Lymphangiosis carcinomatosa in squamous cell carcinomas of larynx and hypopharynx--value of conventional evaluation and additional immunohistochemical staining of D2-40.
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.
Völker
Hans-Ullrich
HU
Institute of Pathology, University of Würzburg, Germany. ullrich.voelker@mail.uni-wuerzburg.de
Scheich
Matthias
M
Nowack
Isabell
I
Metzger
Alexandra
A
Haubitz
Imme
I
Puppe
Bernhard
B
Hagen
Rudolf
R
Müller-Hermelink
Hans-Konrad
HK
Völter
Christiane
C
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
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40