Difference between revisions of "Lymphovascular invasion"
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**Most generally -- LVI = poorer prognosis.<ref name=pmid10101593>{{Cite journal | last1 = Moreira | first1 = LF. | last2 = Kenmotsu | first2 = M. | last3 = Gochi | first3 = A. | last4 = Tanaka | first4 = N. | last5 = Orita | first5 = K. | title = Lymphovascular and neural invasion in low-lying rectal carcinoma. | journal = Cancer Detect Prev | volume = 23 | issue = 2 | pages = 123-8 | month = | year = 1999 | doi = | PMID = 10101593 }}</ref> | **Most generally -- LVI = poorer prognosis.<ref name=pmid10101593>{{Cite journal | last1 = Moreira | first1 = LF. | last2 = Kenmotsu | first2 = M. | last3 = Gochi | first3 = A. | last4 = Tanaka | first4 = N. | last5 = Orita | first5 = K. | title = Lymphovascular and neural invasion in low-lying rectal carcinoma. | journal = Cancer Detect Prev | volume = 23 | issue = 2 | pages = 123-8 | month = | year = 1999 | doi = | PMID = 10101593 }}</ref> | ||
=== | ===Specific tumours and LVI=== | ||
*[[Urothelial carcinoma]]: LVI is an independent predictor of a poor prognosis that has more predictive power than [[tumour stage]].<ref name=pmid19494855>{{Cite journal | last1 = Cheng | first1 = L. | last2 = Montironi | first2 = R. | last3 = Davidson | first3 = DD. | last4 = Lopez-Beltran | first4 = A. | title = Staging and reporting of urothelial carcinoma of the urinary bladder. | journal = Mod Pathol | volume = 22 Suppl 2 | issue = | pages = S70-95 | month = Jun | year = 2009 | doi = 10.1038/modpathol.2009.1 | PMID = 19494855 | URL = http://www.nature.com/modpathol/journal/v22/n2s/full/modpathol20091a.html }}</ref> | *[[Urothelial carcinoma]]: LVI is an independent predictor of a poor prognosis that has more predictive power than [[tumour stage]].<ref name=pmid19494855>{{Cite journal | last1 = Cheng | first1 = L. | last2 = Montironi | first2 = R. | last3 = Davidson | first3 = DD. | last4 = Lopez-Beltran | first4 = A. | title = Staging and reporting of urothelial carcinoma of the urinary bladder. | journal = Mod Pathol | volume = 22 Suppl 2 | issue = | pages = S70-95 | month = Jun | year = 2009 | doi = 10.1038/modpathol.2009.1 | PMID = 19494855 | URL = http://www.nature.com/modpathol/journal/v22/n2s/full/modpathol20091a.html }}</ref> | ||
*Breast cancer: not an independent risk factor.<ref name=pmid19436035>{{Cite journal | last1 = Ejlertsen | first1 = B. | last2 = Jensen | first2 = MB. | last3 = Rank | first3 = F. | last4 = Rasmussen | first4 = BB. | last5 = Christiansen | first5 = P. | last6 = Kroman | first6 = N. | last7 = Kvistgaard | first7 = ME. | last8 = Overgaard | first8 = M. | last9 = Toftdahl | first9 = DB. | title = Population-based study of peritumoral lymphovascular invasion and outcome among patients with operable breast cancer. | journal = J Natl Cancer Inst | volume = 101 | issue = 10 | pages = 729-35 | month = May | year = 2009 | doi = 10.1093/jnci/djp090 | PMID = 19436035 }}</ref> | *Breast cancer: not an independent risk factor.<ref name=pmid19436035>{{Cite journal | last1 = Ejlertsen | first1 = B. | last2 = Jensen | first2 = MB. | last3 = Rank | first3 = F. | last4 = Rasmussen | first4 = BB. | last5 = Christiansen | first5 = P. | last6 = Kroman | first6 = N. | last7 = Kvistgaard | first7 = ME. | last8 = Overgaard | first8 = M. | last9 = Toftdahl | first9 = DB. | title = Population-based study of peritumoral lymphovascular invasion and outcome among patients with operable breast cancer. | journal = J Natl Cancer Inst | volume = 101 | issue = 10 | pages = 729-35 | month = May | year = 2009 | doi = 10.1093/jnci/djp090 | PMID = 19436035 }}</ref> | ||
Revision as of 14:32, 17 May 2012
Lymphovascular invasion, also lymphovascular space invasion, is (non-hematologic) malignant cells within blood vessels and/or lymphatics. It is abbreviated LVI.
The term lymphovascular invasion is preferred to vascular invasion, as it is very difficult to differentiate morphologically small lymphatics and small vascular spaces, without immunohistochemistry.
General
- LVI, in the TNM staging system, does not affect tumour stage; however, there are exceptions.
- Exceptions:
- Seminoma.
- Intrahepatic bile duct carcinoma.
- Hepatocellular carcinoma.[1]
- Exceptions:
- Absence of LVI in the context of proven lymph node metastasis = sampling error.[2]
- The prognostic significance of LVI, generally, is dependent on the tumour type and may depend on the tumour stage and lymph node status.
- Most generally -- LVI = poorer prognosis.[3]
Specific tumours and LVI
- Urothelial carcinoma: LVI is an independent predictor of a poor prognosis that has more predictive power than tumour stage.[4]
- Breast cancer: not an independent risk factor.[5]
- Colorectal carcinoma: independent predictor of poorer prognosis.[6]
Microscopic
Rosen criteria for LVI (in the breast):[7][8]
- Must be outside of the tumour proper.
- LVI is usually very close -- typically within 0.1 cm.
- Contour of cells should differ from possible vessel wall.
- DCIS with retraction artifact mimicing LVI has a contour that matches its surrounding fibrous tissue.
- Endothelium (usu. flat) should be visible.
- Lymphatics are found adjacent to blood vessels - vessels should be present in the vicinity.
Memory device LUBE-O:
- LVI has a Unique contour, Blood vessels and Endothelium in the vicinity, and is Outside of the tumour.
Notes:
- Criteria for LVI vary by the site/tumour.
- In some sites, the first criterium (tumour cells outside of the tumour proper) isn't required.
Stains
- Movat stain - especially useful in colorectal carcinoma so one can readily identify blood vessels.[9]
IHC
Vascular markers:
- CD31.
- CD34.
Markers with high specific to lymphatic spaces:
- D2-40.
See also
References
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf. Accessed on: 6 April 2012.
- ↑ Han, JS.; Molberg, KH.; Sarode, V.. "Predictors of invasion and axillary lymph node metastasis in patients with a core biopsy diagnosis of ductal carcinoma in situ: an analysis of 255 cases.". Breast J 17 (3): 223-9. doi:10.1111/j.1524-4741.2011.01069.x. PMID 21545433.
- ↑ Moreira, LF.; Kenmotsu, M.; Gochi, A.; Tanaka, N.; Orita, K. (1999). "Lymphovascular and neural invasion in low-lying rectal carcinoma.". Cancer Detect Prev 23 (2): 123-8. PMID 10101593.
- ↑ Cheng, L.; Montironi, R.; Davidson, DD.; Lopez-Beltran, A. (Jun 2009). "Staging and reporting of urothelial carcinoma of the urinary bladder.". Mod Pathol 22 Suppl 2: S70-95. doi:10.1038/modpathol.2009.1. PMID 19494855.
- ↑ Ejlertsen, B.; Jensen, MB.; Rank, F.; Rasmussen, BB.; Christiansen, P.; Kroman, N.; Kvistgaard, ME.; Overgaard, M. et al. (May 2009). "Population-based study of peritumoral lymphovascular invasion and outcome among patients with operable breast cancer.". J Natl Cancer Inst 101 (10): 729-35. doi:10.1093/jnci/djp090. PMID 19436035.
- ↑ Lim, SB.; Yu, CS.; Jang, SJ.; Kim, TW.; Kim, JH.; Kim, JC. (Apr 2010). "Prognostic significance of lymphovascular invasion in sporadic colorectal cancer.". Dis Colon Rectum 53 (4): 377-84. doi:10.1007/DCR.0b013e3181cf8ae5. PMID 20305435.
- ↑ Rosen, PP. (1983). "Tumor emboli in intramammary lymphatics in breast carcinoma: pathologic criteria for diagnosis and clinical significance.". Pathol Annu 18 Pt 2: 215-32. PMID 6674861.
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf. Accessed on: 5 August 2011.
- ↑ Howlett, CJ.; Tweedie, EJ.; Driman, DK. (Nov 2009). "Use of an elastic stain to show venous invasion in colorectal carcinoma: a simple technique for detection of an important prognostic factor.". J Clin Pathol 62 (11): 1021-5. doi:10.1136/jcp.2009.065615. PMID 19861561.