Breast tumors lymphatic invasion

Gajdos C, Tartter PI, Bleiweiss IJ. Lymphatic invasion, tumor size, and age are independent predictors of axillary lymph node metastases in women with T1 breast cancers. Ann Surg. 1999 230 692-696. 

Tumor size and the presence and number of involved axillary lymph nodes are primary factors in assessing the risk for breast cancer recurrence and subsequent metastatic disease. Other disease characteristics that provide prognostic information include histologic subtype, nuclear or histologic grade, lymphatic and vascular invasion, and proliferation indices. 

Expression of ras p21 was consistently increased in the invasive component of the primary tumor as compared with the intraductal tumor. In addition, a high level of p21 expression was seen in tumor emboli in lymphatics and blood vessels as compared with the contiguous tumor in parenchymal tissue. It is suggested that markedly enhanced p21 expression is associated with earlier stages (invasion and dissemination) of aggressive breast cancers. 

D2-40, a clone of podoplanin, is a recently developed commercially available antibody directed against the M2A antigen, a 40,000-kD sialoglycoprotein associated with germ cells and lymphatic endothelium. Chu and colleagues evaluated 53 cases of mesothelioma, 28 cases of reactive pleural tissue, 30 cases of pulmonary adenocarcinoma, 35 cases of renal cell carcinoma, 26 cases of ovarian serous carcinoma, 16 cases of invasive breast carcinoma, 11 cases of prostatic adenocarcinoma, and 7 cases of urothelial carcinoma. The authors found D2-40 expression in 51 of 53 (96%) mesotheliomas, 27 of 28 (96%) reactive pleural tissues, and 17 of 26 (65%) ovarian serous carcinomas. They did not find D2-40 in the other tumors examined. The authors also observed that the neoplastic cells immunostained in a cell membrane distribution. 

Lympho-vascular space invasion in breast carcinoma is an independent predictor of axillary lymph node metastasis, which in turn is one of the most important prognostic factors in breast carcinoma.One recent study has shown that peritumoral lymphatic space invasion (and not blood vessel invasion) was determinant of lymph node metastasis.In addition, identification of tumor emboli within dermal lymphatics is also important for correlation purposes in cases of inflammatory carcinomas. 

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