Abstract. Lymph node metastasis is considered a factor in determining the prognosis of squamous cell carcinoma (SCC). Both oral and cervical SCC tumor cells prefer lymph vessels as the route of metastasis. D2-40 is a specific marker of lymphatic endothelial cells. This study clarifies the distribution and characteristics of lymphatic vessels in oral and cervical SCCs. Immunohistochemistry was performed in 20 oral and 20 cervical SCCs (10 non-metastatic and 10 metastatic to lymph nodes) using D2-40, CD31, CD34, CD105 and double staining with D2-40 and keratin. Lymphatic vessel density (LVD) was also determined morphologically. Results showed that lymphatic vessels in both types of SCCs were distributed mainly at the superficial region beneath the epithelium. The LVD in each tumor was significantly higher compared to the corresponding normal mucosa. Moreover, the LVD in lymph node metastasis in each tumor was significantly higher compared to their non-metastatic counterparts. Cancer cell invasion was observed in the lymphatic vessels suggesting the existence of lymph node involvement during metastasis. The new lymphatic vessels that proliferated around the cancer nests in both SCCs have endothelial cell characteristics inferred to be associated with early lymphatic development and initial dissemination of cancer cells.
IntroductionThe role of blood vessels in tumor progression and metastasis has been reported in various malignancies, including oral and cervical cancers (1-3). However, the relationship between blood vessels and lymph node metastasis in malignant tumors is largely unknown. Angiogenesis plays a crucial role in hematogenous and lymphatic metastases for which studies have suggested that lesions that entered a higher angiogenic state have an increased probability of metastasis (3,4). However, certain tumors with marked angiogenesis surprisingly had no evidence of metastasis and were associated with a good prognosis (5,6). Thus, an unclear relationship exists among angiogenesis, metastasis and prognosis.Clinically, lymph node metastasis in oral and cervical cancers occurs in 20-30% of cases and is considered a major factor in determining prognosis. Lymphatic spread is more important than other routes. Via this route malignant cells preferentially metastasize in lymph nodes in the cervical region (7). Also, lymphatic vessels are the preferential routes for metastatic spread of most carcinomas that arise in the cervix (8). Distant lymph node metastasis of cancer cells is often due to the involvement of lymphatic vessels (4,5). Despite the occurrence of lymphatic metastasis in those tumors, few studies have focused on the distribution and characteristics of lymphatic vessels in cancers (9,10). Moreover, it remains questionable whether tumor cells induce lymphangiogenesis.Several lymphatic-specific antibodies have been developed (11). Kahn and Marks developed an antibody called D2-40, reported to be effective in detecting lymphatic vessels in formalin-fixed paraffin sections (12). The antibody does not requi...