; 0.40 and 0.36; respectively, P< 0.05). Only peritumoral D2-40 LVD demonstrated a significant correlation with lymph node metastases (r=0.5, P<0.01). Intratumoral lymphatics were identified in 21/45 (47%) patients and their presence demonstrated a significant correlation with uterine involvement and angiolymphatic invasion (r=0.36, 0.38; respectively, P< 0.05). D2-40 detected angiolymphatic invasion in 14/45 (31%) cases, more than CD31 (10/45, 22%) and H&E (9/45, 20%). Angiolymphatic invasion detected with D2-40 showed a significant correlation with depth of invasion, lymph node metastases and parametrial involvement (r=0.41, 0.38, 0.33; respectively, P< 0.01).
Conclusions: Our study showed that both angiogenesis and lymphangiogenesis play an important role in the progression of endocervical adenocarcinoma. Peritumoral D2-40 LVD, in cervical adenocarcinoma, is significantly correlated with known prognostic parameters such as depth of invasion, circumferential involvement, angiolymphatic invasion and lymph node metastases. In addition, D2-40 detects more angiolymphatic invasion than commonly used endothelial marker (CD31) and routine H&E.
Monday, March 9, 2009 1:00 PM
Poster Session II # 150, Monday Afternoon