title: Peritumoral lymphatic vessel density as a prognostic parameter in endometrial carcinoma: an immunohistochemical study.
abstract: BACKGROUND
  Lymphatic invasion and nodal metastasis play a major role in the spread and prognosis of endometrial adenocarcinoma (EC).
  
  
  OBJECTIVE
  In this study, we investigate tumor lymph-angiogenesis, detected by D2-40, as a predictive marker for the risk of lymph node (LN) metastasis and its relation to other prognostic parameters in EC.
  
  
  METHODS
  Fifty-five cases of EC treated with total hysterectomy and pelvic LN dissection were reviewed. All cases were immunostained for D2-40. Positively stained microvessels (MV) were counted in densely lymphovascular foci (hotspots) at X 400 field (0.17 mm2).
  
  
  METHODS
  Statistical analysis was performing using Chi square "X 2" test.
  
  
  RESULTS
  Lymphovascular invasion was detected in 20 / 55 patients by D2-40 and 14 / 55 by routine hematoxylin and eosin (H and E). Peritumoral lymphatic vessel (LV) count was significantly higher than intratumoral LV count (17 + 7 versus 5 + 4 / 0.17 mm 2 , P < 0.01). Peritumoral D2-40 lymphovascular counts correlated significantly with FIGO grade (P < 0.001), lymphovascular invasion (P = 0.001) and LN metastases (P = 0.005). However, it showed non-significant correlation with peritoneal wash positivity (P = 0.830) and stage of the disease (P = 0.341). Intratumoral lymphovascular invasion detected by D2-40 showed significant correlation with LN metastases (P < 0.01).
  
  
  CONCLUSIONS
  Our study shows that assessing LVD with D2-40 in the endometrial carcinoma might be a valuable parameter for predicting patients having an increased risk of developing of metastatic disease. In addition, D2-40 increases the frequency of detection of lymphatic invasion relative to routine H and E stain.
authors.affiliation: Department of Pathology, MRI Alex University, Toronto, ON, Canada.
authors.forename: Hala K
authors.initials: HK
authors.lastname: Maghraby
authors.forename: Ashgan I
authors.initials: AI
authors.lastname: Elsarha
authors.forename: Reda S
authors.initials: RS
authors.lastname: Saad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001699:Biometry; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D042601:Lymphatic Vessels / Q000473:pathology*; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009389:Neovascularization, Pathologic; D011379:Prognosis
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40