Moy Andrea P, Mochel Mark C, Muzikansky Alona, Duncan Lyn M, Kraft Stefan
Pathology Service, Massachusetts General Hospital, Boston, Massachusetts.
Department of Pathology, Virginia Commonwealth University, Richmond, Virginia.
J Cutan Pathol. 2017 Sep;44(9):734-739. doi: 10.1111/cup.12969. Epub 2017 Jun 19.
Sentinel lymph node (SLN) metastasis is a powerful predictor of survival in primary cutaneous melanoma. Lymphatic invasion (LI) may correlate with increased risk of SLN metastasis. Intralymphatic metastases, often difficult to detect on hematoxylin and eosin (H&E) stained sections, are readily identified with dual immunohistochemistry for melanocytic and lymphatic markers.
We used dual S100/D240 immunohistochemistry to detect LI in 125 melanomas from patients who underwent SLN biopsy and correlated LI with melanoma staging parameters and disease status.
Dual immunohistochemistry allowed for the identification of LI in 33 cases (26%), compared to only 2% on H&E stained sections. Melanomas with LI showed greater thickness, higher mitotic rate and more frequent ulceration. Eleven of 33 cases with LI (33%) and 10 of 92 cases without LI (11%) were associated with a positive SLN (P = .006). More patients without LI were disease-free at last follow-up (80%) than patients with LI (50%; P = .002); LI was significantly associated with decreased progression-free survival.
The detection of LI is improved by dual immunohistochemistry and predicts SLN metastasis. The presence of LI may impact therapeutic planning in melanoma, such as the decision to perform a SLN biopsy.
前哨淋巴结（SLN）转移是原发性皮肤黑色素瘤生存的有力预测指标。淋巴管侵犯（LI）可能与SLN转移风险增加相关。淋巴管内转移在苏木精-伊红（H&E）染色切片上常难以检测到，而通过黑色素细胞和淋巴管标志物的双重免疫组化则可轻易识别。
我们使用双重S100/D240免疫组化检测了125例接受SLN活检患者的黑色素瘤中的LI，并将LI与黑色素瘤分期参数和疾病状态相关联。
双重免疫组化在33例（26%）中检测到LI，而在H&E染色切片上仅为2%。有LI的黑色素瘤显示出更大的厚度、更高的有丝分裂率和更频繁的溃疡。33例有LI的病例中有11例（33%）和92例无LI的病例中有10例（11%）与SLN阳性相关（P = 0.006）。在最后一次随访时，无LI的患者中无病生存的比例（80%）高于有LI的患者（50%；P = 0.002）；LI与无进展生存期缩短显著相关。
双重免疫组化可提高LI的检测率并预测SLN转移。LI的存在可能会影响黑色素瘤的治疗规划，例如决定是否进行SLN活检。
