Lymphovascular invasion

From Libre Pathology
Jump to navigation Jump to search

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.
  • 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

Microscopic

Rosen criteria for LVI (in the breast):[7][8]

  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. URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Hepatocellular_11protocol.pdf. Accessed on: 6 April 2012.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2009/InvasiveBreast_09protocol.pdf. Accessed on: 5 August 2011.
  9. 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.