Laboratory Medicine Program, Anatomic Pathology, University Health Network, Toronto, Canada.
Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.
Int J Surg Pathol. 2023 Sep;31(6):939-948. doi: 10.1177/10668969221110456. Epub 2022 Jul 11.
Lymphovascular invasion (LVI) is an adverse pathological finding in radical prostatectomy (RP) specimens associated with increased risk of metastatic disease. Its variable incidence may be attributed to underreporting. We characterized the location, quantity, and morphology of LVI foci in RP specimens and assessed the relationship between LVI and cribriform and intraductal carcinoma and metastatic risk. . Two pathologists reviewed retrospectively 54 RP specimens reported as positive for LVI. Ambiguous cases were confirmed by immunostaining for ERG, CD31 and D2-40. . In 4/54 (7.4%), LVI could not be confirmed. Main mimickers of LVI were retraction artifact and dislodged tumor cells. Based on our review, the most important criteria to distinguish LVI from its mimickers were a corrugated lining of vascular spaces, endothelial nuclei bulging into the lumen, and presence of proteinaceous material. The LVI frequency per case ranged from 1 to 109 (median 7.5). In 47/50 (94%) cases with LVI, the associated carcinoma comprised cribriform pattern and/or intraductal carcinoma. The most common morphology of LVI foci was cribriform, occurring in 43/50 specimens, representing 469/843 (56%) of LVI foci. Most LVI foci were intraprostatic and located at the carcinoma-stroma interface. Particularly the risk of bone metastases during follow-up was independently associated with higher frequency of LVI foci ( = .009). . The detailed description of prostatic LVI, and awareness of their predominant location and morphology may help its identification and improve the diagnostic accuracy of LVI in pathology reporting. The clinical impact of LVI quantification in prostate cancer needs validation by further studies.
脉管侵犯（LVI）是根治性前列腺切除术（RP）标本中一种不利的病理发现，与转移性疾病风险增加相关。其发生率的差异可能归因于报告不足。我们对 RP 标本中 LVI 焦点的位置、数量和形态进行了特征描述，并评估了 LVI 与筛状和管内癌以及转移风险之间的关系。两位病理学家回顾性地分析了 54 份报告为 LVI 阳性的 RP 标本。对有疑问的病例，通过免疫组化 ERG、CD31 和 D2-40 进行了确认。在 4/54（7.4%）例中，无法确认 LVI。LVI 的主要模拟物是回缩伪影和脱落的肿瘤细胞。根据我们的回顾，区分 LVI 与其模拟物的最重要标准是血管空间的波纹状衬里、内皮细胞核突入管腔以及存在蛋白质物质。每个病例的 LVI 频率范围为 1 至 109（中位数为 7.5）。在 47/50（94%）有 LVI 的病例中，相关的癌包括筛状模式和/或管内癌。LVI 焦点最常见的形态是筛状，发生在 43/50 例标本中，占 LVI 焦点的 469/843（56%）。大多数 LVI 焦点位于前列腺内，位于癌-基质界面。特别是在随访期间发生骨转移的风险与 LVI 焦点的更高频率独立相关（ = .009）。对前列腺 LVI 的详细描述，以及对其主要位置和形态的认识，可能有助于其识别，并提高病理报告中 LVI 的诊断准确性。LVI 在前列腺癌中的定量的临床影响需要进一步研究的验证。
