Morphologic Pattern, Frequency, and Spatial Distribution of Lymphovascular Invasion Foci in Radical Prostatectomy Specimens

Abstract

Introduction. Lymphovascular invasion (LVI) is an adverse pathological finding in radical prostatectomy (RP) specimens associated with increased risk of metastatic disease. Its variable incidence may be attributed to underreporting. We characterized the location, quantity, and morphology of LVI foci in RP specimens and assessed the relationship between LVI and cribriform and intraductal carcinoma and metastatic risk. Methods. Two pathologists reviewed retrospectively 54 RP specimens reported as positive for LVI. Ambiguous cases were confirmed by immunostaining for ERG, CD31 and D2-40. Results. In 4/54 (7.4%), LVI could not be confirmed. Main mimickers of LVI were retraction artifact and dislodged tumor cells. Based on our review, the most important criteria to distinguish LVI from its mimickers were a corrugated lining of vascular spaces, endothelial nuclei bulging into the lumen, and presence of proteinaceous material. The LVI frequency per case ranged from 1 to 109 (median 7.5). In 47/50 (94%) cases with LVI, the associated carcinoma comprised cribriform pattern and/or intraductal carcinoma. The most common morphology of LVI foci was cribriform, occurring in 43/50 specimens, representing 469/843 (56%) of LVI foci. Most LVI foci were intraprostatic and located at the carcinoma-stroma interface. Particularly the risk of bone metastases during follow-up was independently associated with higher frequency of LVI foci ( P = .009). Conclusions. The detailed description of prostatic LVI, and awareness of their predominant location and morphology may help its identification and improve the diagnostic accuracy of LVI in pathology reporting. The clinical impact of LVI quantification in prostate cancer needs validation by further studies.

Histology and PSMA Expression on Immunohistochemistry in High-Risk Prostate Cancer Patients: Comparison with 68Ga-PSMA PET/CT Features in Primary Staging

“…LVI is a negative prognostic finding related to unfavorable outcomes, reduced BCR-free survival, and increased metastatic risk. In fact, as Shifaa et al [ 32 ] demonstrated, 54% of LVI-positive cases showed seminal vesicle invasion (pT3b) and 28% had pN1 at RP. In addition, Gesztes et al [ 33 ] showed that there is a significant association between LVI and p53 expression; they subdivided PCa patients in p53+ and p53- groups and found that 39.8% of group 1 was LVI positive.…”

Vascular Invasion-type Retraction Artifact in Ameloblastoma

“…7,8 The most common mimicker of vascular invasion or pseudoinvasion has been termed retraction artifact, wherein tumor nests are lodged in pseudovascular (non-vascular tissue) spaces. [7][8][9] The purpose of the present communication is to call attention to a previously undescribed retraction artifact in ameloblastoma that was initially diagnosed as vascular invasion of uncertain biological significance or vascular pseudoinvasion following incisional biopsy.…”

“…Tissue artifacts are an intrinsic component of diagnostic surgical pathology. Among them, retraction artifact, also referred to as peritumoral clefting, has been described as a common microscopic feature in different tumor types, [7][8][9][10] but to our knowledge, it has received little or no attention in the literature on odontogenic tumors. This phenomenon reflects separation between the tumor and the stroma due to loss of cellular cohesion and/or tissue shrinkage, leaving either a clear empty or mucin-deposited space that completely or partially encircles the tumor islands.…”

“…[7][8][9] To resolve a diagnostic dilemma, it is imperative to confirm the absence of a definite endothelial lining using immunohistochemistry. [7][8][9] Other than a non-specific fixation artifact during tissue-processing, the cause of the present retraction spaces remains unclear. As the intervening stroma was both myxoid and edematous, focal stromal changes, ie uneven distribution and/or disproportional shrinkage of mucin associated with or subsequent to peritumoral edema may contribute to pseudovascular space formation 1G, inset).…”

“…2,6 Unlike bona fide vascular invasion with therapeutic and prognostic implications, vascular pseudoinvasion resulting from intraoperative or postoperative mechanical displacement of a tumor or normal tissue into vascular spaces is an iatrogenic artifact. 7,8 The most common mimicker of vascular invasion or pseudoinvasion has been termed retraction artifact, wherein tumor nests are lodged in pseudovascular (non-vascular tissue) spaces. [7][8][9] The purpose of the present communication is to call attention to a previously undescribed retraction artifact in ameloblastoma that was initially diagnosed as vascular invasion of uncertain biological significance or vascular pseudoinvasion following incisional biopsy.…”