Parmar Padam, Marwah Nisha, Parshad Sanjeev, Yadav Taruna, Batra Ashima, Sen Rajeev
1Department of Pathology, PT BDS PGIMS, Rohtak, Haryana 124001 India.
2Department of Surgery, PT BDS PGIMS, Rohtak, Haryana India.
Indian J Otolaryngol Head Neck Surg. 2018 Mar;70(1):102-110. doi: 10.1007/s12070-017-1216-0. Epub 2017 Oct 6.
Various studies have demonstrated that the lymphatic system is the additional route for solid tumor metastasis. Lymph nodes metastasis in Head and neck squamous cell carcinoma (HNSCC) is a major prognostic indicator for disease progression and a guide for therapeutic strategies. We conducted a study to compare intratumoral (IT) and peritumoral (PT) lymphatic vessel density (LVD) in HNSCC using lymphatic marker D2-40 and its correlation with lymph node metastasis, histological grading and other clinicopathological parameters. Fifty specimen of HNSCC with modified radical neck dissection tissue were included in the study group. Tissue from tumor, peritumoral tissue, tumor margin and all the lymph nodes were processed for paraffin wax blocks and histopathological diagnosis. Immunohistochemical profile of lymphatic vessels in intratumoral and peritumoral tissue was assessed by subjecting one section each from the tumor and peritumoral tissue to D2-40 immunostain. To determine LVD, four fields with the highest LVD (hot spots) were identified. The mean values were calculated by taking an average of all the measurements. The comparison of LVD between peritumoral and intratumoral area revealed significantly higher PT-LVD ( = 0.001). No significant association was seen between LVD, IT-LVD and PT-LVD and different age groups, gender, site of tumor, risk factors, size of tumor, tumor inflammation, pushing/infiltrating margin and stage of tumors. Significantly higher LVD, IT-LVD and PT-LVD was seen in association with lymph node metastasis. Both high intratumoral and peritumoral LVD were found significantly associated with the presence of lymph node metastasis, however lymphatic vessels were found to be significantly more numerous and larger in peritumoral areas as compared to intratumoral lymphatics. The specificity of D2-40 as a lymphatic endothelial marker was also confirmed. The results of our study support the possibility of using the determination of tumor lymphangiogenesis to identify patients of HNSCC who are at risk of developing the lymph node metastasis.
多项研究表明，淋巴系统是实体瘤转移的另一条途径。头颈部鳞状细胞癌（HNSCC）中的淋巴结转移是疾病进展的主要预后指标及治疗策略的指导依据。我们开展了一项研究，使用淋巴管标志物D2-40比较HNSCC中瘤内（IT）和瘤周（PT）淋巴管密度（LVD），并研究其与淋巴结转移、组织学分级及其他临床病理参数的相关性。研究组纳入了50例接受改良根治性颈清扫术组织的HNSCC标本。取自肿瘤、瘤周组织、肿瘤边缘及所有淋巴结的组织均制成石蜡块并进行组织病理学诊断。通过对肿瘤和瘤周组织各取一张切片进行D2-40免疫染色，评估瘤内和瘤周组织中淋巴管的免疫组化特征。为确定LVD，识别出四个LVD最高的区域（热点）。通过对所有测量值取平均值来计算均值。瘤周和瘤内区域LVD的比较显示，PT-LVD显著更高（P = 0. 001）。LVD、IT-LVD和PT-LVD与不同年龄组、性别、肿瘤部位、危险因素、肿瘤大小、肿瘤炎症、推挤/浸润边缘及肿瘤分期期期期别之间均未发现显著关联。LVD、IT-LVD和PT-LVD与淋巴结转移显著相关。瘤内和瘤周LVD均与淋巴结转移的存在显著相关，但与瘤内淋巴管相比，瘤周区域的淋巴管数量明显更多且更大。D2-40作为淋巴管内皮标志物的特异性也得到了证实。我们的研究结果支持通过测定肿瘤淋巴管生成来识别有发生淋巴结转移风险的HNSCC患者的可能性。
