Abstract
BackgroundLymphatic vessels are major routes for metastasis in head and neck squamous cell carcinoma (HNSCC), but lymphatic endothelial cells (LECs) are difficult to recognize in tumor histological sections. D2-40 stains podoplanin, a molecule expressed in LECs, however, the potential prognostic usefulness of this molecule is not completely understood in HNSCC. We aimed to investigate the value of assessing peritumoral and intratumoral lymphatic vessel density (LVD) as prognostic marker for HNSCC.MethodsThirty-one cases of HNSCC were stained for D2-40 and CD31. LVD and blood vessel density (BVD) were assessed by counting positive reactions in 10 hotspot areas at ×200 magnification.ResultsD2-40 was specific for lymphatic vessels and did not stain blood vascular endothelial cells. LECs showed more tortuous and disorganized structure in intratumoral lymphatic vessels than in peritumoral ones. No statistical differences were observed between peritumoral-LVD and intratumoral-LVD or between peritumoral-BVD and intratumoral-BVD. Tumor D2-40 staining was positively associated with lymphatic vessel invasion (p = 0.011).ConclusionLVD is a powerful marker for HNSCC prognosis. We found significant differences in peritumoral and intratumoral D2-40 immunoreactivity, which could have important implications in future therapeutic strategies and outcome evaluation.
Highlights
Lymphatic vessels are major routes for metastasis in head and neck squamous cell carcinoma (HNSCC), but lymphatic endothelial cells (LECs) are difficult to recognize in tumor histological sections
Metastatic spread to regional lymph nodes through the lymphatic system is one of the major pathways by which head and neck squamous cell carcinoma (HNSCC) disseminates
The aim of this study was to investigate the role of lymphatic vascular density (LVD) in a series of HNSCC and evaluate whether intra or peritumoral lymphatic vessel density (LVD) correlated with the presence of lymph node invasion and distant metastasis, and with patients clinical outcome
Summary
Lymphatic vessels are major routes for metastasis in head and neck squamous cell carcinoma (HNSCC), but lymphatic endothelial cells (LECs) are difficult to recognize in tumor histological sections. D2-40 stains podoplanin, a molecule expressed in LECs, the potential prognostic usefulness of this molecule is not completely understood in HNSCC. Metastatic spread to regional lymph nodes through the lymphatic system is one of the major pathways by which head and neck squamous cell carcinoma (HNSCC) disseminates. The mechanisms that tumors use to metastasize are well documented concerning the hematogenous spread, but lymphatic spread is not so well understood. There is no consensus whether the major pathway of lymphatic spread is through the development of lymphatic vessels intra or peritumorally, with studies published supporting each of the possibilities [2,3]
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