Journal of Cytology & Histology

Detailed Analysis of Lymphatic Invasion Using D2-40 Immunostaining in Early Gastric Adenocarcinoma: Proposal of the Classification of Lymphatic Invasion by D2-40 Immunostaining

Abstract

Toshiharu Matsumoto* and Kanako Ogura

Aims: Lymphatic invasion by D2-40 immunostaining has been evaluated based on the presence of carcinoma cells in the lymphatic lumen, but the entering of carcinoma cells with an invading style into the lymphatic lumen of a lymphatic vessel was reported in early gastric adenocarcinoma (EGAC), in which carcinoma cells localize within mucosa or submucosa. Here, a detailed examination of lymphatic invasion by D2-40 immunostaining is made in EGAC.

Methods: A total of 204 EGAC patients who underwent endoscopic submucosal dissection was examined. Lymphatic invasion was classified as intra-lumen type and invading type by D2-40 immunostaining. In the intra-lumen type, carcinoma cells are present in the lymphatic lumen. In the invading type, carcinoma cells invade the lymphatic vessel with destruction of the lymphatic wall and enter the lymphatic lumen.

Results: Lymphatic invasion was noted in 15 cases. The sites of the invasion were mucosa (1 case), mucosa and submucosa (7 cases), and submucosa (7 cases). Intra-lumen-type invasion was present in all 15 cases, and invading-type invasion was noted in 2 cases (mucosa in 1 case and mucosa and submucosa in 1 case). These data indicate that carcinoma cells entered from both mucosal and submucosal lymphatic vessels and carcinoma cells in the mucosal lymphatic vessels remained in the mucosal lymphatic vessels or moved to submucosal lymphatic vessels. The carcinoma cells in the lymphatic vessels of the submucosa consisted of carcinoma cells that moved from the mucosal lymphatic vessels and carcinoma cells entered from submucosal lymphatic vessels, or they consisted of carcinoma cells that entered from submucosal lymphatic vessels only.

Conclusion: The classification of lymphatic invasion consisting of intra-lumen type and invading type offers an increase in diagnostic accuracy of lymphatic invasion, and it clarifies the entry and movement system of carcinoma cells in lymphatic vessels.

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