Vascular invasion in non-small cell lung carcinoma.

Abstract

Aims:To determine ifthere is any correlation between vascular invasion and prognosis in non-small cell carcinoma of the lung; and to look specifically at invasion of vascular channels by tumour cells. Methods: Eighty seven patients undergoing lobectomy or pneumonectomy for adenocarcinoma or squamous carcinoma were followed up for five years. The histological sections were studied for evidence of vascular invasion using an elastic van Gieson stain. The incidence of intimal fibrosis in arteries and veins was noted and the proportion with vascular invasion evaluated using a scoring system. The presence or absence of lymphatic permeation and tumour necrosis were noted. Survival data were analysed using the log rank test. Results: The overall five year survival was 32%. There were 64 squamous cell carcinomas and 23 adenocarcinomas. Vascular invasion was seen in 77% of patients and lymphatic invasion in 44%. Neither the presence nor absence nor the proportion of blood vessels showing vascular invasion showed any relation to prognosis. Intimal fibrosis and tumour necrosis were unrelated to prognosis. Patients with lymphatic permeation had recurrence and died earlier than those without. Conclusion: The presence of arterial or venous invasion by adenocarcinoma or squamous carcinoma of the lung was unrelated to survival; lymphatic permeation was associated with poor prognosis. The two common non-small cell lung cancers behaved differently from other solid tumours, where vascular invasion was a significant factor in determination of prognosis. This study was undertaken to see if there was a similar correlation between vascular invasion and prognosis in carcinoma of the lung and to look specifically at invasion of vascular channels by tumour cells, rather than combining both vascular and lymphatic channels under the same broad heading. MethodsEighty seven patients who had resections for lung cancer between 1979 and 1983, and for whom there was complete follow up data, were studied retrospectively. The operations were all carried out by a single surgeon (RAML) and in each there was no clinical or radiological evidence of metastasis at the time of surgery. The number of histological blocks taken from each tumour ranged between two and six (mean four). In most of the cases studied at least one tumour block had some adjacent lung tissue in the histological section.Slides from each block were stained conventionally with haematoxylin and eosin and elastic van Gieson to permit clear visualisation of blood vessel laminae. " Only patients with squamous cell and adenocarcinoma were studied as it is well recognised that small cell tumours invade the pulmonary vasculature early. "' Undifferentiated tumours were also not considered as it was felt that they comprise a very mixed group and should be studied separately. Lymphatic invasion was recorded as being present only if tumour cells were seen within areas which had a definite and clearly identifiable endothelial lining.Vascular invasion was identified if tumour was seen with...

Molecular and biological factors in the prognosis of non-small cell lung cancer

“…This may clearly facilitate the development of metastasis. Arterial or venous vascular invasion by tumour cells was present in 77% of 87 patients who underwent lobectomy or pneumectomy for adenocarcinoma or squamous cell carcinoma [48]. Neither the presence, nor the absence, nor the proportion of vasoinvasion was related to survival.…”

Huge Left Atrial Extension of Metastatic Lung Tumor via Pulmonary Vein: Report on the Third Case of Osteosarcoma

“…However, because these new cardiac tumors were unresectable, systemic chemotherapy was performed. mon than primary cardiac tumors and are generally associated with a poor prognosis [1][2][3][4]. Such extension occurs most frequently in non-small cell carcinomas, but also has been reported in primary pulmonary sarcoma.…”

“…Such extension occurs most frequently in non-small cell carcinomas, but also has been reported in primary pulmonary sarcoma. Metastases to the heart occur with approximately 15% of all sarcomas [2,3].…”

“…Primary pulmonary malignancies with invasion of the pulmonary veins and left atrium (LA) occurred most frequently in non-small cell carcinoma of the lung [2].…”

“…Lung cancer is one of the most common causes of metastatic cardiac tumours, but very few cases of intracardiac extension via the pulmonary vein have been seen [1][2][3]. Primary pulmonary malignancies with invasion of the pulmonary veins and left atrium (LA) occurred most frequently in non-small cell carcinoma of the lung [2].…”