Lymphangiogenesis in deep infiltrating endometriosis

Area of Science:

• Gynecology
• Surgical Pathology
• Oncology

Background:

• Deep infiltrating endometriosis (DIE) involves endometriotic foci in lymph nodes (LNs).
• Lymphatic vessels (LVs) are suspected routes for endometriotic cell dissemination from DIE lesions to LNs.
• Investigating LV and lymphangiogenic factors in DIE is crucial for understanding disease spread.

Purpose of the Study:

• To investigate the occurrence and density of lymphatic vessels (LVs) in deep infiltrating endometriosis (DIE) lesions.
• To examine the expression of lymphangiogenic growth factors, VEGF-C and VEGF-D, in DIE tissue.

Main Methods:

• Immunohistochemical analysis using D2-40, LYVE-1, and Prox-1 markers to identify LVs in 38 DIE patients.
• Quantification of LV density (LVD) in DIE lesions compared to healthy tissue.
• Assessment of VEGF-C and VEGF-D expression in endometriotic epithelial and stromal cells.

Main Results:

• LV density was significantly higher in DIE lesions than in healthy tissue.
• LYVE-1 and Prox-1 positive LVs were more abundant than D2-40 positive LVs.
• Endometriotic cells expressed moderate to strong levels of VEGF-C and VEGF-D.

Conclusions:

• Deep infiltrating endometriosis (DIE) lesions possess lymphangiogenic properties.
• These properties likely contribute to the presence of endometriosis in lymphatic vessels and lymph nodes.
• This mechanism supports the loco-regional spread of endometriosis.