Lymphatic involvement shoud be accurately confirmed by D２−４０immunostaining in endoscopic
厚生連医誌
mucosal第１６巻
resection（EMR）specimens
１号 １２６〜１２７ ２００７with microinvasive carcinoma

Invention Report

Lymphatic involvement shoud be accurately confirmed by
D２−４０immunostaining in endoscopic mucosal resection（EMR）specimens with microinvasive carcinoma
Nagaoka Central General Hospital, Department of Pathology ; Pathologist

Toshihiko Ikarashi
The immunostaining analysis with both CD 34 andD 2-40 was very useful for venous and lymphatic involvements, respectively. In case of ambiguous lymphatic configuration on routine Hematoxylin-Eosin（HE）stained
slides the lymphatic invasion should be immunohistochemically examined with Anti-D 2-40 antibody. Especially in endoscopic mucosal resection an early invasivecancer required immunostaining analysis for lymphaticpermeation.
Key Words : D 2-40, immunostain, lymphatic invasion,microinvasion, carcinoma, endoscopic mucosal resection（EMR）
BackgroundIn a routine microscopic analysis of cancer specimens the vascular invasion（v-factor）and lymphatic invasion（ly-factor）was confirmed by either histochemical
staining with Elastica-Masson Goldner stain（EMG）or immunostaining with reagents against Factor VIII and CD34. These were useful for identifying endothelium, but not
specific for lymphatic vessels. Lately D 2-40 has been
purely demonstrated in lymphatic endothelium and its reagent, Anti-D 2-40 antibody, has been used for lymphatic
involvement. So the histological analysis with both CD 34
and D 2-40 was very useful for venous and lymphatic involvements, respectively.
We should remember that even early-stage carcinoma with microscopic invasion could involve lymphatic
vessels, which was usually ignored histologically if lymphatic configuration could not be confirmed accurately on
routine HE slides. In endoscopic mucosal resection an
early invasive cancer required immunohistochemical
analysis for lymphatic permeation.
In this paper we could confirm lymphatic invasion
by the immunohistochemical analysis with anti-D 2-40 antibody on EMR specimen with microinvasion and reported
here.
Case

nosed as early carcinoma of stomach by routine microscopic analysis : L, Post, O-IIc，
1 x 1 x 0.2 cm, EMR,
tub 1, sm 2, int, infβ, lyo, vo, ce（−），HE（Fig.1, 2）.
No lymphatic invasion was confirmed because of absence of tumor cells in usual lymphatic configuration.
Additional immunostaining was done with the following reagents：!monoclonal mouse anti-human CD 34
Class II antibody（Anti-CD 34, DakoCytomation, http : //dakocytomation.jp/）：mainly reacted Class II on membrane of vascular endothelium, significant for blood vascular invasion by cancer，"monoclonal mouse anti-human
D 2-40 antibody（Anti-D 2-40, DakoCytomation, http : //dakocytomation.jp/）：reacted sialoglycoprotein in bothcytoplasm and membrane of lymphatic endothelium andunreacted with vascular endothelium, useful in identifying
lymphatic invasion by cancer.
One lymphatic invasion was shown in the deepest
area with D 2-40 reagent but there was no venous involvement（Fig. 3）.
Conclusion
As for the judgment of cancer progress the lymphatic involvement was one of the most important factors.
We should pay attention to confirm lymphatic invasion
because there was late recurrence of early carcinoma after
EMR. Immunostaining with D 2-40 reagent is valuable
for lymphatic assessment. Specimens with early invasion,
especially in EMR, should be immunostained with both D
2-40 and CD 34 reagents to judge whether to bring additional therapy or not.
References
１．Ikarashi T. Immunohistochemical identification oflymphovascular invasion with antibodies against endothelium-secific antigens −von Wiellebrand 7 s factor（vWF, factor VIII），CD 31, and CD 34−．NiigataKen Koseiren Med J 1999；9：13-7.
２．Kahn HJ, Marks A. A new monoclonal antibody, D2-40, for detection of lymphatic invasion in primary tumors. Lab Invest 2002；82：1255-7.

A patient aged 72 y/o took EMR. He was diag-― 126 ―厚生連医誌

第１６巻

１号 １２６〜１２７ ２００７

和文抄録
小さな工夫
微小浸潤癌であった内視鏡下粘膜切除標本に対して、
D２−４０免疫染色によりリンパ管侵襲を確認すべきである。
長岡中央綜合病院、病理部；病理医
五十嵐俊彦

は、CD３４と D２−４０の免疫染色が有用である。通常のHE 染色標本においてリンパ管構造が不明瞭な場合においては抗 D２−４０抗体による免疫染色を実施すべきである。特に、早期浸潤 EMR 標本においては、リンパ管侵襲の判定にはこの免疫染色が必須である。
キーワード： D２−４０、免疫染色、リンパ管侵襲、微小浸潤癌、内視鏡下粘膜切除

癌組織における静脈侵襲とリンパ管侵襲の判定にFig. 1

Fig. 3Fig. 2― 127 ―