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The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors.

Almeida BG, Bacchi CE, Carvalho JP, Ferreira CR, Carvalho FM - Clinics (Sao Paulo) (2014)

Bottom Line: The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.Lack of MUC2 expression was an important factor excluding metastasis.The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objective: Ovarian mucinous metastases commonly present as the first sign of the disease and are capable of simulating primary tumors. Our aim was to investigate the role of intratumoral lymphatic vascular density together with other surgical-pathological features in distinguishing primary from secondary mucinous ovarian tumors.

Methods: A total of 124 cases of mucinous tumors in the ovary (63 primary and 61 metastatic) were compared according to their clinicopathological features and immunohistochemical profiles. The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.

Results: Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC. The lymphatic vascular density was increased among primary tumors. However, after multivariate analysis, the best predictors of a secondary tumor were a size of 10.0 cm or less, bilaterality and cytokeratin 7 negativity. Lack of MUC2 expression was an important factor excluding metastasis.

Conclusions: The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment. However, considering the differential diagnosis, the best discriminator of a secondary tumor is the combination of tumor size, laterality and the pattern of expression of cytokeratin 7 and MUC2.

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Mucinous ovarian tumor showing ten lymphatic vessels identified by podoplanin staining using the D2-40 antibody (original magnification 200X).
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f3-cln_69p660: Mucinous ovarian tumor showing ten lymphatic vessels identified by podoplanin staining using the D2-40 antibody (original magnification 200X).

Mentions: Immunohistochemical detection of cytokeratin 7 (CK7), cytokeratin 20 (CK20), CA125, CDX-2, CA19.9, MUC2, MUC5AC and podoplanin was performed using slides from TMA blocks. The sources and dilutions of the antibodies as well as the epitope retrieval methods used are listed in Table 2. Bound antibodies were detected using Novolink® (Leica, Bannockburn, IL, USA). For all the markers, with the exception of podoplanin, any percentage of unequivocally positive neoplastic cells was scored as positive for the markers, although all the positive cases showed more than 10% stained cells. Identification of lymphatic vessels was established based on the presence of cells that were positive for podoplanin and that had a morphology consistent with vessel structure (Figure 3). In tumor sections that were negative for podoplanin staining, adjacent lymphatic endothelial cells that appeared normal served as positive internal controls.


The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors.

Almeida BG, Bacchi CE, Carvalho JP, Ferreira CR, Carvalho FM - Clinics (Sao Paulo) (2014)

Mucinous ovarian tumor showing ten lymphatic vessels identified by podoplanin staining using the D2-40 antibody (original magnification 200X).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221329&req=5

f3-cln_69p660: Mucinous ovarian tumor showing ten lymphatic vessels identified by podoplanin staining using the D2-40 antibody (original magnification 200X).
Mentions: Immunohistochemical detection of cytokeratin 7 (CK7), cytokeratin 20 (CK20), CA125, CDX-2, CA19.9, MUC2, MUC5AC and podoplanin was performed using slides from TMA blocks. The sources and dilutions of the antibodies as well as the epitope retrieval methods used are listed in Table 2. Bound antibodies were detected using Novolink® (Leica, Bannockburn, IL, USA). For all the markers, with the exception of podoplanin, any percentage of unequivocally positive neoplastic cells was scored as positive for the markers, although all the positive cases showed more than 10% stained cells. Identification of lymphatic vessels was established based on the presence of cells that were positive for podoplanin and that had a morphology consistent with vessel structure (Figure 3). In tumor sections that were negative for podoplanin staining, adjacent lymphatic endothelial cells that appeared normal served as positive internal controls.

Bottom Line: The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.Lack of MUC2 expression was an important factor excluding metastasis.The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Objective: Ovarian mucinous metastases commonly present as the first sign of the disease and are capable of simulating primary tumors. Our aim was to investigate the role of intratumoral lymphatic vascular density together with other surgical-pathological features in distinguishing primary from secondary mucinous ovarian tumors.

Methods: A total of 124 cases of mucinous tumors in the ovary (63 primary and 61 metastatic) were compared according to their clinicopathological features and immunohistochemical profiles. The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody.

Results: Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC. The lymphatic vascular density was increased among primary tumors. However, after multivariate analysis, the best predictors of a secondary tumor were a size of 10.0 cm or less, bilaterality and cytokeratin 7 negativity. Lack of MUC2 expression was an important factor excluding metastasis.

Conclusions: The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment. However, considering the differential diagnosis, the best discriminator of a secondary tumor is the combination of tumor size, laterality and the pattern of expression of cytokeratin 7 and MUC2.

Show MeSH
Related in: MedlinePlus