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Stewart-Treves syndrome angiosarcoma expresses phenotypes of both blood and lymphatic capillaries

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Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome (STS).This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiotherapy for breast cancer.Angiosarcoma spread is facilitated by the formation of blood vessels (angiogenesis) and lymph vessels (lymphangiogenesis).In the future antiangiogenic therapy may improve the poor outcome of current treatments.There was evidence that blocking the angiogenenesis would inhibit progression of angiosarcoma.It seems reasonable to hypothesize that blocking the lymphangiogenesis may yield similar results.Although angiosarcomas commonly derive from blood vessels,in case of STS angiosarcomas chronic lymphoedema may suggest its lymphatic origin.The goal of this study was to visualize interstitial space and lymphatics in the central and peripheral regions of STS angiosarcoma.Methods On tissue samples obtained from STS angiosarcoma we have performed:first colour stereoscopic lymphography to visualise the morphology of lymphatic vessels and extracellular spaces,second immunohistochemical staining specific for lymphatic vessels endothelium (LYVE-1) and blood endothelial cells (CD31,factor Ⅷ) and prolymphangiogenic vascular endothelial growth factor (VEGF-C) for precise identification of lymphatic endothelia.STS angiosarcoma morphology was assessed by comparison of pictures obtained on lymphography,microscopy and confocal microscopy.Results STS angiosarcomas present heterogenous morphology with areas dominated by hemangiosarcoma and lymphangiosarcoma structures.STS angiosarcoma expressed phenotypes of both blood and lymphatic endothelia.LYVE-1 and VEGF-C is expressed by STS angiosarcoma and may be used to discriminate tumour differentiation.Morphology of lymphatic vessels and spaces in the tumour suggest absence of their normal lymphatic function.Conclusions Our results confirmed both hemangio-and lymphangiogenic origin of STS angiosarcoma.Expression of VEGF-C makes STS angiosarcoma a good candidate for targeted antilymphangiogenic therapy.However,morphology of intratumoral lymphatics on colour lymphography suggested their impaired function,which can hamper drug distribution.

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作者单位: Department of General, Oncologic and Vascular Surgery, Military Health Service Institute, Warsaw, Poland;Department of Surgery, Wolski Hospital, Warsaw, Poland [1] Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland [2] Department of Oncology,Military Health Service Institute, Warsaw,Poland [3] Department of Pathology ,Military Health Service Institute, Warsaw,Poland [4] Department of General, Oncologic and Vascular Surgery, Military Health Service Institute, Warsaw, Poland [5]
期刊: 《中华医学杂志(英文版)》2013年126卷2期 231-237页 SCIMEDLINEISTICCSCDBP
栏目名称: ORIGINAL ARTICLES
DOI: 10.3760/cma.j.issn.0366-6999.20120993
发布时间: 2013-04-19
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