title: Lymphangiosis carcinomatosa in squamous cell carcinomas of larynx and hypopharynx--value of conventional evaluation and additional immunohistochemical staining of D2-40.
abstract: BACKGROUND
  Recent studies revealed a predictive value of lymphatic vessel invasion (L1) for the nodal metastasizing and poor prognosis in malignant tumors at different sites. The monoclonal antibody D2-40 (podoplanin) stains specifically endothelial cells of lymphatic vessels and improves the search for L1. However, the importance of this immunohistochemical staining was not investigated in squamous cell carcinomas (SCC) of larynx and hypopharynx.
  
  
  OBJECTIVE
  This study was performed to compare the diagnostic potential of conventional and immunohistochemical determination of L1 in SCC of larynx and hypopharynx with special respect to the predictive value for nodal metastasizing and prognosis.
  
  
  METHODS
  119 SCCs of the larynx (n = 70) respectively hypopharynx (n = 49) were investigated. The lymphatic vessel invasion was assessed by conventional method (HE stain) and immunohistochemical staining with an antibody against D2-40 (DAKO, Germany). Immunohistochemistry was performed in accordance with manufacturer's protocol. L1 was searched microscopically in a standardized magnification (x200) in serial sections of tumor samples (1 section per cm tumor diameter).
  
  
  RESULTS
  The immunohistochemical investigation did not show significant advantages for the prediction of regional nodal metastases. Despite a low sensitivity (< 50%) in both methods, the specificity can reach 80%. The negative predictive value in both methods seems acceptable (up to 80%), whereas the positive predictive value is not higher than 64%. Cases with L1 detected either conventionally or immunohistochemically did not show a significant shorter survival than cases with L0. However, a non-significant shorter survival was found. Only in SCC of hypopharynx, a combination of both methods revealed patients with a significant worse prognosis.
  
  
  CONCLUSIONS
  The status of lymphatic vessel invasion should be documented in standardized tumor reports. A benefit of an additional immunohistochemical investigation was not found, for the daily routine HE-stain seems sufficient.
authors.affiliation: Institute of Pathology, University of Würzburg, Germany. ullrich.voelker@mail.uni-wuerzburg.de
authors.forename: Hans-Ullrich
authors.initials: HU
authors.lastname: Völker
authors.forename: Matthias
authors.initials: M
authors.lastname: Scheich
authors.forename: Isabell
authors.initials: I
authors.lastname: Nowack
authors.forename: Alexandra
authors.initials: A
authors.lastname: Metzger
authors.forename: Imme
authors.initials: I
authors.lastname: Haubitz
authors.forename: Bernhard
authors.initials: B
authors.lastname: Puppe
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hagen
authors.forename: Hans-Konrad
authors.initials: HK
authors.lastname: Müller-Hermelink
authors.forename: Christiane
authors.initials: C
authors.lastname: Völter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D005858:Germany; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism; D007124:Immunoenzyme Techniques; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism; D042583:Lymphangiogenesis / Q000276:immunology*; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D008297:Male; D011379:Prognosis
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40