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Diagnosing vascular invasion in colorectal carcinomas: improving reproducibility and potential pitfalls
  1. Gábor Cserni1,2,
  2. István Sejben1,
  3. Rita Bori1
  1. 1Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
  2. 2Department of Pathology, University of Szeged, Szeged, Hungary
  1. Correspondence to Dr Gábor Cserni, Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyiri ut 38, Kecskemét H-6000, Hungary; cserni{at}

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Blood and lymphatic vessel invasion (BLVI) has been long recognised as a category I prognostic factor in colorectal carcinomas (CRC) along with the pT and pN categories of the Tumour-Node-Metastasis system, preoperative carcinoembryonal antigen levels and the residual tumour (R) classification.1

Small vessel involvement includes the invasion of capillary-type vessels (figure 1A), where a reliable distinction between lymphatic and blood capillaries cannot be made on H&E-stained or general endothelial marker (eg, CD31, CD34) immunostained sections. Theoretically, the two types of capillary invasion lead to different consequences: lymphatic vessel invasion (LI) precedes and may be predictive of lymph node metastasis, whereas blood capillaries may be the source of systemic dissemination.2–4 The development of lymphatic endothelial markers like podoplanin (D2-40) or lymphatic endothelial hyaluronan receptor (LYVE-1) enables a distinction between lymphatic and blood capillaries: lymphatics can be defined as D2-40, LYVE-1, CD31 and CD34 positive capillaries, whereas blood capillaries are D2-40 and LYVE-1 negative but can be highlighted by CD31 or CD34 antibodies.4–7 Without such a distinction, small vessel invasion is best recorded as (lympho-)vascular invasion (LVI) or angiolymphatic invasion.1 The impact of LI or LVI is mainly seen in patients with conservative removal (eg, polypectomy) of invasive carcinomas without a resection allowing the histopathologic assessment of the lymph nodes.

Figure 1

Types of vessel invasion in colorectal carcinomas. (A) Small vessel (ie, capillary) invasion corresponding to (lympho-)vascular invasion. (B and C) Venous invasion (VI) stained by orcein and elastica van Gieson, respectively. Right to the vein invaded by carcinoma is an accompanying artery, which helps the recognition of VI. (D) Invasion of an artery. ((A) CD34 ×400, (B) Orcein ×100, (C) Elastica van Gieson ×100, (D) Orcein ×100). This figure is only reproduced in colour in the online version.

By contrast, large vessel invasion includes venous invasion (VI) …

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  • Contributors GC drafted the first version of the manuscript, made the photos during a period of several years. Diagnoses, collection and discussion of cases during this period, finalisation of the manuscript done by all authors: GC, IS and RB.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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