The pre-lymphatic pathway, the rooths of the lymphatic system in breast tissue: a 3D study

Abstract

Three-dimensional (3D) visualisation of microscopic structures provides useful information about their configuration and the spatial (hence functional) relationship between different components in tissues. This paper describes 3D dynamic reconstructions of the pre-lymphatic labyrinth in two cases of "normal" breast core biopsies and one case of pseudoangiomatous stromal hyperplasia. Direct anastomoses between pre-lymphatic channels and true lymphatics of the breast were demonstrated. It is concluded that pre-lymphatics are a way of communication between breast epithelial/stromal structures and the main lymphatic system. The present findings suggest that the existence of pre-lymphatics has to be taken in consideration in the intramammary spread of malignant tumours.

Pseudoangiomatous stromal hyperplasia: An observation on its microscopic involvement in breast carcinoma and the presence of lymph node metastases

“…Undetected or unsampled lymphatic involvement in these 4 cases cannot be excluded, while the correlation of two findings does not necessarily establish a cause and effect relationship. However, the involvement of PASH may be a marker of such involvement, given the results of this study and the findings of Damiani et al (1) and Asioli et al (2). Furthermore, we cannot exclude such undetected or unsampled lymphatic involvement in other cases with lymph node metastases, but without vascular involvement and the absence of PASH foci.…”

“…Fisher et al concluded that PASH and this lymphatic labyrinth (spaces ultrastructurally lined by slender cells with tapering cytoplasmic processes that are either fibroblasts or lymphatic endothelial cells) are related structures (6). Recently, Asioli et al, in a three-dimensional study of two cases of normal breast tissue and one case of PASH, demonstrated direct anastomoses between pre-lymphatic channels and true lymphatics of the breast (2). The missing lymphatic labyrinth described by Hartveit is now considered to be the normal counterpoint of the spaces that constitute pseudoangiomatous hyperplasia (7).…”

The distribution of lesions in 1–14-mm invasive breast carcinomas and its relation to metastatic potential

“…In the first type, the multifocal tumor is really an early carcinoma, and, in the second type, this is less clear. Intramammary spread of the tumor may be the initial step in generating LNM and is probably associated with involvement of the prelymphatic system [44] and/or with LVI [45]. Involvement of the prelymphatic system was previously demonstrated in invasive lobular carcinomas using large-format histology sections [46].…”

Incomplete inside-out growth pattern in invasive breast carcinoma: association with lymph vessel invasion and recurrence-free survival

“…This suggests that an inside-out morphologic change is at least partly responsible for the detachment of tumor cells from the stroma. As we identified an incidental case with a connection between a clear space and a D2-40 positive lymphatic vessel with draining tumor cells, it is possible that the clear spaces share the "pre-lymphatic channels" connecting to true lymphatics described by some investigators [28][29][30].…”