Presence Of Lymphatic Vascular Invasion Research Articles

Retrospective study on the profile of patients undergoing intraoperative radiotherapy with INTRABEAM for breast cancer treatment at a Brazilian cancer center.

e12538 Background: Conservative breast therapy combined with adjuvant radiotherapy has been the preferred treatment for early-stage breast cancer for many decades. Considering that most breast cancer recurrences occur near the original tumor site, partial breast radiotherapy has become an alternative for patients in this scenario, allowing for a single-dose radiation application directly to the tumor site. This technique has advantages such as reducing local toxicity and improving the quality of life for treated patients, in addition to decreasing the waiting time for radiotherapy treatment in developing countries like ours. Our case series is the largest in Latin America to date, and we believe that reporting the results of our experience will be valuable for the scientific community and aid in treatment decision-making in low- and middle-income countries. Methods: This is a retrospective study based on data from the medical records of 209 patients with early-stage breast cancer undergoing conservative surgery and intraoperative radiotherapy at A.C. Camargo Cancer Center (São Paulo, Brazil) from 2016 to 2023. Results: In our cohort, 88.5% of tumors were invasive ductal carcinomas. The majority were T1b (41.8%), had histological grade 2 (45.4%), nuclear grade 2 (62.7%), and showed no axillary involvement (87.6%). All patients received intraoperative radiotherapy in a single dose of 20 Gy radiation at the tumor site with a voltage of 50 kV. In our study, 17.7% of patients required additional external radiotherapy due to postoperative histopathological findings inconsistent with treatment indication criteria, including 35.3% for micrometastasis and 32.4% for nodal macrometastasis, 10.8% for narrow or compromised margins, 10.8% for histological types not covered in the final report, 2.7% for multifocality, 2.7% for extensive ductal carcinoma in situ, 2.7% for negative progesterone receptor, and 2.7% for the presence of lymphatic vascular invasion. The average follow-up time for patients was 36 months. The local recurrence rate was 0.5%. Conclusions: The results of this study support established data indicating the efficacy of intraoperative radiotherapy in early-stage breast cancer treatment. Therefore, for carefully selected patients, this technique with should be considered as a treatment option. We will continue to follow this patient cohort to identify the occurrence of late recurrences and publish long-term follow-up data.

104P - Prognostic significance of tumour location to the oncologic outcome of colon cancer

BackgroundA growing amount of data has indicated the possibility that tumor location may play a prognostic role in colon cancer. The present study set out to investigate the relation between the location of colon cancer (right side vs. left side) and the patient’s oncologic outcome. MethodsThis retrospective chart review studied 654 colon cancer patients who had been treated and followed up on at three tertiary hospitals between 2010 and 2015. To determine the most important independent factors of oncologic outcomes, the Cox regression multivariate analysis model used to analyze the prognostic impact of the primary tumor location and other clinical-, pathologic-, and treatment-related factors. ResultsIn the univariate analysis, the prognostic factors for disease-free survival (DFS) were the primary tumor stage (< 0.001), node stage (<0.001), tumor grade (P = 0.013), surgical margin status (P = 0.001), lymphatic vascular invasion (LVI) (<0.001), and perineural invasion (PNI) (<0.001). Additionally, the prognostic factors for disease-free survival (OS) were the primary tumor stage (<0.001), node stage (<0.001), tumor grade (P = 0.036), presence of LVI (<0.001), presence of PNI (<0.001), and the mucinous type (P = 0.042). However, in the multivariate analysis, the presence of LVI, T3-4 lesions, tumor grade II-III, and an advanced disease stage remained independent prognostic factors for DFS as well as OS. However, the colon cancer location was not prognostic factor in terms of DFS or OS. ConclusionsAlthough right-sided colon cancers present more aggressive clinical features, tumor location is not a significant prognostic factor for DFS and OS in colon cancer patients. Legal entity responsible for the studyThe present study was approved by the University Research Ethics Committee and all procedures were performed in accordance with the ethical standards of the National Research Committee and with the Helsinki Declaration. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.

Immunohistochemical WWOX Expression and Association with Angiogenesis, p53 Expression, Cell Proliferation and Clinicopathological Parameters in Cervical Cancer.

The current study evaluated the expression of WW domain-containing oxidoreductase (WWOX), its association with clinicopathological features and with p53, Ki-67 (cell proliferation) and CD31 (angiogenesis) expression in patients with invasive cervical squamous cell carcinoma (ICSCC). To the best of our knowledge, no other study has evaluated this association. Women with IB stage-ICSCC (n = 20) and women with uterine leiomyoma (n = 20) were prospectively evaluated. Patients with ICSCC were submitted to type B-C1 radical hysterectomy and pelvic lymphadenectomy. Patients in the control group underwent vaginal hysterectomy. Tissue samples were stained with hematoxylin and eosin for histological evaluation and protein expression was detected by immunohistochemistry studies. The WWOX expression was significantly lower in the tumor compared with the expression in the benign cervix (p = 0.019). The WWOX expression was inversely associated with the CD31 expression in the tumor samples (p = 0.018). There was no association between the WWOX expression with the p53 expression (p = 0.464) or the Ki-67 expression (p = 0.360) in the samples of invasive carcinoma of the cervix. There was no association between the WWOX expression and tumor size (p = 0.156), grade of differentiation (p = 0.914), presence of lymphatic vascular invasion (p = 0.155), parametrium involvement (p = 0.421) or pelvic lymph node metastasis (p = 0.310) in ICSCC tissue samples. The results suggested that WWOX may be involved in ICSCC carcinogenesis, and this marker was associated with tumor angiogenesis.

Prognostic Significance of Mucinous Histologic Subtype on Oncologic Outcomes in Patients With Colorectal Cancer.

PurposeMucinous adenocarcinomas account for about 10% of all colorectal cancers. This study aimed to investigate the prognostic impact of mucinous histologic subtype on oncologic outcomes in patients with colorectal cancer.MethodsThis retrospective study was performed at two large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of patients with colorectal cancer who were treated and followed up between 2000 and 2013.ResultsTotally, 144 of 1,268 patients with a colorectal adenocarcinoma (11.4%) had mucinous histologic subtype. Statistically significant results found in this research are as follows: Mucinous histologic subtype tended to present in younger patients and to have larger tumor size, higher histologic grade, higher node stage, larger number of positive nodes, and higher rate of perineural invasion compared to nonmucinous histologic subtype. On the univariate analysis, mucinous subtype was a prognostic factor for disease-free and overall survival. On the multivariate analysis, primary tumor location, node stage and lymphatic-vascular invasion were independent prognostic factors for the local control rate. Rectal tumor location, higher disease stage, tumor grade II, and presence of lymphatic-vascular invasion had negative influences on disease-free survival, as did rectal tumor location, higher disease stage and presence of lymphatic-vascular invasion on overall survival.ConclusionMucinous histologic subtype was associated with some adverse pathologic features in patients with colorectal cancer; however, it was not an independent prognostic factor for oncologic outcome.

Adequacy of Lymph Node Staging in Colorectal Cancer: Analysis of 250 Patients and Analytical Literature Review

Background: The extent of lymph node involvement is the most important prognostic factor in resected locoregional colorectal cancer. Currently, examination of at least 12 lymph nodes is recommended for adequate colorectal cancer staging. Objectives: The present study aimed to evaluate the adequacy of lymph node staging in 250 patients with colorectal cancer and analytical literature review. Patients and Methods: Two hundred fifty patients with histologically proven locoregional invasive colorectal adenocarcinoma from 2005 to 2011 were included. All patients were treated by standard surgical resection for their disease. Twenty-three patients with rectal cancer received neoadjuvant treatment. All potential tumor, patient and treatment variables were evaluated for their impact on the average total number of lymph node examined. Results: In this study, 147 men and 103 women with a median age of 54 (range 23-84) years were included. The median total number of lymph nodes examined was 7 (mean 9.35). Sixty-nine patients (27.6%) had adequate (≥ 12) lymph nodes examination, and twenty patients (8%) had no nodes examined. In univariate analysis, younger age, colon primary site, larger tumor size, the presence of lymphatic vascular invasion, the lack of neoadjuvant treatments, individual surgeon B and Hospital B were more associated with the average total number of lymph node examined. Conclusion: This study indicates that only less than a third of patients with colorectal cancer underwent adequate lymph nodes examination. Further investigation using careful pathologic reviewing of specimens with inadequate lymph node examined is suggested for differentiating true inadequate lymph node dissection from inadequate lymph node detection.

919 LYMPHANGIOGENESIS IN NON SEMINOMATOUS TESTICULAR CANCER AND ITS ASSOCIATION TO THE STATUS OF METASTASIS AT DIAGNOSIS

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease III1 Apr 2012919 LYMPHANGIOGENESIS IN NON SEMINOMATOUS TESTICULAR CANCER AND ITS ASSOCIATION TO THE STATUS OF METASTASIS AT DIAGNOSIS Julia Heinzelbecker, Tobias Gropp, Christel Weiß, Katrin Hüttl, Annette Steidler, Axel Haecker, Christian Bolenz, and Lutz Trojan Julia HeinzelbeckerJulia Heinzelbecker Mannheim, Germany More articles by this author , Tobias GroppTobias Gropp Mannheim, Germany More articles by this author , Christel WeißChristel Weiß Mannheim, Germany More articles by this author , Katrin HüttlKatrin Hüttl Mannheim, Germany More articles by this author , Annette SteidlerAnnette Steidler Mannheim, Germany More articles by this author , Axel HaeckerAxel Haecker Mannheim, Germany More articles by this author , Christian BolenzChristian Bolenz Mannheim, Germany More articles by this author , and Lutz TrojanLutz Trojan Mannheim, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the role of lymph vessel density (LVD) and lymphangiogenesis in nonseminomatous testicular germ cell tumors (NSGCT) using the specific lymphatic endothelial cell (LEC) marker LYVE-1. METHODS Paraffin embedded tumor samples from 77 patients (clinical stage 1: n=45; metastatic disease: n=32) were stained with the LEC marker LYVE-1. LVD was assessed in different areas using a standardised method. Proliferating LECs were detected using fluorescence double immunostaining of LYVE-1 and Ki67 in a subgroup of 50 patients. The presence of lymphatic vascular invasion (LVI) was documented. The parameters were correlated with clinico-pathological data. Median follow-up was 46 (range: 3 – 170) months. RESULTS Peritumoral lymph vessels were identified in 57 patients (74.0%; mean LVD: 2.16 (±2.17)), intratumoral lymph vessels in 11 patients (14.3%; mean LVD: 0.16 (± 0.73)) and nontumoral lymph vesssels in 56 patients (81.2%; mean LVD: 3.17 (±3.24)). Higher peritumoral LVD was associated with the presence of metastatic disease at diagnosis (p= 0.0824). In five patients (10%) proliferating lymphatic vessels were present. Four of these patients had metastatic disease at diagnosis. None of these patients relapsed nor died. Altogether four patients relapsed and four patients died one of them due to relapse of the disease. In three of the four patients who died peritumoral lymph vessels were present with a mean LVD of 3.88 (± 2.99). Lymphvascular invasion was found in 24 patients (31.2%). The presence of LVI was significantly associated with metastatic disease at the time of diagnosis (p= 0.0121). LVI was significantly more frequent in tumours with a high peritumoral LVD (p= 0.0005). CONCLUSIONS For the first time we evaluated LVD in NSGCT. Our findings show an association of LVD with metastatic disease at diagnosis. The existence of proliferating lymphatic vessels indicates that lymphangiogenesis may play a role in the dissemination of NSGCT. LVI was associated with metastasis at the time of diagnosis. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e374-e375 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia Heinzelbecker Mannheim, Germany More articles by this author Tobias Gropp Mannheim, Germany More articles by this author Christel Weiß Mannheim, Germany More articles by this author Katrin Hüttl Mannheim, Germany More articles by this author Annette Steidler Mannheim, Germany More articles by this author Axel Haecker Mannheim, Germany More articles by this author Christian Bolenz Mannheim, Germany More articles by this author Lutz Trojan Mannheim, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Safety of Partial Breast Reconstruction in Extended Indications for Conservative Surgery in Breast Cancer

Breast conservation surgery after large volume excisions for women with relatively larger or multicentric operable breast cancer (OBC) and in some locally advanced breast cancers (LABC) post neo-adjuvant chemotherapy (NACT), is known to be a feasible option using a latissimus dorsi flap. However, the oncological safety of such a procedure is not well reported in literature. Two hundred and twenty one women with breast cancer (148-OBC, 73-LABC) underwent BCT plus LD during March 1998 to August 2009. One hundred and forty six women (72-LABC, 66-OBC) received prior NACT for downstaging, followed by completion of adjuvant therapy in all, including postoperative radiotherapy and hormone therapy where indicated. Women aged 20-62years, with tumors 1.5-15cm (median 5.0cm), underwent volume replacement surgery with LD flap. All positive cut margins (total-4.9%, gross positive-1.3%) were re-excised to ensure negative margins. The mean surgical time for excision of primary with axillary clearance followed by volume replacement by LD was 5h and mean hospital stay 6days. Donor site morbidity was seen in 11 patients and 3 had minor recipient site infection. At a median follow up of 36months, ten of 221 patients (4.5%) had failed locally (7-OBC, 3-LABC). The determinants of local recurrence were presence of lymphatic vascular invasion (p = 0.016) and axillary metastasis (p = 0.003). BCT plus LD flap is an oncologically safe, technically quick procedure with minimal morbidity, and should be offered to all eligible women as an extended breast conservation procedure.

Introduction to sessions on 'What can surgeons do for us (and we for them): radiology, pathology, molecular biology and local therapy'

A number of important issues surrounding local control of breast cancer continue to attract debate. In breast conserving surgery, the balance between excising sufficient tissue to achieve a satisfactory cosmetic outcome while also achieving adequate long-term local control remains an issue of contention. Despite the review by Singletary [1] indicating that wider excisions are unlikely to reduce local recurrence rates, there remains considerable conflict among surgeons and radiation oncologists as to what is the optimum width of clear margin after breast conserving surgery. There has been increasing focus on trying to identify those patients who are at significant risk for local recurrence from radiological, pathological and molecular biology perspectives. The radiological issues have focused on the role played by magnetic resonance imaging and its value in identifying mammographically occult disease. There remain some radiologists who advocate its widespread use, but evidence of its value is limited [2]. Work by Tabar and coworkers [3] suggests there is a group of patients with widespread casting type microcalcification on mammograms; they consider this to represent neoductgenesis, and it was a poor prognostic sign in their series. Using all of the information that we are provided with by radiologists and incorporating mammographic patterns of cancer into prognosis remains challenging and is an area of controversy. As well as margins, the pathologist assesses a variety of factors that have been shown to influence local recurrence, including histological grade and the presence of lymphatic vascular invasion. Even with accurate pathology, however, it is difficult to identify those who will develop local recurrence with any precision. For this reason, there has been a move to investigate molecular markers. Gene array profiles have been investigated recently but cannot yet accurately identify those patients at risk for local recurrence. Therefore, the greatest influence on local recurrence after breast conserving surgery is currently the surgeon's ability to reduce the volume of disease within the breast, to a level that can be adequately controlled by radiotherapy. Thus, the art of surgery and the ability of the surgeon to remove diseased tissue while retaining sufficient breast tissue to produce a satisfactory outcome is a major reason why such surgery is best carried out by those with a large volume of clinical experience.

Lymphatic Vascular Invasion in Ovarian Serous Tumors of Low Malignant Potential With Stromal Microinvasion

Stromal microinvasion in ovarian serous tumors of low malignant potential (S-LMP) stratifies patients at long-term risk for disease progression independent of stage and primary ovarian histology. Despite the histologic impression and often-quoted incidence of lymphatic vascular invasion (LVI) in S-LMP with stromal microinvasion, there has been no formal evaluation in a case control series of S-LMP. The presence and extent of (LVI) was assessed in 20 S-LMP with stromal microinvasion and 20 S-LMP case controls without stromal microinvasion and compared with a series of low-grade and high-grade serous carcinomas using D2-40 monoclonal antibody recognizing podoplanin, a novel lymphatic endothelial marker. S-LMP case controls were matched for primary ovarian histology (usual vs. micropapillary), International Federation of Gynecology and Obstetrics (FIGO) stage, and age (best possible match). The patterns of stromal microinvasion included individual eosinophilic cells and cell clusters, cribriform, simple and noncomplex branching papillae, and inverted macropapillae. Immunohistologic staining with D2-40 monoclonal antibody clearly identified intratumoral LVI in 12/20 (60%) S-LMP with stromal microinvasion and 0/20 S-LMP without stromal microinvasion. Although only 4/13 (31%) low-grade serous carcinomas and 7/20 (35%) high-grade serous carcinomas had intratumoral LVI, hilar LVI was more common in the carcinomas (15% low-grade; 69% high-grade). Intratumoral LVI in S-LMP ranged from focal (6 cases) to multifocal (6 cases, maximum of 5 discrete foci) in any 1 section and included isolated single cells, simple papillae, and in 1 case, cribriform glands. Multifocal LVI was identified in 1 study patient who was pregnant. One of the 12 S-LMP patients with LVI had an intra-abdominal recurrence with high-grade disease at 16 months; whereas all other patients with follow-up were free of disease. LVI in ovarian S-LMP was significantly associated with the presence of stromal microinvasion (P<0.0001) and is independent of age, stage, primary ovarian histology, and pattern or extent of microinvasion. The presence of LVI in microinvasive S-LMP corroborates the view that microinvasion represents an early, but very low risk, invasive process that morphologically links S-LMP and low-grade serous carcinoma.

Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger

To assess the need for adjuvant radiotherapy following mastectomy for patients with node-negative breast tumors 5 cm or larger. Between 1981 and 2002, a total of 70 patients with node-negative breast cancer and tumors 5 cm or larger were treated with mastectomy and adjuvant systemic therapies but without radiotherapy at three institutions. We retrospectively assessed rates and risk factors for locoregional failure (LRF), overall survival (OS), and disease-free survival (DFS) in these patients. With a median follow-up of 85 months, the 5-year actuarial LRF rate was 7.6% (95% confidence interval, 3%-16%). LRF was primarily in the chest wall (4/5 local failures), and lymphatic-vascular invasion (LVI) was statistically significantly associated with LRF risk by the log-rank test (p=0.017) and in Cox proportional hazards analysis (p=0.038). The 5-year OS and DFS rates were 83% and 86% respectively. LVI was also significantly associated with OS and DFS in both univariate and multivariate analysis. This series demonstrates a low LRF rate of 7.6% among breast cancer patients with node-negative tumors 5 cm and larger after mastectomy and adjuvant systemic therapy. Our data indicate that further adjuvant radiation therapy to increase local control may not be indicated by tumor size alone in the absence of positive lymph nodes. LVI was significantly associated with LRF in our series, indicating that patients with this risk factor require careful consideration with regard to further local therapy.

Evaluation of endoscopic mucosal resection and nodal micrometastasis in pN0 submucosal gastric cancer

Endoscopic mucosal resection (EMR) is a minimally invasive, standard treatment for intramucosal (early) gastric cancers, but is not standard for submucosal gastric cancers based on existing criteria. We evaluated the possibility of extending EMR as a therapy for submucosal gastric cancers by analyzing nodal micrometastasis through immunohistochemical staining in patients with apparent node-negative submucosal gastric cancer, the patients for whom EMR might be appropriate. We used anti-cytokeratin (AE1/AE3) antibody to immunohistochemically detect nodal micrometastasis that was not identified by routine pathological examination in 162 patients (total, 2048 lymph nodes) with apparent node-negative submucosal gastric cancer. The relationship between the incidence of nodal micrometastasis and clinicopathological factors was analyzed. Micrometastasis was detected in 45 of 2048 nodes (2.2%), representing 31 of 162 patients (19%). A significantly high incidence of nodal micrometastasis was found with submucosal cancers of large size (>2 cm), as well as with tumors that showed lymphatic or venous invasion and deeper submucosal invasion (p<0.0001). Nodal micrometastasis was also recognized in 2 cases of histologically well-differentiated tumors with focal submucosal invasion without venous or lymphatic invasion. Of the 162 patients, only 2 died of recurrent disease regardless of nodal involvement. Based on the present results, risk factors for nodal micrometastasis are tumor size, presence of lymphatic-vascular invasion, and depth of tumor, which are nearly the same as those established in previous pathological studies that used hematoxylin and eosin staining. We conclude that EMR is not recommended for patients with submucosal gastric cancer.

Predictors of axillary lymph node metastases in patients with T1 breast cancer. A multivariate analysis.

In T1 tumors, the reported incidence of lymph node metastases ranges from 21% to 35%. The authors analyzed the pathology parameters of T1 tumors for their association with the likelihood of axillary lymph node metastases. Two hundred sixty-three patients with T1 unilateral invasive breast cancer were studied. All underwent axillary dissection, and the pathologic status of the nodes was known. The parameters of the primary tumor evaluated included size, histologic subtype, nuclear grade, DNA ploidy, S-phase fraction (SPF), hormone receptor status, lymphatic/vascular invasion (LVI), and host reaction. Seventy-two (27%) patients had nodes that were positive for metastasis. Univariate analysis showed that lymph node metastases were associated with tumors larger than 1 cm (P = 0.001), moderate or poorly differentiated nuclear grade (P = 0.005), high SPF (P = 0.041), presence of LVI (P < 0.001) and patients younger than 60 years (P = 0.01). However, independent predictors of lymph node metastasis in the multivariate logistic regression analyses were tumor size and LVI. Twenty-five patients had tumors larger than 1.0 cm and presence of LVI; of these, 17 (68%) had lymph node metastases. Of the 79 patients who had neither of these features, only 7 (9%) had lymph node metastases. The authors conclude that characteristics of the primary tumor can help assess the risk for axillary lymph node metastases. Selected patients who are assessed to be at minimal risk might be spared routine axillary dissection or radiation therapy to the axilla.

Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas

A retrospective study of 53 patients with squamous cell carcinomas of the oral cavity and oropharynx was undertaken to evaluate histopathologic parameters in predicting cervical lymph node metastasis. Biopsy and surgical specimens were examined for degree of differentiation, pattern and depth of stromal invasion, lymphatic-vascular invasion, and lymphoplasmacytic response in relation to metastasis. The incidence of lymph node metastasis in tumors showing grade III type diffuse invasion (71.4%) and with stromal invasion of more than 8 mm in depth (83.3%) was significantly higher than that of tumors with well-demarcated boundaries (44.4% to 5.2%) and superficial invasion (35.3% to 8.3%). Lymph node metastasis also increased in the presence of lymphatic-vascular invasion by tumor cells, whereas the degree of differentiation and lymphoplasmacytic response was not related to metastasis. Thus, the pattern and the depth of stromal invasion and the presence of lymphatic-vascular invasion were important indicators in prediction of cervical lymph node metastasis. Prophylactic neck dissection is advocated when grade III type diffuse invasion, invasion exceeding 8 mm in depth, or grade II type invasion accompanied by a 4 mm to 8 mm depth of invasion is observed in a biopsy specimen.