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Utilização de imunohistoquímica para avaliação da densidade linfática no mesentério de adenocarcinomas do cólon
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Abstract(s)
Introdução: O cancro colorretal apresenta-se como uma das neoplasias mais comuns nos países desenvolvidos. A sua capacidade de metastização ocorre por recurso a vasos sanguíneos e/ou linfáticos. Nas últimas décadas a importância da linfangiogénese no cancro tem sido discutida sendo que, desde que a técnica cirúrgica para a excisão total do mesorreto (ETM) demonstrou efeitos positivos nas recidivas locais do cancro do reto e, mais tarde, com a proposta da implementação da técnica cirúrgica da excisão completa do mesocólon (CME) para o cancro do cólon, a importância da manutenção da integridade do mesocólon e consequente rede linfática tem-se mantido em acesso debate. Até ao momento ainda não se conseguiu entender o verdadeiro benefício da manutenção da integridade da rede linfática e, como tal, a implementação rotineira da CME ainda não ocorreu. Objetivo: Determinar, em doentes com adenocarcinoma do cólon, a densidade linfática mesentérica em regiões peritumorais e em regiões distais ao tumor e correlacionar a densidade linfática mesentérica com diferentes características clínico-patológicas e clínico-histológicas. Métodos: Participaram neste estudo 49 doentes com adenocarcinoma do cólon de estadios T2 e T3. A avaliação da densidade linfática mesentérica foi realizada por imunohistoquímica com recurso ao anticorpo monoclonal D2-40 da podoplanina. Avaliou-se ainda a influência que diversas características clínico-patológicas e clínico-histológicas poderiam ter na densidade linfática mesentérica com recurso ao programa estatístico IBM SPSS. Resultados: Verificou-se maiores densidades linfáticas na região peritumoral comparativamente às regiões distais ao tumor. A densidade linfática peritumoral não se relacionou positivamente com nenhuma das características clínico-patológicas e clínico-histológicas analisadas, no entanto, a densidade linfática distal ao tumor demonstrou significância estatística na relação com o índice de massa corporal, o número de gânglios positivos isolados, a profundidade de invasão do tumor e o envolvimento ganglionar. Conclusão: O papel biológico dos vasos linfáticos na progressão tumoral continua controverso. Apenas se conseguiu correlacionar a densidade linfática com parâmetros clínico-patológicos e clínico-histológicos em regiões distais ao tumor o que reflete a importância de uma técnica cirúrgica bem executada. Continuam a ser necessários mais estudos para a compreensão do papel da linfangiogénese na disseminação tumoral.
Introduction: Colorectal cancer presents itself as one of the most common neoplasms in developed countries. Their ability to metastization occurs by resource to blood vessels and/or lymphatic vessels. In recent decades the importance of lymphangiogenesis in cancer has been discussed being that as long as the surgical technique for total mesorectal excision (TME) demonstrated positive effects on local recurrences of rectal cancer and, later, with the proposal for the implementation of complete mesocolic excision (CME) surgical technique for colon cancer, the importance of maintaining the integrity of the mesocolon and consequent lymphatic network it is been keeping himself in intense debate. Until the moment has not yet been understood the true benefit of maintaining the integrity of the lymphatic network and, as such, the routine implementation of the CME has not yet occurred. Objective: Determine, in patients with colon adenocarcinoma, the mesenteric lymphatic density in peritumoral regions and in distal regions to the tumor and correlate the lymphatic density mesenteric with different clinic-pathological and clinic-histological features. Methods: Participated in this study 49 patients with adenocarcinoma of the colon with stages T2 and T3. The evaluation of mesenteric lymphatic density was carried out by immunohistochemistry using the antibody monoclonal D2-40 of podoplanin. It was also evaluated the influence that several clinic-pathological and clinic-histological features could have in mesenteric lymphatic density using the IBM SPSS statistical program. Results: There were higher lymphatic densities in the peritumoral region compared to the distal regions of the tumor. The lymphatic peritumoral density was not positively related to any of the clinic-pathological and clinic-histological characteristics analyzed, however, the lymphatic density distal to the tumor demonstrated statistical significance in the relationship with the body mass index, the number of isolated positive lymph node, the depth of invasion of the tumor and the lymph node involvement. Conclusion: The biological role of the lymph vessels in the tumor progression remains controversial. Only the lymphatic density was correlated with the clinic-pathological and clinic-histological parameters in distal regions to the tumor which reflects the importance of a well-executed surgical technique. Further studies are still needed to understand the role of the lymphangiogenesis in the tumor dissemination.
Introduction: Colorectal cancer presents itself as one of the most common neoplasms in developed countries. Their ability to metastization occurs by resource to blood vessels and/or lymphatic vessels. In recent decades the importance of lymphangiogenesis in cancer has been discussed being that as long as the surgical technique for total mesorectal excision (TME) demonstrated positive effects on local recurrences of rectal cancer and, later, with the proposal for the implementation of complete mesocolic excision (CME) surgical technique for colon cancer, the importance of maintaining the integrity of the mesocolon and consequent lymphatic network it is been keeping himself in intense debate. Until the moment has not yet been understood the true benefit of maintaining the integrity of the lymphatic network and, as such, the routine implementation of the CME has not yet occurred. Objective: Determine, in patients with colon adenocarcinoma, the mesenteric lymphatic density in peritumoral regions and in distal regions to the tumor and correlate the lymphatic density mesenteric with different clinic-pathological and clinic-histological features. Methods: Participated in this study 49 patients with adenocarcinoma of the colon with stages T2 and T3. The evaluation of mesenteric lymphatic density was carried out by immunohistochemistry using the antibody monoclonal D2-40 of podoplanin. It was also evaluated the influence that several clinic-pathological and clinic-histological features could have in mesenteric lymphatic density using the IBM SPSS statistical program. Results: There were higher lymphatic densities in the peritumoral region compared to the distal regions of the tumor. The lymphatic peritumoral density was not positively related to any of the clinic-pathological and clinic-histological characteristics analyzed, however, the lymphatic density distal to the tumor demonstrated statistical significance in the relationship with the body mass index, the number of isolated positive lymph node, the depth of invasion of the tumor and the lymph node involvement. Conclusion: The biological role of the lymph vessels in the tumor progression remains controversial. Only the lymphatic density was correlated with the clinic-pathological and clinic-histological parameters in distal regions to the tumor which reflects the importance of a well-executed surgical technique. Further studies are still needed to understand the role of the lymphangiogenesis in the tumor dissemination.
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Keywords
Linfangiogénese Excisão completa do mesocólon Podoplanina Densidade linfática peritumoral Densidade linfática distal ao tumor