Breast – Malignant, Males, Children - Breast cancer - Prognostic factors

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Breast-malignant, males, children

Breast cancer - Prognostic factors - Angiolymphatic invasion

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 20 September 2009

Last major update: September 2009

Features

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● Prognostic significance particularly for lymphatic invasion (AJSP 2007;31:1825, AJSP 1977;1:25) and D2-40 microvessel density (AJCP 2008;129:578); note that D2-40 is not specific for lymphatic endothelium because it also stains breast myoepithelium (Hum Path 2008;39:175, Appl Immunohistochem Mol Morphol 2009 Apr 9 [Epub ahead of print])

● 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 Path 2002;15:904, Hum Path 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 Path 2007;38:247, Mod Path 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)

Micro images

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Various images

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

Blood versus lymphatic vascular invasion

CD31 and D2-40

D2-40 stains endothelium of D2-40+ lymphatics without tumor

lymphatic but not artery or vein emboli at advancing front of tumor

D2-40+ lymphatics containing Tumor emboli within tumor

tumor emboli

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)

Other images: retraction artifact

End of Breast – Malignant, Males, Children > Prognostic factors > Angiolymphatic invasion

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