[526] Lymphovascular Markers in Melanoma Sentinel Lymph Nodes

Stewart G Neill, Grant W Carlson, Andrew J Page, Jason Wang, Cynthia Cohen. Emory University School of Medicine, Atlanta, GA

Background: Cutaneous malignant melanomas principally metastasize to lymph nodes, and sentinel lymph node (SLN) sampling has become a critical facet of melanoma prognosis and treatment. Evidence has shown that melanomas trigger lymphangiogenesis at the tumor-stromal junction and that this process is correlated with SLN metastasis. Further, there is evidence that melanomas may produce premetastatic niches in SLNs through a similar process of influencing lymphangiogenesis. SLNs excised in the treatment of melanomas were retrospectively stained for lymphovascular immunohistochemical markers (CD31, CD34, D2-40) to identify changes in intranodal vascular density and correlate those changes with clinical outcomes.
Design: 65 melanomas with SLN biopsy, clinical follow-up, and adequate paraffin-embedded nodal tissue were studied. Immunohistochemistry for CD31, CD34, and D2-40 was performed. Stained slides were analyzed for microvessel density (MVD) based upon the manual quantitation of vessels within three 20x high-powered fields over “hot spots”. Automated quantitation of staining density and intensity was performed using a Dako ACIS III scanner. Mean MVDs, mean staining percentages (% stain), and mean staining intensities were compared.
Results: 65 melanoma patients included 8 with negative SLNs and recurrence, 26 with negative SLNs and no recurrence, and 31 positive nodes with and without recurrence.

		CD31			D2-40
	Number	Mean MVD	% Stain	Intensity	Mean MVD	% Stain	Intensity
Negative with recurrence	8	78.5*	50.1	101.4*	9.1	22.5*	69.4*
Negative without recurrence	26	117.5*	44.2	84.2*	6.2	13.1*	71.3*
Positive	31	93.7*	37.4	89.4*	7.2	7.1*	63.8*

(* indicates p < 0.05)

D2-40 % staining by image cytometry is significantly greater in the negative SLNs with recurrence than in the negative SLNs without recurrence (p = 0.002) and in the positive SLNs (p = 0.001). D2-40 and CD31 intensity is significantly greater in negative SLNs with recurrence than in positive SLNs (p = 0.003, p = 0.04, respectively); CD31 intensity is significantly greater in negative SLNs with recurrence than in those without recurrence (p = 0.001). CD34, both visually and by image cytometry, showed no significant differences amongst the three groups.
Conclusions: D2-40 and CD31 image cytometry shows more lymphatic and vascular channels in negative SLNs with subsequent recurrence than in those without recurrence and in positive SLNs. This indicates increased lymphangiogenesis and angiogenesis in SLNs prior to melanoma metastasis.
Category: Dermatopathology

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 99, Wednesday Afternoon