title: Identification of lymphatics within the colonic lamina propria in inflammation and neoplasia using the monoclonal antibody D2-40.
abstract: BACKGROUND
  Lymphatic vessels are believed to be absent in the colon above the level of the mucularis mucosae. However, in our experience, lymphatic vessels are sometimes identifiable within the lamina propria in the setting of inflammation and neoplasia.
  
  
  OBJECTIVE
  We sought to assess the presence of lymphatics within the colonic lamina propria in neoplastic and inflammatory conditions using the lymphatic endothelium-specific immunohistochemical marker D2-40.
  
  
  METHODS
  Representative sections of normal colon, inflamed colon, hyperplastic polyps, inflammatory polyps, adenomatous polyps, adenomatous polyps containing intramucosal carcinoma, and invasive colonic adenocarcinomas were subjected to immunohistochemical staining with D2-40. The presence of immunopositive lymphatic vessels was assessed. Lymphatic density within the lamina propria was calculated quantitatively, and the presence of inflammation was graded subjectively on a four-tiered scale (0-3).
  
  
  RESULTS
  Lymphatics were not identified within the lamina propria of normal colon. However, lymphatics were identified within the lamina propria in the majority of cases with neoplasia and/or inflammation. Additionally, there was a non-significant trend toward higher lymphatic vessel density in cases with increasing inflammation.
  
  
  CONCLUSIONS
  Lymphatic vessels are present within the lamina propria of colon in pathologic states, including cases of intramucosal carcinoma. This "aberrant" lymphangiogenesis is likely to be driven by inflammation and/or neoplasia.
authors.affiliation: Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA. barton.kenney@yale.edu
authors.forename: Barton C
authors.initials: BC
authors.lastname: Kenney
authors.forename: Dhanpat
authors.initials: D
authors.lastname: Jain
mesh_terms: D000911:Antibodies, Monoclonal / Q000032:analysis*; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis*; D003092:Colitis / Q000473:pathology*; D003110:Colonic Neoplasms / Q000737:chemistry* / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000737:chemistry / Q000473:pathology*; D009092:Mucous Membrane / Q000737:chemistry / Q000473:pathology*
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D014408:Biomarkers, Tumor; C500987:monoclonal antibody D2-40