title: Altered pigment epithelium-derived factor and vascular endothelial growth factor levels in lymphangioma pathogenesis and clinical recurrence.
abstract: OBJECTIVE
  To determine the role of angiogenesis in the clinical behavior and pathogenesis of lymphangioma tumors.
  
  
  METHODS
  A retrospective study. Median follow-up period was 44.5 months.
  
  
  METHODS
  Children's Memorial Hospital, Chicago, Ill.
  
  
  METHODS
  Tumor specimens from 12 pediatric patients who underwent surgical excision of cervicofacial lymphangioma were examined for expression of angiogenic inducer vascular endothelial growth factor (VEGF) and angiogenic inhibitor pigment epithelium-derived factor (PEDF) using immunohistochemical analysis. Specimens were divided into recurrent and nonrecurrent tumors based on clinical information.
  
  
  METHODS
  Staining patterns of VEGF and PEDF were evaluated in lymphangioma specimens. Staining patterns were then compared in both recurrent and nonrecurrent groups and graded in a blinded fashion. Histological evidence of increased angiogenesis including microvascular density, stromal fibrosis, and inflammation were graded in each group and correlated with recurrence.
  
  
  RESULTS
  Lymphangioma specimens demonstrated histological evidence of increased angiogenic activity including multiple areas of increased VEGF staining combined with little PEDF staining. Sex, age at onset, or tumor location did not correlate with recurrence. Furthermore, recurrent specimens had increased histological evidence of angiogenesis as well as increased VEGF and decreased PEDF activity compared with nonrecurrent lesions.
  
  
  CONCLUSIONS
  Lymphangiomas exhibit tumorlike pathogenesis owing to the high expression of angiogenic inducers compared with the low expression of inhibitors. Recurrence may be influenced by this imbalance of angiogenic mediators. Further research with antiangiogenic therapy using agents such as PEDF analogues or anti-VEGF receptor antibodies is indicated because they may stabilize or suppress the growth of these neoplasms.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Sidle
authors.forename: John
authors.initials: J
authors.lastname: Maddalozzo
authors.forename: Jason D
authors.initials: JD
authors.lastname: Meier
authors.forename: Mona
authors.initials: M
authors.lastname: Cornwell
authors.forename: Veronica
authors.initials: V
authors.lastname: Stellmach
authors.forename: Susan E
authors.initials: SE
authors.lastname: Crawford
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005136:Eye Proteins / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000209:etiology* / Q000378:metabolism*; D006801:Humans; D007087:Illinois; D007150:Immunohistochemistry; D007223:Infant; D007229:Infant Welfare; D008202:Lymphangioma / Q000209:etiology* / Q000378:metabolism*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000378:metabolism*; D009414:Nerve Growth Factors / Q000378:metabolism*; D011480:Protease Inhibitors / Q000378:metabolism*; D012189:Retrospective Studies; D015843:Serpins / Q000378:metabolism*; D013223:Statistics as Topic; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*; D000099174:Pigment Epithelium-Derived Factor
chemical_list: D014408:Biomarkers, Tumor; D005136:Eye Proteins; D009414:Nerve Growth Factors; D011480:Protease Inhibitors; D015843:Serpins; D042461:Vascular Endothelial Growth Factor A; D000099174:Pigment Epithelium-Derived Factor