Lymphovascular invasion

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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.
  • LVI generally = poorer prognosis.[1]

Microscopic

Rosen criteria for LVI (in the breast):[2][3]

  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.

Stains

IHC

Vascular markers:

  • CD31.
  • CD34.

Markers with high specific to lymphatic spaces:

  • D2-40.

See also

References

  1. 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.
  2. 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.
  3. URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf. Accessed on: 5 August 2011.
  4. 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.