Synne Knopp1, Ruth Holm, Claes Tropé, Jahn M Nesland. 1. Department of Pathology, University of Oslo, Faculty Division, The Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway. synne.knopp@klinmed.uio.no
Abstract
OBJECTIVE: In early stage vulvar carcinoma patients, there is at trend towards individualized treatment in order to reduce morbidity and sequela following inguinal lymph node dissection. However, recurrences in the groin are almost always fatal. In the present study, we address the occult lymph node metastases in vulvar squamous cell carcinoma patients by using serial sectioning and immunostaining of lymph nodes in a larger series of vulvar carcinoma patients and relate the findings to clinical follow-up data. METHODS: From 75 vulvar squamous cell carcinoma patients staged surgical FIGO I-III, 421 lymph nodes found negative at the hematoxylin & eosin (H&E) routine investigation were scrutinized. From formalin-fixed and paraffin-embedded tissues, sections were cut with 150 mum interval and stained with H&E and cytokeratin AE1/AE3. Two classes were used to describe the amount of tumor cells: <100 cells and >100 cells. RESULTS: Positive cytokeratin AE1/AE3 staining was found in 25/421 (6%) of the lymph nodes. Occult lymph node metastases were found in 17/75 (23%) of the patients. Correlation was found between lymph node metastasis and site of recurrence (P = 0.01). Twenty-eight percent of the patients had relapse. CONCLUSIONS: The present study underlines the importance of serial sectioning and immunostaining of lymph nodes in the search for micrometastases in vulvar carcinoma patients. However, the results of the present study do not suggest a more thorough examination of non-sentinel lymph nodes in vulvar carcinoma patients where the sentinel lymph nodes are thoroughly examined.
OBJECTIVE: In early stage vulvar carcinomapatients, there is at trend towards individualized treatment in order to reduce morbidity and sequela following inguinal lymph node dissection. However, recurrences in the groin are almost always fatal. In the present study, we address the occult lymph node metastases in vulvar squamous cell carcinomapatients by using serial sectioning and immunostaining of lymph nodes in a larger series of vulvar carcinomapatients and relate the findings to clinical follow-up data. METHODS: From 75 vulvar squamous cell carcinomapatients staged surgical FIGO I-III, 421 lymph nodes found negative at the hematoxylin & eosin (H&E) routine investigation were scrutinized. From formalin-fixed and paraffin-embedded tissues, sections were cut with 150 mum interval and stained with H&E and cytokeratin AE1/AE3. Two classes were used to describe the amount of tumor cells: <100 cells and >100 cells. RESULTS: Positive cytokeratin AE1/AE3 staining was found in 25/421 (6%) of the lymph nodes. Occult lymph node metastases were found in 17/75 (23%) of the patients. Correlation was found between lymph node metastasis and site of recurrence (P = 0.01). Twenty-eight percent of the patients had relapse. CONCLUSIONS: The present study underlines the importance of serial sectioning and immunostaining of lymph nodes in the search for micrometastases in vulvar carcinomapatients. However, the results of the present study do not suggest a more thorough examination of non-sentinel lymph nodes in vulvar carcinomapatients where the sentinel lymph nodes are thoroughly examined.
Authors: Magdalena Kowalewska; Jakub Radziszewski; Krzysztof Goryca; Mateusz Bujko; Malgorzata Oczko-Wojciechowska; Michal Jarzab; Janusz Aleksander Siedlecki; Mariusz Bidzinski Journal: BMC Cancer Date: 2012-06-06 Impact factor: 4.430