The prognostic significance of tumor lymphangiogenesis and lymphatic vessel density in endometrioid carcinoma of the uterine corpus

Abstract

The present study aimed to assess the prognostic significance of tumor lymphangiogenesis and lymphatic vessel density (LVD) in endometrioid carcinoma of the uterine corpus. The association between LVD and various factors, including lymphatic vessel invasion (LVI), and nodal metastases, were investigated. Among 202 surgically treated cases, 19 cases with nodal metastases with the infiltration reaching the outer-half myometrium (N+ group) were selected. The LVDs of hotspots in each case were examined at 100× magnification on D2-40 stained slides of the inner- and outer-half myometrium of the peritumoral, and control compartments. Furthermore, for the peritumoral compartment, the LVDs in two types of areas, LVI-present and LVI-absent, were examined for each location of myometrium, which amounted to 6 spots/case. They were statistically compared. Second, to determine whether the existing myometrium influenced LVD, LVDs in the intratumoral compartment were investigated, which were defined as a region where residual muscular tissue was unrecognizable with desmin-immnostaining. As a negative control group, LVDs of the inner- and outer-half myometrium of the peritumoral, and control compartments of 29 cases without nodal metastases in stage IB (N− group) were examined. No significant association was identified between the LVD and frequency of LVI. However, the LVDs in the peritumoral compartment and inner-half myometrium were higher compared those in the control compartment, and outer-half myometrium in N+ and N− groups, respectively. No significant differences were identified in LVD of the peritumoral compartment between groups. The lymphatic vessels were absent where the existing muscular tissue was absent in 16/19 cases. Although higher LVDs in the peritumoral compartment suggested tumor lymphangiogenesis, it was not associated with LVI and nodal metastases. Other factors that influenced LVD were the location in the myometrium and the existing myometrium.

Preponderance of endometrial carcinoma in elderly patients

“…It was reported that poor outcome is correlated with lymphovascular invasion ( 8 ), aggressive histology and cervical invasion in early (stage I or II) EMC in the multivariate analysis ( 1 ). In addition, elderly EMC patients (≥70 years) appear to have worse outcomes compared with younger patients, regardless of other poor prognostic factors, and EMC also appears to be intrinsically more aggressive in elderly patients.…”

“…The prognosis of patients with EMC is associated with variable pathological factors, including histological type, tumor grade ( 7 ), depth of myometrial invasion and lymphovascular invasion ( 8 ), as well as clinicopathological stage as determined by the International Federation of Gynecology and Obstetrics (FIGO) classification ( 9 ), which is a critical determinant of the prognosis of EMC, irrespective of its histological type. Tumor grade is essentially prognostic for endometrioid carcinoma, but not for type II EMC, as this type has the potential to behave aggressively ( 10 ).…”