title: Association of D2-40 and MMP-1 expression with cyst formation in lung metastatic lesions of cutaneous angiosarcoma on the scalp: immunohistochemical analysis of 23 autopsy cases.
abstract: Cutaneous angiosarcoma of the scalp can rapidly develop into pulmonary metastasis. The pulmonary metastatic lesions display a unique appearance, so-called thin-walled cysts, which cause a fatal relapsed pneumothorax by rupturing. We analyzed 23 autopsy cases of angiosarcoma with pulmonary metastasis to elucidate the mechanism of the thin-walled cyst development. Of the 23 cases of cutaneous angiosarcoma of the scalp with pulmonary metastasis, radiological examination revealed pulmonary metastatic lesions as thin-walled cysts (39%), nodules (39%), mixed cysts and nodules (13%), and ground-glass opacity (9%). All the cases but one with cystic metastases were complicated by pneumothorax. The cystic lesions were accompanied by podoplanin (D2-40)-positive tumor cells in the luminal surface of the cysts. In both primary cutaneous lesions and pulmonary metastatic lesions, the D2-40 expression was positive for angiosarcoma cells in 100% and 92% of the cases, respectively. While the estrogen-regulated gene (ERG) expression was also positive for most of the primary and metastatic pulmonary angiosarcomas, D2-40 was a more useful marker to differentiate tumor cells from the background than was the ERG expression of the vascular endothelium. Matrix metalloproteinase-1 (MMP-1) expression was also predominant in primary lesions (95%) and pulmonary metastatic lesions (82.6%). Proteinases, like MMP-1, might be associated with a developing thin-walled cyst, although there were no differences in the MMP-1 expression in either the cystic or nodular metastasis. Two extremely aggressive cases showed cystic metastasis with central necrosis that was not observed in other cases. These results suggest a pathogenesis of thin-walled cysts in some progressive cases.
authors.affiliation: Department of Dermatology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan. Electronic address: masuderm@med.kitasato-u.ac.jp.
authors.forename: Mamiko
authors.initials: M
authors.lastname: Masuzawa
authors.forename: Tetuo
authors.initials: T
authors.lastname: Mikami
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Numata
authors.forename: Wataru
authors.initials: W
authors.lastname: Tokuyama
authors.forename: Mikio
authors.initials: M
authors.lastname: Masuzawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Murakumo
authors.forename: Isao
authors.initials: I
authors.lastname: Okayasu
authors.forename: Kensei
authors.initials: K
authors.lastname: Katsuoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000378:metabolism*; D045744:Cell Line, Tumor; D003560:Cysts / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D006394:Hemangiosarcoma / Q000150:complications / Q000378:metabolism* / Q000556:secondary; D006801:Humans; D008168:Lung / Q000378:metabolism / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications / Q000378:metabolism* / Q000556:secondary; D008297:Male; D020781:Matrix Metalloproteinase 1 / Q000378:metabolism*; D008875:Middle Aged; D012535:Scalp / Q000378:metabolism* / Q000473:pathology; D012878:Skin Neoplasms / Q000150:complications / Q000378:metabolism* / Q000473:pathology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40; D020781:Matrix Metalloproteinase 1
keywords: Angiosarcoma; Lung metastasis; Matrix metalloproteinase-1; Podoplanin; Thin-walled cyst