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Lymphovascular invasion (view source)

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[[Image:Laryngeal squamous carcinoma - LVI -- very high mag.jpg|thumb|right|Lymphovascular invasion in a case of [[laryngeal cancer]]. [[H&E stain]].]]
'''Lymphovascular invasion''', also '''lymphovascular space invasion''', is (non-hematologic) malignant cells within [[blood vessels]] and/or lymphatics.  It is abbreviated '''LVI'''.
'''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]].
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==
==General==
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**Exceptions:
**Exceptions:
***[[Seminoma]].
***[[Seminoma]].
***Intrahepatic bile duct carcinoma.
***[[Squamous cell carcinoma of the penis]].
***Intrahepatic bile duct carcinoma ([[cholangiocarcinoma]]).<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/IntrahepBileDucts_12protocol_3101.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/IntrahepBileDucts_12protocol_3101.pdf]. Accessed on: 23 May 2013.</ref>
***[[Hepatocellular carcinoma]].<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf]. Accessed on: 6 April 2012.</ref>
***[[Hepatocellular carcinoma]].<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf]. Accessed on: 6 April 2012.</ref>
*Absence of LVI in the context of proven [[lymph node metastasis]] = sampling error.<ref name=pmid21545433>{{Cite journal  | last1 = Han | first1 = JS. | last2 = Molberg | first2 = KH. | last3 = Sarode | first3 = V. | title = 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. | journal = Breast J | volume = 17 | issue = 3 | pages = 223-9 | month =  | year =  | doi = 10.1111/j.1524-4741.2011.01069.x | PMID = 21545433 }}</ref>
*Absence of LVI in the context of proven [[lymph node metastasis]] = sampling error.<ref name=pmid21545433>{{Cite journal  | last1 = Han | first1 = JS. | last2 = Molberg | first2 = KH. | last3 = Sarode | first3 = V. | title = 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. | journal = Breast J | volume = 17 | issue = 3 | pages = 223-9 | month =  | year =  | doi = 10.1111/j.1524-4741.2011.01069.x | PMID = 21545433 }}</ref>
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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>


===Tumours and LVI===
===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>
 
*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>
{| class="wikitable sortable"
*[[Colorectal carcinoma]]: independent predictor of poorer prognosis.<ref name=pmid20305435>{{Cite journal  | last1 = Lim | first1 = SB. | last2 = Yu | first2 = CS. | last3 = Jang | first3 = SJ. | last4 = Kim | first4 = TW. | last5 = Kim | first5 = JH. | last6 = Kim | first6 = JC. | title = Prognostic significance of lymphovascular invasion in sporadic colorectal cancer. | journal = Dis Colon Rectum | volume = 53 | issue = 4 | pages = 377-84 | month = Apr | year = 2010 | doi = 10.1007/DCR.0b013e3181cf8ae5 | PMID = 20305435 }}</ref>
!Tumour
!Prognosis
!Comment
|-
| [[Urothelial carcinoma]]
| independent predictor of a poor prognosis in bladder tumours
| LVI has more predictive power than [[tumour stage]] in the [[urinary bladder]];<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> appears to be less important in upper urinary tract disease<ref name=pmid24954108>{{Cite journal  | last1 = Kim | first1 = HS. | last2 = Kim | first2 = M. | last3 = Jeong | first3 = CW. | last4 = Kwak | first4 = C. | last5 = Kim | first5 = HH. | last6 = Ku | first6 = JH. | title = Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: A systematic review and meta-analysis. | journal = Urol Oncol | volume =  | issue =  | pages =  | month = Jun | year = 2014 | doi = 10.1016/j.urolonc.2014.05.008 | PMID = 24954108 }}</ref>  
|-
| [[Breast cancer]]
| not an independent predictor<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>
|
|-
| [[Colorectal carcinoma]]
| independent predictor of poorer prognosis (sporadic cancers)<ref name=pmid20305435>{{Cite journal  | last1 = Lim | first1 = SB. | last2 = Yu | first2 = CS. | last3 = Jang | first3 = SJ. | last4 = Kim | first4 = TW. | last5 = Kim | first5 = JH. | last6 = Kim | first6 = JC. | title = Prognostic significance of lymphovascular invasion in sporadic colorectal cancer. | journal = Dis Colon Rectum | volume = 53 | issue = 4 | pages = 377-84 | month = Apr | year = 2010 | doi = 10.1007/DCR.0b013e3181cf8ae5 | PMID = 20305435 }}</ref>
| may be used as a [[quality]] measure; 25% of cases should have vascular invasion<ref>{{Cite journal  | last1 = Messenger | first1 = DE. | last2 = Driman | first2 = DK. | last3 = Riddell | first3 = R. | last4 = McLeod | first4 = R. | last5 = Kirsch | first5 = R. | title = Is Venous Invasion in Colorectal Cancer an Under-Reported Finding
among Canadian Pathologists? Results of a Population-Based Survey
of Ontario Pathologists. | journal = Can J Pathol | volume = 2 | issue = 4 | pages = 46-9 | month = | year = 2012 | doi = | PMID = | url = http://www.allegrahamilton.com/publications/ajp/cjp/p4_2/ }} </ref>
|-
|}


==Microscopic==
==Microscopic==
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*Criteria for LVI vary by the site/tumour.
*Criteria for LVI vary by the site/tumour.
**In some sites, the first criterium (tumour cells outside of the tumour proper) isn't required.
**In some sites, the first criterium (tumour cells outside of the tumour proper) isn't required.
===Images===
<gallery>
Image:Merkel_cell_carcinoma_-_high_mag.jpg | Small focus of LVI in a [[merkel cell carcinoma]]. (WC/Nephron)
Image: Seminoma LVI -- low mag.jpg | [[LVI]] - low mag. (WC/Nephron)
Image: Seminoma LVI -- intermed mag.jpg | LVI - intermed. mag. (WC/Nephron)
</gallery>
<gallery>
Image: CRC with LVI - HE -- very low mag.jpg | [[colorectal carcinoma|CRC]] with LVI - very low mag. (WC/Nephron)
Image: CRC with LVI - HE -- low mag.jpg | CRC with LVI - low mag. (WC/Nephron)
Image: CRC with LVI - HE -- intermed mag.jpg | CRC with LVI - intermed. mag. (WC/Nephron)
Image: CRC with LVI - HE - alt -- high mag.jpg | CRC with LVI - high mag. (WC/Nephron)
Image: CRC with LVI - HE -- very high mag.jpg | CRC with LVI - very high mag. (WC/Nephron)
</gallery>


==Stains==
==Stains==
*[[Movat stain]] - especially useful in [[colorectal carcinoma]] so one can readily identify [[blood vessel]]s.<ref name=pmid19861561>{{Cite journal  | last1 = Howlett | first1 = CJ. | last2 = Tweedie | first2 = EJ. | last3 = Driman | first3 = DK. | title = Use of an elastic stain to show venous invasion in colorectal carcinoma: a simple technique for detection of an important prognostic factor. | journal = J Clin Pathol | volume = 62 | issue = 11 | pages = 1021-5 | month = Nov | year = 2009 | doi = 10.1136/jcp.2009.065615 | PMID = 19861561 }}</ref>
*[[Movat stain]] - especially useful in [[colorectal carcinoma]] so one can readily identify [[blood vessel]]s.<ref name=pmid19861561>{{Cite journal  | last1 = Howlett | first1 = CJ. | last2 = Tweedie | first2 = EJ. | last3 = Driman | first3 = DK. | title = Use of an elastic stain to show venous invasion in colorectal carcinoma: a simple technique for detection of an important prognostic factor. | journal = J Clin Pathol | volume = 62 | issue = 11 | pages = 1021-5 | month = Nov | year = 2009 | doi = 10.1136/jcp.2009.065615 | PMID = 19861561 }}</ref>
*Elastin stain.
===Images===
<gallery>
Image: CRC with LVI - elastin -- very low mag.jpg | [[colorectal carcinoma|CRC]] with LVI - elastin - very low mag. (WC/Nephron)
Image: CRC with LVI - elastin -- low mag.jpg | CRC with LVI - elastin - low mag. (WC/Nephron)
Image: CRC with LVI - elastin -- intermed mag.jpg | CRC with LVI - elastin - intermed. mag. (WC/Nephron)
Image: CRC with LVI - elastin - alt -- high mag.jpg | CRC with LVI - elastin - high mag. (WC/Nephron)
Image: CRC with LVI - elastin -- very high mag.jpg | CRC with LVI - elastin - very high mag. (WC/Nephron)
</gallery>


==IHC==
==IHC==
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Markers with high specific to lymphatic spaces:
Markers with high specific to lymphatic spaces:
*D2-40.
*[[D2-40]].


==See also==
==See also==
*[[Cancer]].
*[[Cancer]].
*[[Intravascular lymphoma]].
*[[Intravascular lymphoma]].
*[[Perineural invasion]].
*[[Angioinvasion]].
*[[MELF]].


==References==
==References==
Michael
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