Lymphangiogenesis and Its Correlation with the VEGF Expression and the Sentinel Lymph Node in Cutaneous Melanomas

Petr Buzrla,Oldrich Motyka,Jana Dvorackova

doi:10.1155/2014/372979

Abstract

The aim of the study is to evaluate the density of intratumoral and peritumoral lymphatic vessels in primary cutaneous melanomas and to assess their correlation with the status of sentinel lymph nodes and the VEGF expression in tumor cells and stromal cells. A total of 40 patients were enrolled in the study: the melanomas were radically excised with the extirpation of the sentinel lymph node. The study subjects were divided into two groups: 20 cases with positive and 20 cases with negative sentinel lymph node results. The density of lymphatic vessels was evaluated by the antibody D2-40 and the VEGF expression was investigated in the semiquantitative way. The VEGF expression in melanoma cells and the stromal cells was negative to variable positive at both SLN negative and SLN positive patients in all pT stages. In the group of SLN positive patients, the density of intratumoral lymphatic vessels was low up to moderate, while it was observed to be absent, somewhere on the low level in the group of SLN negative patients. On the other side, the density of peritumoral lymphatic vessels was equally numerous at both SLN negative and SLN positive patients. The lymphatic invasion was found out at 4 SLN positive patients only. The ulceration was chiefly in the group of LN positive patients. The results show that the density of lymphangiogenesis and the intensity of the VEGF expression are considered to be an unreliable predictor of melanoma metastasis to the sentinel lymph node, but the ulceration and the lymphatic invasion can predict the potential for metastasis.

Highlights

Cutaneous melanoma is the most aggressive and malignant tumor of the skin
We observed a very weak expression of the VEGF in the melanoma cells (Figure 1), in contrast to the stromal cells, which were stained for VEGF very strongly (Figure 2)
We found out that the melanoma cells were negative, rarely weakly up to moderately positive in all pT stages in both groups of patients, sentinel lymph node results (SLN) positive and SLN negative, while the VEGF expression by stroma cells was mostly negative and weakly positive in patients with positive SLN

Summary

Introduction

Cutaneous melanoma is the most aggressive and malignant tumor of the skin. It is considered to be an epidemic malignant disease, as its worldwide incidence increased by 697 per cent between 1950 and 2000. The cutaneous melanoma occurs in all age groups, predominantly among the middle-aged. Both sexes are affected approximately but, in Central Europe, the occurrence is higher in women. The incidence of cutaneous melanomas keeps rising up worldwide. The incidence of new cases of cutaneous melanomas rises by 2.4 per cent every year. The standard therapy primarily includes a surgical excision of the affected skin, followed by the extirpation of the sentinel lymph node. In the advanced stages of the disease with metastases, an adjuvant therapy is often indicated, including immunotherapy with interferon-α, radiotherapy, chemotherapy, and targeted therapy

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