title: Changes in specialized blood vessels in lymph nodes and their role in cancer metastasis.
abstract: BACKGROUND
  High endothelial venules (HEV) have been recognized to play a role in metastasis by its changes seen in the cancer microenvironment of lymph nodes (LN) and solid cancers. Squamous cell carcinoma (SCC) of the tongue is a prevalent tumor of the head and neck region with high propensity for LN metastasis. The extent of LN metastasis is the most reliable adverse prognostic factor. Primary tumors can induce vasculature reorganization within sentinel LN before the arrival of tumor cells and HEV represents these remodelled vessels. This study aims to evaluate the cancer induced vascular changes in regional lymph nodes (LN) of patients by studying the morphological and functional alterations of HEV and its correlation with clinical outcome and pathological features.
  
  
  METHODS
  This study was based on 65 patients with SCC tongue who underwent primary surgical treatment including neck dissection. The patients were categorized into 2 groups based on the presence of malignancy in their cervical lymph nodes. A review of the patients' pathological and clinical data was performed from a prospective database. Immunohistochemical staining of the tissue blocks for HEV and high-power-field image analysis were performed and analyzed with correlation to the patients' clinical and pathological features.
  
  
  RESULTS
  The total number of HEV was found to be significantly associated to disease-free interval. There was a similar association comparing the HEV parameters to overall survival. The density of abnormal HEV was significantly higher in patients with established metastases in their lymph nodes and HEV was shown to be a better prognosis factor than conventional tumor staging. The HEV morphological metamorphosis demonstrates a spectrum that correlates well with disease progression and clinical outcome.
  
  
  CONCLUSIONS
  The results suggest that the HEV displays a spectrum of morphological changes in the presence of cancer and LN metastasis, and that HEV is possibly involved in the process of cancer metastasis. We revealed the relationship of HEV and their metamorphosis in pre-metastatic and metastatic environments in regional lymph nodes of tongue cancer patients in relation to clinical outcomes. The significant observation of modified dilated HEV containing red blood cells in lymph nodal basin of a cancer suggests the shifting of its function from one primarily of immune response to that of a blood carrying vessel. It also demonstrated potential prognostic value. More studies are needed to elucidate its potential role in cancer immunotherapy and as a potential novel therapeutic approach to preventing metastasis by manipulating the remodelling processes of HEV.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore, Singapore. seryee@yahoo.com
authors.forename: Ser Yee
authors.initials: SY
authors.lastname: Lee
authors.forename: Qian
authors.initials: Q
authors.lastname: Chao-Nan
authors.forename: Ooi Aik
authors.initials: OA
authors.lastname: Seng
authors.forename: Chen
authors.initials: C
authors.lastname: Peiyi
authors.forename: Wong Hui Min
authors.initials: WH
authors.lastname: Bernice
authors.forename: Myint Swe
authors.initials: MS
authors.lastname: Swe
authors.forename: Wong Jing
authors.initials: WJ
authors.lastname: Chii
authors.forename: Hwang Siok Gek
authors.initials: HS
authors.lastname: Jacqueline
authors.forename: Soo Khee
authors.initials: SK
authors.lastname: Chee
mesh_terms: D016022:Case-Control Studies; D018572:Disease-Free Survival; D004730:Endothelium, Vascular / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000098:blood supply* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D009369:Neoplasms / Q000098:blood supply* / Q000473:pathology*; D014699:Venules / Q000473:pathology*