Various immunostaining patterns of CD31, CD34 and endoglin and their relationship with lymph node metastasis in oral squamous cell carcinomas

Correlation of Pattern of Invasion, Stromal Inflammation and Lymphovascular Invasion With Histopathological Grading in Oral Squamous Cell Carcinoma: A Retrospective Study

INTRODUCTION

Despite the progress in diagnostics and treatment modalities, the survival rate of oral squamous cell carcinoma (OSCC) patients has remained unchanged. Early diagnosis of the disease helps in better treatment and prognosis. Identifying clinicopathological and histopathological parameters that help predict disease progression is crucial.

OBJECTIVES

To assess the significance of various clinical and histopathological factors in OSCC and to correlate the patterns of invasion of tumour (POI), stromal inflammation, and lymphovascular invasion with the histopathological grading of OSCC.

MATERIALS AND METHODS

This study included 30 oral squamous cell carcinoma cases from 2015 to 2021. The surgically operated cases of OSCC were obtained from the archives of the Oral Pathology Department. The subjects were categorized according to the degree of differentiation of OSCC. The parameters like the pattern of invasion of tumour (POI), stromal inflammation, and lymphovascular invasion were assessed and correlated with the different histopathological grades of OSCC.

RESULTS

We observed a statistically significant correlation between the pattern of invasion and stromal inflammation with histopathological grades of OSCC. There was no significant association between lympho-vascular invasion and histopathological grades of OSCC.

CONCLUSION

We conclude that histopathological parameters like the pattern of invasion and stromal inflammation significantly impact different grades of OSCC. These parameters should be included in routine histo-pathological reports for predicting clinical outcomes and management of the disease.

Role of tissue markers associated with tumor microenvironment in the progression and immune suppression of oral squamous cell carcinoma

Head and neck cancers (HNC) continues to dominate major cancers contributing to  mortality worldwide. Squamous cell carcinoma is the major type of HNC. Oral Squamous Cell Carcinoma grouped under HNC is a malignant tumor occurring in the oral cavity. The primary risk factors of OSCC are tobacco, alcohol consumption, etc. This review focuses on modulations, mechanisms, growth and differentiation of oral squamous cell carcinoma. Cancer cell surrounds itself with a group of elements forming a favorable environment known as tumor microenvironment (TME). It consists of numerous cells which includes immune cells, blood cells and acellular components that are responsible for the progression, immunosuppression, metastasis and angiogenesis of cancer. This review highlights the most important tissue biomarkers (mTOR, CAF, FOXp3, CD163, CD33, CD34) that are associated with TME cells. mTOR remains as the primary regulator responsible in cancer and its importance towards immune-suppression is highlighted. Tumor-associated macrophages associated with cancer development and its relationship with immunomodulatory mechanism and Tregs, which are potential blockers of immune response and its mechanism and aberrations are discussed. Cancer-associated fibroblasts that are a part of TME and their role in evading the immune response and myeloid derived suppressor cells that have slight control over the immune response and their mechanism in the tumor progression is further explained. These markers have been emphasised as therapeutic targets and are currently in different stages of clinical trials.

Endoglin in head and neck neoplasms

Tumors of the head and neck region form a heterogeneous group of pathologies, including various benign lesions and malignant neoplasms. Endoglin, also known as CD105, is an accessory receptor for transforming growth factor beta (TGF-β), that regulates angiogenesis, both under physiological and pathological conditions. It is highly expressed in proliferating endothelial cells. Therefore, it is considered as a marker of tumor-related angiogenesis. In this review we discuss the role of endoglin as a possible marker of carcinogenesis, as well as a potential target for antibody-based therapies in the neoplasms of the head and neck region.

Study of expression of endoglin (CD105) in oral squamous cell carcinoma

Context:

Oral cancer is the 8^th most common cancer in the world. An important feature of carcinogenesis is angiogenesis. Endoglin is a powerful marker of neovascularization in solid malignancies. This study was done to ascertain its role as an indicator of metastasis and prognosis.

Aim:

This study aimed to evaluate and compare the expression of endoglin (CD105) in metastatic primary tumor, lymph node of the metastasized tumor, nonmetastatic primary tumor and in normal buccal mucosa immunohistochemically.

Settings and Design:

The total sample size comprised 45 formalin-fixed paraffin-embedded tissue blocks, n = 10 metastasized primary tumor, n = 10 lymph nodes of metastasized primary tumor, n = 20 nonmetastasized oral squamous cell carcinoma and n = 5 normal buccal mucosa were studied.

Subjects and Methods:

Immunohistochemistry for endoglin was performed and microvessel density (MVD) was determined by hot spot method. Microvessel density was compared between the groups.

Statistical Analysis:

Statistical analysis was used using one-way ANOVA. P < 0.05 was statistically significant.

Results:

Endoglin expression in metastatic cases (0.68 + 0.10) was higher than nonmetastatic cases (0.45 + 0.20) and the difference was statistically significant (P = 0.002).

Conclusion:

This study shows that presence of endoglin determines the metastatic potential of the tumor and its prognosis, thus, could be considered as a potential target of therapy.

Histological evaluation of a novel phosphorylated pullulan-based pulp capping material: An in vivo study on rat molars

AIM

To evaluate the dental pulp response to a novel mineral trioxide aggregate containing phosphorylated pullulan (MTAPPL) in rats after direct pulp capping.

METHODS

Ninety-six cavities were prepared in the maxillary first molars of 56 male Wistar rats. The dental pulps were intentionally exposed and randomly divided into four groups according to the application of pulp capping materials: MTAPPL; phosphorylated pullulan (PPL); a conventional MTA (Nex-Cem MTA, NCMTA; positive control); and Super-Bond (SB; negative control). All cavities were restored with SB and observed for pulpal responses at 1-, 3-, 7- and 28-day intervals using a histological scoring system. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U-test with Bonferroni's correction, and the level of significance was set at 0.05. DMP1 and CD34 antigen were used to evaluate odontoblast differentiation and pulpal vascularization, respectively.

RESULTS

On day 1, mild inflammatory cells were present in MTAPPL and NCMTA groups; fewer inflammatory cells were present in the PPL, whereas SB was associated with a mild-to-moderate inflammatory response. A significant difference was observed between PPL and SB (p < .05). No mineralized tissue deposition was observed. On day 3, moderate-to-severe inflammatory cells were present in PPL and SB, whereas MTAPPL and NCMTA had a mild inflammatory response. Initial mineralized tissue deposition was observed in the NCMTA, MTAPPL and SB. A significant difference was observed between MTAPPL and PPL (p < .05). On day 7, a thin layer of mineralized tissue was observed in all tested groups with no or mild inflammatory response. On day 28, no inflammatory response was observed in MTAPPL, whereas NCMTA, PPL and SB had mild inflammatory responses. A significant difference was observed between MTAPPL and SB (p < .05). Complete mineralized tissue barrier formation was observed in MTAPPL, NCMTA and PPL with no significant difference (p > .05). SB exhibited incomplete mineralized tissue barriers, significantly different from NCMTA, MTAPPL and PPL (p < .05). The staining with CD34 was positive in all the groups on all observation days.

CONCLUSION

The favourable pulpal responses and induction of mineralized tissue formation associated with MTAPPL indicate its potential application as a direct pulp capping material.

Histopathological Factors in Oral Squamous Cell Carcinoma-Should a Clinician Look Beyond Clinical Staging?

PURPOSE

Several researchers have proposed and investigated the prognostic implications of various parameters, but have failed to provide concrete evidence regarding the inclusion or exclusion of histopathological features while clinically managing an oral squamous cell carcinoma (OSCC) case. The study purpose was to measure the prognostic values of a set of key histologic features and its association with its clinical outcome-5-year survival.

MATERIALS AND METHODS

This is a prospective cohort study and the sample was composed of patients treated for OSCC (April 2014 - March 2015). The predictor variables included pattern of tumor invasion (POI), stromal inflammation, angiogenesis, and vascular invasion with the outcome being survival of subjects observed over this 5-year period. Sociodemographic data (age, sex, marital status, systemic disease, habits etc), clinical staging and TNM staging were also recorded. We used multivariate regression analysis for predictor analysis; Kaplan-Meier survival curves and Cox hazard modeling was also performed using the data.

RESULTS

This article includes 50 subjects with a mean age of 54.94 years and 58% were male and their characteristics collected at the baseline and at a 12-, 24-, 36-, 48-, and 60-month follow-up. The overall 5-year survival was 48%. We saw a significant association between N-stage and POI (0.027), T-stage and mean vascular density (0.042), and T-stage and vascular invasion (0.046). POI, angiogenesis, and vascular invasion were found as significant predictors of overall 5-year survival (P < .001).

CONCLUSIONS

This study shows that histopathological parameters such as POI are important while determining the clinical outcome of OSCC. Histopathological parameters such as angiogenesis and vascular invasion can provide valuable information about the overall survival and prognosis.

Desmin and CD31 immunolabeling for detecting venous invasion of the pancreatobiliary tract cancers

Although venous invasion (VI) is a poor prognostic factor for patients with pancreatobiliary tract cancers, its histopathologic characteristics have not been well described. We evaluated the patterns of VI and the added benefit provided by CD31, desmin, and dual CD31‒desmin immunolabeling for identification of VI. We included 120 surgically resected pancreatobiliary tract cancer cases—59 cases as a test set with known VI and 61 cases as a validation set without information of VI. VI was classified into three patterns: intraepithelial neoplasia-like (IN-like), conventional, and destructive. Hematoxylin and eosin (H&E) staining and CD31, desmin, and dual CD31‒desmin immunolabeling were performed. Foci number and patterns of VI were compared with the test and validation sets. More foci of VI were detected by single CD31 (P = 0.022) than H&E staining in the test set. CD31 immunolabeling detected more foci of the conventional pattern of VI, and desmin immunolabeling detected more foci of the destructive pattern (all, P < 0.001). Dual CD31‒desmin immunolabeling identified more foci of VI (P = 0.012) and specifically detected more foci of IN-like (P = 0.045) and destructive patterns (P < 0.001) than H&E staining in the validation set. However, dual CD31‒desmin immunolabeling was not helpful for detecting the conventional pattern of VI in the validation set. Patients with VI detected by dual CD31‒desmin immunolabeling had shorter disease-free survival (P <0.001) than those without VI. VI detected by dual CD31‒desmin immunolabeling was a worse prognostic indicator (P = 0.009). More foci of VI could be detected with additional single CD31 or dual CD31‒desmin immunolabeling. The precise evaluation of VI with dual CD31‒desmin immunolabeling can provide additional prognostic information for patients with surgically resected pancreatobiliary tract cancers.

Assessment of Tumor Angiogenesis by Expression of CD 105 in Ameloblastoma, Odontogenic Keratocyst and Central Giant Cell Lesion

Background:

Angiogenesis is critical for tumor growth and reflects the aggressive behavior of invasive odontogenic lesions [like amelogenesis (AM) (AM), Odontogenic Keratocyst (OKC) and Central giant cell lesion (CGCL)]. Mean vascular density (MVD) shows the angiogenic potential and CD105 is an ideal endothelial biomarker due to its specificity to new blood vessels for MVD detection. The aim of the study was to compare the MVD (angiogenic potential) among AM, OKC and CGCL in comparison to Pyogenic Granuloma (PG) using CD105 biomarker.

Methods:

Sixty-four primary cases of odontogenic invasive tumors (AM, OKC and CGCL) and PG, diagnosed clinically and histologically were included in the study, with 16 samples in each group. Tissue samples of peripheral AM, Peripheral GCL of jaws, malignant AM, and specimen with insufficient tissue were excluded. Tissue sections were embedded, processed and stained using Hematoxylin and Eosin (H and E). Immunohistochemistry was performed using antibodies against CD105, with positive brown cytoplasmic staining in the endothelial cells of neo-vasculature. Distinct countable, positively stained endothelial cell or clusters were evaluated under light microscope for identification of MVD. ANOVA and t-test were applied for statistical analysis of data.

Results:

Highest MVD was displayed in CGCL (32.99±0.77) and the minimum was observed in OKC (7.21± 0.75) respectively. CGCL showed significantly higher MVD to AM, OKC and PG lesions (p<0.05). AM (8.07± 0.36) and Odontogenic Keratocyst (7.21± 0.75) showed comparable MVD, which was lower than PG (14.7± 0.96) and CGCL vascular density (p < 0.01) respectively.

Conclusion:

CGCL was most aggressive, with highest MVD among the investigated odontogenic lesions (OKC, AM and PG). The proliferative aggressive behavior of Odontogenic Keratocyst is comparable to AM due to comparable mean vascular density.

Pattern of tumor invasion, stromal inflammation, angiogenesis and vascular invasion in oral squamous cell carcinoma - A prognostic study

INTRODUCTION

Oral cancer is one of the leading causes of mortality, and its worsening impact on the society has revealed the danger it poses in the coming future. Several researchers proposed and investigated the prognostic implications of various clinicopathologic and histopathologic parameters.

AIM AND OBJECTIVES

The aim of this study--assessing significance of histopathological features like pattern of tumor invasion, stromal inflammation, angiogenesis and vascular invasion on the clinical outcome of oral squamous cell carcinoma any possible correlations between the parameters, TNM Staging and prognosis were assessed and evaluated for a 5-year period.

MATERIALS AND METHODS

This study includes description of 50 diagnosed cases (mean age: 61.40, 29 males, and 21 females) of oral squamous cell carcinoma and their characteristics collected at baseline and at a 12-month follow up. The cases were grouped on the basis of their histological grade (well-differentiated, moderately differentiated, and poorly-differentiated).

RESULTS

All the data collected was tabulated in a baseline descriptive table, and all the parameters were compared between the 3 different histological groups. On cross-tabulations we found statistical significant difference the parameters of stromal inflammation with recurrence, clinical stage with T-stage, T-stage with N-stage, and N-stage with clinical stage. On analysis of the follow up we found 16 patients (32%) with recurrence and 9 patients (18%) succumb to the disease.

CONCLUSION

This study provides a significant insight on the importance of a combined histopathological analysis and clinical staging process to deliver an accurate prognostic opinion and also subsequently effect the treatment protocol.

Correlation of narrow band imaging vascular patterns with immunohistological microvessel density in vocal fold lesions

INTRODUCTION

The microarchitecture of the mucosal and submucosal vessels is crucial for diagnosis of vocal fold lesions. Neo-angiogenesis is a confirmed biological parameter that implicates progression and metastasis in laryngeal cancer.

OBJECTIVE

This study investigates the correlation between vascular pattern classifications by narrow band imaging and immunohistological microvessel density in different types of intraepithelial vocal fold lesions.

METHODS

Analysis of immunohistological microvessel density using CD31 and CD34 antibodies was performed in 77 lesions including: 20 non-dysplastic lesions, 20 with low-grade dysplasia, 17 with high-grade dysplasia and 20 invasive cancers. The evaluation of vascular patterns with narrow band imaging according to the Ni classification and European Laryngological Society guidelines was performed prior to surgical resection.

RESULTS

The mean value of CD31 microvessel density was the highest for Ni Type IV lesions (20.55), whereas for the longitudinal and perpendicular patterns according to the European Laryngological Society classification it was 12.50 and 19.45 respectively. The highest mean value of microvessel density with CD 34 was identified in Ni Type Va (35.43) lesions and in the longitudinal and perpendicular patterns according to the European Laryngological Society classification was 15.12 and 30.40 respectively.

CONCLUSIONS

The microvascular morphological changes of intraepithelial laryngeal lesions observed under narrow band imaging endoscopy are positively correlated with angiogenesis indexes of immunohistological evaluation.

Relationship Between Apoptosis of Endplate Microvasculature and Degeneration of the Intervertebral Disk

OBJECTIVE

To explore the relationship between intervertebral disk degeneration and endplate microvasculature, and to determine the role of apoptosis in the pathophysiology underlying end plate microvasculature.

METHODS

Twelve 6-month-old rabbits were randomly divided into group A (control group where animals underwent a sham operation, in which the loading device was implanted but without loading) and group B (degeneration group, where a calibrated spring within the loading device would immediately create static shear force of 50 N to the disk of L4-5). Paraffin-embedded midsagittal sections of the L4-5 disk were obtained 4 weeks after surgery in the both groups. Sections were stained with cluster of differentiation (CD) 31 immunohistochemistry to measure the blood vessel density in the endplate, with CD31 immunofluorescence and terminal dUTP nick-end labeling (TUNEL) to detect the apoptosis of vascular endothelial cells in the endplate.

RESULTS

After 4 weeks, the microvasculature density was 91 ± 8 vessels/mm² in group A and 47 ± 2 vessels/mm² (P < 0.001) in group B, demonstrating that vessels were reduced in the endplate of intervertebral disk degeneration. CD31 immunofluorescence and TUNEL showed that apoptosis of vascular endothelial cells exists in the endplate of intervertebral disk degeneration.

CONCLUSIONS

The results of this study suggest that apoptosis of vascular endothelial cells results in a decrease in endplate microvasculature density, further affecting the pathologic process of intervertebral disk degeneration.

Gellan Gum-based luminal fillers for peripheral nerve regeneration: an in vivo study in the rat sciatic nerve repair model

Peripheral nerve injuries (PNI) resulting in a gap to be bridged between the transected nerve ends are commonly reconstructed with autologous nerve tissue, but there is a need for valuable alternatives. This experimental work considers the innovative use of the biomaterial Gellan Gum (GG) as a luminal filler for nerve guidance channels made from chitosan with a 5% degree of acetylation. The engineered constructs should remodel the structural support given to regenerating axons by the so-called bands of Büngner. Four different GG formulations were produced by combining varying amounts of High-Acyl GG (HA-GG) and Methacrylated GG (MA-GG). The effective porosity of the freeze-dried networks was analysed by SEM and micro-CT 3D reconstructions, while the degradation and swelling abilities were characterized in vitro for up to 30 days. The metabolic activity and viability of immortalized Schwann cells seeded onto the freeze-dried networks were also evaluated. Finally, the developed hydrogel formulations were freeze-dried within the chitosan nerve guides and implanted in a 10 mm rat sciatic nerve defect. Functional and histomorphological analyses after 3, 6, and 12 weeks in vivo revealed that although it did not result in improved nerve regeneration, the NGC25:75 formulations could provide a basis for further development of GG scaffolds as luminal fillers for hollow nerve guidance channels.

Endoglin-targeted contrast-enhanced ultrasound imaging in hepatoblastoma xenografts

Angiogenesis is required for the growth of hepatoblastoma (HB). In the present study, an ultrasonic contrast agent, microbubbles (MB), was combined with an endoglin antibody, and then injected into nude mice with HB. This was conducted to detect specific binding to microvessels via non-linear harmonic imaging for tumor angiogenesis assessment. In addition, endoglin expression in experimental animals was measured using western blotting, reverse transcription-quantitative polymerase chain reaction and immunohistochemistry. In vitro, human umbilical vein endothelial cells (HUVECs) were co-cultured with conditioned media collected from HepG2 cells. Western blotting and reverse transcription-quantitative PCR was performed to detect the changes of endoglin expression. In targeted ultrasound imaging, it was determined that the differential targeted enhancement of MB_endoglin was significantly higher than that of MB_isotype. Over expression of endoglin was identified in the tumor of experimental nude mice; however, it was not present in the liver of the mice. Endoglin expression in HUVECs was significantly increased by co-culture with the conditioned media of HepG2 cells; therefore, the results suggest that endoglin is upregulated in angiogenic vessels in the HepG2 cell xenografts in nude mice. Thus, endoglin-targeted ultrasound imaging is presented as a potential approach for the diagnosis of liver carcinoma.

Nestin-positive microvessel density is an independent prognostic factor in breast cancer

The process of angiogenesis based on new vessel formation within the tumour area plays a significant role in the progression of breast cancer. Nestin is an intermediate filament protein and participates in the cytoskeleton organization. Nestin expression in the endothelium of blood vessels is mainly limited to newly forming vessels, thus being a more specific marker of angiogenesis than the commonly used vascular antigens. The aim of this study was to determine the prognostic value of nestin-positive microvessel density (Nes+MVD) in breast cancer patients and to confirm that nestin expression is related to newly forming tumour vessels. In this study, 137 cases of ductal breast carcinoma and 19 cases of non-malignant breast tissue lesions (NBTLs) were examined. Immunohistochemical reactions were performed on paraffin sections using antibodies against nestin, CD34 and CD31 antigens. For each marker, the microvessel density (MVD) was determined. Nestin expression was also examined in human endothelial cell lines (HUVEC-SVT, HMEC-1 and HEPC-CB.1) representing a different level of endothelial cell maturity. HUVEC-SVT and HMEC-1 cells represent the endothelium of mature vessels, whereas HEPC-CB.1 cells represent the early endothelial progenitor cells (EPCs). We have demonstrated that high Nes+MVD may be associated with a more aggressive course of the disease and a poorer prognosis. We have also found a higher Nes+MVD in the cases with lymph node metastases, with higher histological grade, with advanced-stage disease and with the triple-negative (TN) breast cancer. In addition, nestin expression in vessels was associated with a shorter overall survival (OS) and earlier relapse, and in the case of OS nestin was an independent prognostic factor. Finally, we further confirmed that nestin expression in endothelial cells reflects a progenitor nature of newly forming vessels.

Mast cells and angiogenesis in malignant and premalignant oral lesions: An immunohistochemical study

Introduction and Objectives:

Angiogenesis is a complex event facilitated by angiogenic factors released from neoplastic and host immune cells. Among host immune cells, mast cells (MCs) may have greater significance in tumor progression through angiogenesis. The objectives of the study were to evaluate and correlate mast cell density (MCD) and microvessel density (MVD) in normal gingival tissue, leukoplakia with and without dysplasia and oral squamous cell carcinoma (OSCC) cases.

Materials and Methods:

Among eighty selected cases, twenty were of normal gingiva, twenty each of leukoplakia without and with dysplasia and twenty of OSCC. The slides were stained with CD34 and counterstained with 0.1% toluidine blue, followed by quantification of MCD and MVD per high-power field (×40) using Image-Pro Express software.

Statistical Analysis:

Chi-square test and correlation coefficient were used for statistical analysis.

Observation and Results:

A statistically significant difference in the values of MVD and MCD between normal gingival tissue, leukoplakia with and without dysplasia and OSCC (P = 0.000) was observed. MVD and MCD showed a positive correlation between the study groups.

Conclusion:

MVD and MCD increased significantly in cases of OSCC as compared to leukoplakia with and without dysplasia and normal gingival tissue. It was concluded that MCs may play a significant role in angiogenesis by releasing pro-angiogenic and angiogenic factors which may in turn favor the progression of premalignant lesion to a malignant one.

Late Effects of Head and Neck Radiotherapy on Pulp Vitality Assessed by Pulse Oximetry

INTRODUCTION

Radiation therapy (RT) of malignant tumors in the head and neck area may have damaging effects on surrounding tissues. The aim of this investigation was to evaluate the long-term effects of ionizing radiation on pulp vitality by measuring pulp oxygenation levels (%SpO2) in patients with history of RT of intraoral and oropharyngeal tumors 4-6 years after treatment.

METHODS

In an experimental group RT (n = 90, history of RT) and a control group CON (n = 90, no history of RT), pulp vitality was assessed by measuring %SpO2 by using pulse oximetry and pulp sensitivity by cold thermal testing. All anterior teeth without history of endodontic therapy of the participants in group RT were measured (n = 693), regardless of the quadrant and the irradiated area. An equal number of anterior teeth were tested in group CON.

RESULTS

There was no significant difference between the %SpO2 levels in group RT (92.7%; standard deviation, ± 1.83) and group CON (92.6%; standard deviation, ± 1.80). All teeth in RT and CON groups showed a positive response to the thermal test. All tested teeth were considered vital.

CONCLUSIONS

Pulp %SpO2 was found to be within normal limits 4-6 years after RT. This suggests that RT may not have a long-term influence on pulp vitality, and reported short-term changes in pulpal microcirculation because of RT may be temporary.

Introducing Cytology-Based Theranostics in Oral Squamous Cell Carcinoma: A Pilot Program

We aimed to evaluate the feasibility and reliability of brush cytology in the biomarker expression profiling of oral squamous cell carcinomas within the concept of theranostics, and to correlate this biomarker profile with patient measurable outcomes. Markers representative of prognostic gene expression changes in oral squamous cell carcinoma was selected. These markers were also selected to involve pathways for which commercially available or investigational agents exist for clinical application. A set of 7 markers were analysed by immunocytochemistry on the archival primary tumour material of 99 oral squamous cell carcinoma patients. We confirmed the feasibility of the technique for the expression profiling of oral squamous cell carcinomas. Furthermore, our results affirm the prognostic significance of the epidermal growth factor receptor (EGFR) family and the angiogenic pathway in oral squamous cell carcinoma, confirming their interest for targeted therapy. Brush cytology appears feasible and applicable for the expression profiling of oral squamous cell carcinoma within the concept of theranostics, according to sample availability.

Microvessel Landscape Assessment in Pancreatic Ductal Adenocarcinoma: Unclear Value of Targeting Endoglin (CD105) as Prognostic Factor of Clinical Outcome

OBJECTIVES

Tumor angiogenesis based on microvessel density assessment has been associated with poor prognosis in several studies of patients with pancreatic ductal adenocarcinoma (PDAC). Expression of endoglin (CD105), a tumor-induced vascularization marker, has been found to represent a negative prognostic factor in many malignant tumors. The aim of our study was to assess the value of tumoral microvascularity both with pan-endothelial markers and endoglin as well, in correlation with the clinical outcome of patients with PDAC.

METHODS

Fifty-eight patients with PDAC, 36 males and 22 females, with a mean (SD) age of 65.4 (10.0) years were included in the study. Deparaffinized sections from formalin-fixed areas both from the center and periphery (invasion front) of the tumors were immunostained for CD105 as well as for the endothelial markers CD31 and CD34. Tumoral angiogenesis was assessed on the basis of microvessel density (number of vessels per square millimeter) and on microvascular area (square micrometers) as well.

RESULTS

High intratumoral microvascular area, in endoglin-stained sections, was found to be of marginal prognostic significance for recurrence (log rank, P 0.05). Survival was also marginally associated with CD31 intratumoral microvascular area (log rank, P 0.05).

CONCLUSIONS

Further studies are needed before endoglin replaces the conventional angiogenesis markers in PDCA.

Characterization, Localization and Patterning of Lymphatics and Blood Vessels in Oral Squamous Cell Carcinoma: A Comparative Study Using D2-40 and CD-34 IHC Marker

OBJECTIVES

Lymphatic metastasis has always been regarded as a major prognostic indicator for disease progression and as a guide for therapeutic strategies to oral squamous cell carcinoma (OSCC). Differentiating lymphatic vessels from blood vessels is difficult, partly due to lack of specific method for identifying lymphatics. A new lymphatic vessel reactive antibody D2-40 has been introduced recently. Here we examined immunohistochemical localization of lymphatic vessels and blood vessels using D2-40 and CD-34 respectively in different histological grades of OSCC. Their expression in intra-tumoural and peri-tumoural region was also compared.

MATERIALS AND METHODS

Forty two formalin-fixed paraffin-embedded tissue blocks of excised specimens of OSCC were immunohistochemically evaluated using D2-40 and CD-34 antibodies. Lymphatic vessel density (LVD) (D2-40 positivity) and micro vessel density (MVD) (CD34 positivity) in both intratumoural and peritumoural areas were assessed by hot spot method.

RESULTS

Regardless of histopathological differentiation, LVD-- and MVD in peritumoural areas were found greater than intratumoural areas (p>0.05). Interestingly, other than lymphatic vessels, D2-40 positivity was also detected in tumour cells as well as in basal layer of epithelium adjacent to OSCC. Two patterns of distribution of CD34 positive vessel - circumscribing type and penetrating type were also observed in the cancer nest area.

CONCLUSION

D2-40 can be used as a marker to differentiate lymphatic vessels from blood vessels. Lymphatic and blood vessel proliferation might be much more extensive in the peritumoural area. D2-40 expression in epithelium adjacent to tumour indicates its role in the process of differentiation. Further, its expression in potential malignant disorder may provide better insight in predicting prognosis and pathogenesis of these lesions.

Expression of CD34 and maspin in ameloblastoma from a West African subpopulation

Ameloblastoma is a locally invasive odontogenic tumor with a high recurrence rate. Its local invasiveness is aided by angiogenesis, which can be correctly estimated by CD34. On the other hand, maspin decreases the local invasive and metastatic capability of cancer cells and functions as an angiogenesis inhibitor. We aim to assess the association between maspin expression and microvessel density in ameloblastoma. Twenty-five formalin-fixed paraffin-embedded (FFPE) blocks of ameloblastoma cases were prepared for antibody processing to CD34 and maspin. Positive immunohistochemical staining was marked by brown cytoplasmic/membrane coloration for CD34 and by nuclear/cytoplasmic coloration for maspin. At the ×40 magnification, we counted blood vessels in two areas of dimension; 300 × 400 μm (area A) and 150 × 200 μm (area B) adjacent to the tumor region to assess relative dispersion of the vessels bordering the tumor. The overall approximate microvessel density (MVD) for area A = 11 (minimum 2, maximum 21) and that for area B = 5 (minimum 1, maximum 10). The MVD in the area A of plexiform ameloblastoma was similar to that of the unicystic, while the hemangiomatous variant had the highest MVD for area A. Maspin positivity was present only in the cytoplasm of ameloblast, stellate reticulum, and the fibrous connective tissue in varying proportions. There was no evidence of the anti-angiogenesis effect of maspin in ameloblastoma from this study. The significance of cytoplasmic localization of maspin in the ameloblasts and stellate reticulum cells needs further investigation.

VEGF and CD 34: A correlation between tumor angiogenesis and microvessel density-an immunohistochemical study

Background:

Angiogenesis is the formation of new vessels from preexisting ones which takes place by capillary sprouting. It is seen in healing, at sites of injury and collateral circulation in ischemia. It is also seen in tumors, as once the original blood supply of a tumor is exhausted it cannot grow without further blood supply. Also as the angiogenic capacity of a tumor increases, its microvasculature, that is, microvessel density (MVD) also increases. Based on this literary evidence we carried out an immunohistochemical (IHC) study to observe the relationship between the expression of vascular endothelial growth factor (VEGF) [angiogenesis] and CD 34 [MVD] in oral squamous cell carcinoma (OSCC).

Aim:

To evaluate the correlation between expression of VEGF and CD 34, the role of MVD in progression of OSCC and to compare the degree of angiogenesis in different grades of OSCC.

Settings and Design:

In this study we observed the relation between angiogenesis and MVD and the overall effect of this on oral cancer.

Materials and Methods:

Thirty-three cases of OSCC were stained with hematoxylin and eosin, (H and E) to confirm the diagnosis and immunohistochemically using VEGF and CD 34 antibody. The slides were evaluated for positivity and intensity of staining.

Statistical Analysis:

The result was subjected to statistical analysis using analysis of variance (ANOVA) test and Fisher's exact test.

Results:

VEGF positivity as well as MVD was found to be independent of the grade of the tumor. Tumor MVD was found to be independent of expression of VEGF.

The distribution and ultrastructure of the forming blood capillaries and the effect of apoptosis on vascularization in mouse embryonic molar mesenchyme

Vascularization is essential for organ and tissue development. Teeth develop through interactions between epithelium and mesenchyme. The developing capillaries in the enamel organ, the dental epithelial structure, occur simultaneously by mechanisms of vasculogenesis and angiogenesis at the onset of dentinogenesis. The vascular neoformation in the dental mesenchyme has been reported to start from the cap stage. However, the mechanisms of vascularization in the dental mesenchyme remain unknown. In the hope of understanding the mechanisms of the formation of dental mesenchymal vasculature, mouse lower molar germs from embryonic day (E) 13.5 to E16.5 were processed for immunostaining of CD31 and CD34, terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) and transmission electron microscopy (TEM). In addition, the role of apoptosis for the vascularization in dental mesenchyme was examined by in vitro culture of E14.0 lower molars in the presence of the apoptosis inhibitor (z-VAD-fmk) and a subsequent subrenal culture. Our results showed that CD31- and CD34-positive cells progressively entered the central part of the dental papilla from the peridental mesenchyme. For TEM, angioblasts, young capillaries with thick endothelium and endothelial cells containing vacuoles were observed in peripheral dental mesenchyme, suggesting vasculogenesis was taking place. The presence of lateral sprouting, cytoplasmic filopodia and transluminal bridges in the dental papilla suggested angiogenesis was also occurring. Inhibition of apoptosis delayed the angiogenic vascularization of the dental papilla. Therefore, these data demonstrated that molar mesenchyme is progressively vascularized by mechanisms of both vasculogenesis and angiogenesis and apoptosis partially contributes to the vascularization of the dental papilla.

Immunohistochemical profiling of Ameloblastomas using cytokeratin, vimentin, smooth muscle actin, CD34 and S100

Background:

Ameloblastoma is characterized as a slow growing, non-metastatic and a locally invasive tumor with a high risk of recurrence. Immunohistochemical evaluation of ameloblastomas using epithelial and connective tissue specific markers help in studying the histogenesis and assessing the biological behavior. The aim of the study was to study the expression patterns of cytokeratin, vimentin, smooth muscle actin (SMA), S100 and CD34 in ameloblastomas.

Materials and Methods:

The material for the study consisted of 24 cases of ameloblastomas. The excised specimens were grossed and bits were taken from different areas of the specimen. Based on the histopathology, the cases were classified into different types and stained for immunohistochemistry.

Results:

The cases showed strong positivity to cytokeratin, vimentin, moderate positivity for SMA and S100. Five cases were also moderately positive for CD34 in blood vessels.

Conclusion:

The results and hypothesis achieved from the study, proved to be consistent, not only augmenting the already existing hypothesis but also imparting new concepts of hypothesis.

Human adipose tissue-derived SSEA-4 subpopulation multi-differentiation potential towards the endothelial and osteogenic lineages

Human adipose tissue has been recently recognized as a potential source of stem cells for regenerative medicine applications, including bone tissue engineering (TE). Despite the gathered knowledge regarding the differentiation potential of human adipose tissue-derived stem cells (hASCs), in what concerns the endothelial lineage many uncertainties are still present. The existence of a cell subpopulation within the human adipose tissue that expresses a SSEA-4 marker, usually associated to pluripotency, raises expectations on the differentiation capacity of these cells (SSEA-4(+)hASCs). In the present study, the endothelial and osteogenic differentiation potential of the SSEA-4(+)hASCs was analyzed, aiming at proposing a single-cell source/subpopulation for the development of vascularized bone TE constructs. SSEA-4(+)hASCs were isolated using immunomagnetic sorting and cultured either in α-MEM, in EGM-2 MV (endothelial growth medium), or in osteogenic medium. SSEA-4(+)hASCs cultured in EGM-2 MV formed endothelial cell-like colonies characterized by a cobblestone morphology and expression of CD31, CD34, CD105, and von Willebrand factor as determined by quantitative reverse transcriptase (RT)-polymerase chain reaction, immunofluorescence, and flow cytometry. The endothelial phenotype was also confirmed by their ability to incorporate acetylated low-density lipoprotein and to form capillary-like structures when seeded on Matrigel. SSEA-4(+)hASCs cultured in α-MEM displayed fibroblastic-like morphology and exhibited a mesenchymal surface marker profile (>90% CD90(+)/CD73(+)/CD105(+)). After culture in osteogenic conditions, an overexpression of osteogenic-related markers (osteopontin and osteocalcin) was observed both at molecular and protein levels. Matrix mineralization detected by Alizarin Red staining confirmed SSEA-4(+)hASCs osteogenic differentiation. Herein, we demonstrate that from a single-cell source, human adipose tissue, and by selecting the appropriate subpopulation it is possible to obtain microvascular-like endothelial cells and osteoblasts, the most relevant cell types for the creation of vascularized bone tissue-engineered constructs.

Localization and characterization of lymphatic vessels in oral and cervical squamous cell carcinoma

Lymph node metastasis is considered a factor in determining the prognosis of squamous cell carcinoma (SCC). Both oral and cervical SCC tumor cells prefer lymph vessels as the route of metastasis. D2-40 is a specific marker of lymphatic endothelial cells. This study clarifies the distribution and characteristics of lymphatic vessels in oral and cervical SCCs. Immunohistochemistry was performed in 20 oral and 20 cervical SCCs (10 non-metastatic and 10 metastatic to lymph nodes) using D2-40, CD31, CD34, CD105 and double staining with D2-40 and keratin. Lymphatic vessel density (LVD) was also determined morphologically. Results showed that lymphatic vessels in both types of SCCs were distributed mainly at the superficial region beneath the epithelium. The LVD in each tumor was significantly higher compared to the corresponding normal mucosa. Moreover, the LVD in lymph node metastasis in each tumor was significantly higher compared to their non-metastatic counterparts. Cancer cell invasion was observed in the lymphatic vessels suggesting the existence of lymph node involvement during metastasis. The new lymphatic vessels that proliferated around the cancer nests in both SCCs have endothelial cell characteristics inferred to be associated with early lymphatic development and initial dissemination of cancer cells.

Pulp vitality in patients with intraoral and oropharyngeal malignant tumors undergoing radiation therapy assessed by pulse oximetry

INTRODUCTION

The aim of this study was to evaluate pulp oxygenation levels (%SpO(2)) in patients with malignant intraoral and oropharyngeal tumors treated by radiotherapy (RT).

METHODS

Pulp oxygenation levels were measured by pulse oximetry. Twenty patients were selected, and two teeth of each participant (n = 40) were analyzed, regardless of the quadrant and the area irradiated, at four different time points: TP1, before RT; TP2, at the beginning of RT with radiation doses between 30 and 35 Gy; TP3, at the end of RT with radiation doses between 60 and 70 Gy; and TP4, 4 to 5 months after the beginning of cancer treatment.

RESULTS

Mean %SpO(2) at the different time points were 93% (TP1), 83% (TP2), 77% (TP3), and 85% (TP4). The Student's t test showed statistically significant differences between TP1 and TP2 (P < .01), TP3 (P < .01), and TP4 (P < .01). TP3 was also statistically significantly different when compared with TP2 (P < .01) and TP4 (P < .01). No statistically significant difference could be observed between TP2 and TP4.

CONCLUSIONS

Because the mean %SpO(2) before RT was greater than during and after therapy and values obtained 4 to 5 months after the beginning of RT were close to the initiation of RT, pulp tissue may be able to regain normal blood flow after RT. If the changes in the microcirculation of the dental pulp were indeed transitory, preventive endodontic treatment or extraction in patients who are currently undergoing or recently received RT and who show negative signs of pulp sensitivity may not be necessary for pulpal reasons.

Increased glucose metabolism by FDG-PET correlates with reduced tumor angiogenesis in oral squamous cell carcinoma

Hypoxia is known to have been related with angiogenesis and glycolysis, and may have an influence on tumor treatment effect. Because glucose utilization is higher in malignant cells than that in normal cells, dynamic glucose metabolism of tumor has been evaluated by means of [(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET). To investigate the significance of tumor vascularization in oral squamous cell carcinoma, we compared tumor angiogenesis with the FDG-PET findings. Twenty patients underwent FDG-PET. For the quantitative evaluation of FDG uptake in each tumor, the mean standardized uptake value (SUV) was calculated. Microvessel structures labeled with CD34 antigen were investigated in pretreatment biopsy specimens. Using an image analyzer, we calculated the following microvessel parameters: the ratio of the total number of microvessels (TN) to tumor area (TA), the ratio of the total microvessel perimeter (TP) to the TA, and the ratio of the tumor tissue area more than 150 μm distant from each microvessel (hypoxic ratio, %). The SUV was compared with the above parameters. Simple regression analysis revealed a statistical significance between the SUV and the TN:TA ratio (p = 0.046), as well as between the SUV and the TP:TA ratio (p = 0.0206). The SUV was found to be inversely related to the TN:TA and TP:TA ratios. Elevated glucose metabolism assessed by FDG-PET correlated with reduced vascularization. Higher glucose metabolism might therefore reflect a state of hypoxia.

CD105 is a marker of tumour vasculature and a potential target for the treatment of head and neck squamous cell carcinoma

BACKGROUND

The importance of angiogenesis in solid tumour growth is well recognised. Tumour angiogenesis is considered the result of an imbalance between pro- and anti-angiogenic factors produced by both the malignancy and normal cells. Endoglin (CD105) is a proliferation-associated, hypoxia-inducible glycoprotein that seems to be clinically superior to other pan-endothelial markers in the selective evaluation of tumour angiogenesis. Several studies have revealed CD105 up-regulation in a wide range of tumour endothelia. Since 2002, endothelial CD105 expression has also been retrospectively investigated in patients with head and neck squamous cell carcinoma (HNSCC).

METHODS

An exhaustive literature review was performed to investigate available evidence on CD105 expression and its biological role and therapeutic potential in HNSCC.

RESULTS

The available evidence supports the hypothesis that CD105 expression in HNSCC may be a valuable parameter for pinpointing patients at greater risk of recurrent malignancy and with a worse prognosis. A high CD105 expression in HNSCC was associated with metastatic lymph nodes in most of the studies.

CONCLUSIONS

Prospective studies are mandatory to confirm that CD105 expression is a significant prognostic hallmark in HNSCC. The results of prospective studies could be relevant for the adoption of stricter follow-up protocols and/or alternative therapeutic regimens for patients with a high CD105 expression in HNSCC. Great interest is currently being focused on vascular targeting for therapeutic purposes. Preclinical studies on appropriate animal models resembling HNSCC to investigate the effects of inhibiting CD105 may show the efficacy of combined treatment strategies associating angiogenic-targeted with conventional therapies for HNSCC.

Targeting cancer vasculature via endoglin/CD105: a novel antibody-based diagnostic and therapeutic strategy in solid tumours

Endoglin/CD105 is well acknowledged as being the most reliable marker of proliferation of endothelial cells, and it is overexpressed on tumour neovasculature. Our current knowledge of its structure, physiological role, and tissue distribution suggests that targeting of endoglin/CD105 is a novel and powerful diagnostic and therapeutic strategy in human malignancies, through the imaging of tumour-associated angiogenesis and the inhibition of endothelial cell functions related to tumour angiogenesis. Among biotherapeutic agents, monoclonal antibodies have shown a major impact on the clinical course of human malignancies of different histotypes. Along this line, the potential efficacy of anti-endoglin/CD105 antibodies and their derivatives for clinical purposes in cancer is supported by a large body of available pre-clinical in vitro and in vivo data. In this review, the main findings supporting the translation of antibody-based endoglin/CD105 targeting from pre-clinical studies to clinical applications in human cancer are summarized and discussed.

Angiogenesis and CD34 expression as a predictor of recurrence in oral squamous cell carcinoma

PURPOSE

To assess immunohistologic features of angiogenesis of T1N0M0 oral squamous cell carcinoma (OSCC), and to identify predictors of regional recurrence. The identification of prognostic markers of early lymph node involvement in OSCC could allow for the use of more targeted biologic therapies for patients with early-stage tumors.

PATIENTS AND METHODS

The study included patients treated for T1N0M0 OSCC at the Mayo Clinic from 1986 to 2001. All patients had initial surgical resection without neck dissection, and all had adequate follow-up with histologic specimens for review. Patients with lip, pharyngeal, or salivary gland tumors were excluded. Patient specimens were regraded and assessed for the histologic markers p53 and CD34 (penetrating and circumscribing patterns). The Kaplan-Meier method was used to estimate patient survival and survival free of regional recurrence.

RESULTS

The study included 175 patients. The overall 5-year survival was 75%, and 5-year survival free of regional recurrence was 80.3%. Twenty-eight patients had regional recurrence. High-grade tumors (P = .03) and the penetrating pattern of CD34 (P = .02) were significantly associated with early regional metastasis from early-stage OSCC. The presence of p53 was not independently associated as a marker for regional metastasis.

CONCLUSION

Early-stage T1 OSCC with high-grade lesions and a penetrating pattern of CD34 was associated with a statistically significant risk of cervical lymph node metastasis, compared with a circumscribing pattern of CD34.

Nanocapsule-delivered Sleeping Beauty mediates therapeutic Factor VIII expression in liver sinusoidal endothelial cells of hemophilia A mice

Liver sinusoidal endothelial cells are a major endogenous source of Factor VIII (FVIII), lack of which causes the human congenital bleeding disorder hemophilia A. Despite extensive efforts, gene therapy using viral vectors has shown little success in clinical hemophilia trials. Here we achieved cell type-specific gene targeting using hyaluronan- and asialoorosomucoid-coated nanocapsules, generated using dispersion atomization, to direct genes to liver sinusoidal endothelial cells and hepatocytes, respectively. To highlight the therapeutic potential of this approach, we encapsulated Sleeping Beauty transposon expressing the B domain-deleted canine FVIII in cis with Sleeping Beauty transposase in hyaluronan nanocapsules and injected them intravenously into hemophilia A mice. The treated mice exhibited activated partial thromboplastin times that were comparable to those of wild-type mice at 5 and 50 weeks and substantially shorter than those of untreated controls at the same time points. Further, plasma FVIII activity in the treated hemophilia A mice was nearly identical to that in wild-type mice through 50 weeks, while untreated hemophilia A mice exhibited no detectable FVIII activity. Thus, Sleeping Beauty transposon targeted to liver sinusoidal endothelial cells provided long-term expression of FVIII, without apparent antibody formation, and improved the phenotype of hemophilia A mice.

Gene silencing of transcription factor Gli2 inhibits basal cell carcinomalike tumor growth in vivo

Basal cell carcinoma (BCC) belongs worldwide to the most frequent malignancy among Caucasians. The understanding of the molecular mechanisms of BCC formation, which is a prerequisite for the development of efficient new therapies, is still incomplete. The formation of sporadic BCCs in the skin is associated with uncontrolled hedgehog signaling, and the transcription factor Gli2 has been identified as a key mediator or effector of this signaling. There is indication in the literature that preventing Gli2 function may inhibit BCC formation and growth in vivo; however, the mechanism is unclear and difficult to study in humans. Therefore, we used a mouse tumor allograft model to investigate the role of Gli2 in tumor formation. A constitutively Gli2 expressing mouse tumor cell line was stably transfected with Gli2-specific shRNA to induce Gli2 gene silencing or with control shRNA. Injecting the Gli2 gene silenced cells into nude mice for tumor formation we detected a strongly retarded tumor growth compared with control tumor cells. Investigating the mechanisms, we found that Gli2 gene silencing has led to the disruption of the tumor structure as demonstrated by staining tumor sections with hematoxylin. Two main reasons for the tumor destruction were identified. We found that apoptosis was markedly increased while vascularization was strongly decreased in these tumors. Thus, important functions of the transcription factor Gli2 in this tumor model are the prevention of apoptosis and the promotion of microvascularization.

Setup and characterization of a human head and neck squamous cell carcinoma xenograft model in nude rats

OBJECTIVE

To develop and characterize a new head and neck cancer animal model.

STUDY DESIGN

A human head and neck squamous cell carcinoma (HNSCC) xenograft model in nude rats was established via subcutaneous inoculation of a human-origin HNSCC cell line, SCC-4. The tumor was evaluated for growth characteristics, pathologic features by hematoxylin-eosin (HE) staining, and immunohistochemistry of epidermal growth factor receptor (EGFR). 2-[18F] fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) imaging characteristics were studied too.

RESULTS

A new HNSCC animal model was successfully established. Tumor sizes reached about 1 cm3 on day 15 after tumor cell inoculation. HE staining pathology has confirmed that this tumor is a typical SCC. EGFR immunohistochemistry demonstrated this tumor model to be strongly EGFR positive. 18F-FDG PET study has shown that 18F-FDG accumulated in tumors.

CONCLUSIONS

This study has demonstrated that this tumor model is an appropriate HNSCC tumor model for animal studies on HNSCC.

Visualisation of human dental pulp vasculature by immunohistochemical and immunofluorescent detection of CD34: A comparative study

CD34 is considered a pan-endothelial cell marker for paraffin-embedded sections. In this study, both immunohistochemistry and immunofluorescence were applied in human dental pulp specimens of moderate thickness (10 microm) in order to observe the vasculature of this tissue using CD34. Both techniques revealed a homogenous staining pattern with capillaries and larger vessels showing complete and strong membrane staining reflecting the high capacity of the pulp for regeneration and response to different stimuli. A novel approach in the identification of the pulpal vasculature by Cy5-conjugated anti-CD34 is introduced in this study. By this technique the dense capillary plexus of the sub-odontoblastic region, which is responsible for the reaction of the tissue to any physical or chemical stimuli or pathological condition, can be clearly identified, while immunohistochemistry did not reveal such a detailed staining pattern.

CD105-assessed micro-vessel density is associated with malignancy recurrence in laryngeal squamous cell carcinoma

AIMS

Angiogenesis is essential for malignancies growth. CD105 is a proliferation-associated protein abundantly expressed in angiogenic endothelial cells. The aim of this study has been to determine the expression of CD105 in laryngeal squamous cell carcinoma (SCC) and to investigate the role of CD105-assessed mean vascular density (MVD) in predicting patients' prognosis.

METHODS

The sections of 43 consecutive cases of laryngeal SCC were stained with mouse monoclonal antibody CD105. All the measures were performed by a computer-based image analysis system. The percentage of the fields occupied by CD105-assessed micro-vessels was determined.

RESULTS

The mean CD105-assessed MVD were 11% and 6% in laryngeal SCC with and without malignancy recurrence, respectively. Multivariate logistic regression stated that CD105-assessed MVD was significantly related to disease recurrence (p=0.030).

CONCLUSIONS

Our preliminary results suggest that CD105-assessed MVD may be a valuable parameter for predicting patients having an increased risk of developing laryngeal carcinoma loco-regional recurrence.

Endoglin expression is associated with poor oncologic outcome in oral and oropharyngeal carcinoma

CONCLUSIONS

The present preliminary results suggest that endoglin (CD105)-assessed micro-vessel density (MVD) in primary oral and oropharyngeal squamous cell carcinomas (SCCs) may identify patients at risk of disease recurrence or poor oncological outcome after treatment.

OBJECTIVES

MVD is an independent prognostic indicator in several human malignancies. Endoglin antibodies have shown a greater specificity for tumour vasculature in comparison with pan-endothelial markers. The present explorative study evaluated endoglin expression and its prognostic role in oral and oropharyngeal SCCs.

PATIENTS AND METHODS

The study considered 13 consecutive cases of oral and oropharyngeal SCC with lymph node metastases (pN+) and 13 consecutive pN0 cases. CD105-assessed MVD was calculated at 400x magnification.

RESULTS

The mean MVDs were 3.6 and 3.1 in pN+ and pN0 groups, respectively (p>0.05). The mean CD105-assessed MVDs were 4.7 in the group with locoregional recurrence and 2.9 in the group without locoregional recurrence or post-treatment diagnosis of distant metastasis (p=0.01). The mean CD105-assessed MVD in primary oral and oropharyngeal SCCs with poor oncological outcome (recurrence of disease or occurrence of distant metastasis) was 4.3. The mean MVD in primary oral and oropharyngeal SCCs with good outcome was 2.9. Statistical analysis showed a significant difference between CD105-assessed MVD in poor and good outcome groups (p=0.02).

Bilateral symmetrical lymphangiomas of the gingiva: case report

Background

Lymphangioma is a benign lesion that is related to proliferation of lymphatic vessels. Lymphangioma of the gingiva is a rare lesion that manifest as a pebbly hyperplasia on gingiva. The purpose of this study is to report a case of bilateral symmetrical lymphangioma of the gingiva.

Case presentation

A 32-year-old man was presented with bilateral hyperplasia of gingiva in upper canine regions. The lesions were resected completely and evaluated histologically. The microscopic evaluation revealed lymphangioma.

Conclusion

Bilateral lymphangioma of the gingiva is a very rare lesion which its origin is controversial.

Endoglin (CD105) as a prognostic factor in head and neck squamous cell carcinoma

Endoglin (CD105) is a proliferation-associated protein abundantly expressed in angiogenic endothelial cells. Recent studies revealed that CD105 is intensively expressed in tumor vasculature, whereas intratumoral microvessel density (MVD) determined with the use of antibodies to CD105 has been found to be an important prognostic indicator for the outcome in a number of malignancies. In the current study, we investigated endoglin expression and evaluated MVD in 108 patients with head and neck squamous cell carcinoma. Endoglin was intensively expressed in intratumoral blood vessels, whilst lymphatics were rarely positive for CD105. High microvessel density was associated with a more aggressive tumor phenotype, including advanced clinical stage (p = 0.008) and the presence of lymph node metastasis at the time of diagnosis (p = 0.02). When microvessel counts were assessed for their prognostic values (high vs low MVD), there was a statistically significant difference in the overall survival among patients with tumors of the oral cavity and larynx (p < 0.001) and in the disease-free survival among patients with tumors of the lower lip (p = 0.01). The prognostic impact of microvessel density was not dependent on clinical stage or lymph node status. The results of the current study suggest that CD105 is a promising target for tumor imaging and prognosis.