Difference between revisions of "Lymphovascular invasion"

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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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===Specific 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==

Latest revision as of 15:58, 5 March 2020

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.

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

Specific tumours and LVI

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;[5] appears to be less important in upper urinary tract disease[6]
Breast cancer not an independent predictor[7]
Colorectal carcinoma independent predictor of poorer prognosis (sporadic cancers)[8] may be used as a quality measure; 25% of cases should have vascular invasion[9]

Microscopic

Rosen criteria for LVI (in the breast):[10][11]

  1. Must be outside of the tumour proper.
    • LVI is usually very close -- typically within 0.1 cm.
  2. Contour of cells should differ from possible vessel wall.
    • DCIS with retraction artifact mimicing LVI has a contour that matches its surrounding fibrous tissue.
  3. Endothelium (usu. flat) should be visible.
  4. 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.

Images

  • Small focus of LVI in a merkel cell carcinoma. (WC/Nephron)

  • LVI - low mag. (WC/Nephron)

  • LVI - intermed. mag. (WC/Nephron)

  • CRC with LVI - very low mag. (WC/Nephron)

  • CRC with LVI - low mag. (WC/Nephron)

  • CRC with LVI - intermed. mag. (WC/Nephron)

  • CRC with LVI - high mag. (WC/Nephron)

  • CRC with LVI - very high mag. (WC/Nephron)

Stains

Images

  • CRC with LVI - elastin - very low mag. (WC/Nephron)

  • CRC with LVI - elastin - low mag. (WC/Nephron)

  • CRC with LVI - elastin - intermed. mag. (WC/Nephron)

  • CRC with LVI - elastin - high mag. (WC/Nephron)

  • CRC with LVI - elastin - very high mag. (WC/Nephron)

IHC

Vascular markers:

  • CD31.
  • CD34.

Markers with high specific to lymphatic spaces:

See also

References

  1. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/IntrahepBileDucts_12protocol_3101.pdf. Accessed on: 23 May 2013.
  2. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf. Accessed on: 6 April 2012.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Kim, HS.; Kim, M.; Jeong, CW.; Kwak, C.; Kim, HH.; Ku, JH. (Jun 2014). "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.". Urol Oncol. doi:10.1016/j.urolonc.2014.05.008. PMID 24954108.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Messenger, DE.; Driman, DK.; Riddell, R.; McLeod, R.; Kirsch, R. (2012). [http://www.allegrahamilton.com/publications/ajp/cjp/p4_2/ "Is Venous Invasion in Colorectal Cancer an Under-Reported Finding among Canadian Pathologists? Results of a Population-Based Survey of Ontario Pathologists."]. Can J Pathol 2 (4): 46-9. http://www.allegrahamilton.com/publications/ajp/cjp/p4_2/.
  10. ↑ 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.
  11. ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf. Accessed on: 5 August 2011.
  12. ↑ 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.
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