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Breast malignant, males, children

Breast cancer

Prognostic factors - Angiolymphatic invasion

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 19 December 2012, last major update February 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.


● Prognostic significance particularly for lymphatic invasion (Am J Surg Pathol 2007;31:1825, Am J Surg Pathol 1977;1:25) and D2-40 microvessel density (Am J Clin Pathol 2008;129:578)
● Note that D2-40 is not specific for lymphatic endothelium because it also stains breast myoepithelium (Hum Pathol 2008;39:175, Appl Immunohistochem Mol Morphol 2009;17:425)
● Lymphatic invasion occurs primarily at invasive front of tumor
● Related variables - presence of 6+ apoptotic figures in tumor emboli in patients without nodal metastases and 4+ mitotic figures in tumor emboli of patients with nodal metastases (Mod Pathol 2002;15:904, Hum Pathol 2008;39:427)
● Lymph vessel tumor emboli in stroma invasive tumor area (by H&E or D2-40) predicts high risk of tumor recurrence or death (Hum Pathol 2007;38:247, Mod Pathol 2007;20:183)
● Lymphatic invasion may be particularly important in node negative patients (Ann Oncol 2007;18:1632)
● Although they should be distinguished, lymphatic invasion is associated with extensive retraction artifact (Am J Surg Pathol 2007;31:129)
● Correlates with more positive lymph nodes (sentinel and non-sentinel) and size of largest metastatic deposits (Am Surg 2011;77:874)

Micro images

Various images

Cuff of lymphatic invasion around a small vein in a vascular bundle

Contributed by Dr. Semir Vranic, University of Sarajevo, Bosnia:
Tumor in vessel wall     Post-chemotherapy

CD31 and D2-40

Not angiolymphatic invasion

Not angiolymphatic invasion, but shrinkage artifact with partly necrotic tumor
in space created by shrinkage; no endothelial cells are present, elastic stain
highlights elastic tissue in walls of vessels (AFIP)

Retraction artifact

Blood vessel versus lymphatic vascular invasion

D2-40 stains endothelium of lymphatic but not artery or vein

D2-40+ lymphatics without tumor emboli at advancing front of tumor

D2-40+ lymphatics containing tumor emboli

Tumor emboli within tumor

End of Breast malignant, males, children > Breast cancer > Prognostic factors - Angiolymphatic invasion

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