ORIGINAL ARTICLE

Lymphatic vessel density in the neoplastic progression of Barrett’s oesophagus to adenocarcinoma

M-A Brundler^1,3, J A Harrison², B de Saussure¹, M de Perrot¹ and M S Pepper^2,4

¹ Department of Clinical Pathology, University of Geneva Medical Centre, 1211 Geneva 4, Switzerland
² Department of Morphology, University of Geneva Medical Centre
³ Birmingham Children’s Hospital Steelhouse Lane, Birmingham B4 6NH, UK
⁴ NetCare Molecular Medicine Institute, Unitas Hospital, 0140 Lyttelton, Pretoria, South Africa

Correspondence to:
Correspondence to:
Professor M S Pepper
NetCare Molecular Medicine Institute, Unitas Hospital, Clifton Avenue, 0140 Lyttleton, Pretoria, South Africa; mpepper{at}doctors.netcare.co.za

Background: Oesophageal adenocarcinoma is an aggressive neoplasm with poor prognosis as a result of early lymph node metastasis.

Aims: To measure lymphatic vessel density (LVD) in the neoplastic progression from Barrett’s metaplasia to adenocarcinoma and determine whether LVD can predict the risk of cancer. In addition, to correlate LVD with lymph node metastasis and assess whether LVD could be used as a prognostic indicator for outcome or survival.

Methods: LVD and microvascular density (MVD) were assessed after immunohistochemical staining of vessels in Barrett’s metaplasia, dysplasia, and adenocarcinoma tissues and were correlated with clinicopathological features.

Results: LVD was significantly reduced in adenocarcinoma, being half that seen in normal stomach/oesophagus or metaplasia/dysplasia. LVD did not correlate with tumour grade, stage, or clinical outcome; however, patients who had either lymph node metastasis or invasion of tumour cells into peritumorous lymphatic vessels had a significantly worse overall survival. MVD was also assessed as a prognostic marker; its increase appeared to be linked more with the development of Barrett’s metaplasia than adenocarcinoma.

Conclusions: The reduction in lymphatic vessel numbers was not useful for determining disease outcome in the patient group studied. It is the entry of tumour cells into pre-existing peritumorous lymphatic vessels that confers a significantly worse overall survival.

Abbreviations: LVD, lymphatic vessel density; LYVE-1, lymphatic endothelium specific hyaluronan receptor; MVD, microvascular density; VEGFR-3, vascular endothelial growth factor receptor 3

Keywords: lymphangiogenesis; lymphatic vessel density; Barrett’s metaplasia; dysplasia; oesophageal adenocarcinoma

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