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Int Poster J Dent Oral Med 5 (2003), No. 4     15. Dec. 2003

Int Poster J Dent Oral Med 2003, Vol 5 No 04, Poster 205

Micro vessel density as an indicator of invasive growth pattern in basal cell carcinoma

Language: English

Authors:
Dr. Alexander W. Eckert, Dr. Dr. Peter Maurer, Matthias Lautner, Lutz Meyer, Prof. Dr. Dr. Johannes Schubert,
Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie
Tarek Mustafa,
Universitätsklinik und Poliklinik für Allgemein-, Visceral- und Gefäßchirurgie
Dr. Ulf Krause,
Institut für Pathologie, Martin-Luther-Universität Halle-Wittenberg

Date/Event/Venue:
September 3-7th, 2002
XVIth Congress of the European Association for Cranio-Maxillofacial Surgery
Münster/Germany

Introduction

Basal cell carcinoma is currently the most common cutaneous cancer of the facial skin. Therefore, there is still a need to find reliable prognostic indicators that correlate with outcome and may detect patients at a high risk of local recurrence. Recent studies have suggested that there is a significant correlation between tumor angiogenesis, expressed as the micro vessel density within and toward the tumor, and tumor aggressiveness (Staibano et al. 1996). The aim of this study was to evaluate the angiogenesis in basal cell carcinomas by measuring the micro vessel density with regard to the local, especially osseous infiltration, and local tumor recurrence in a pilot study.

Material and Methods

The study consits of of 9 basal cell carcinoma patients. All basal cell carcinomas were complete resected. Micro vessels were highlighted by immunhistochemically staining for CD 31, the vascular endothelial growth factor (VEGF) and HIPPEL-LINDAU's proteine in formalin-fixed, paraffin-embedded tissues. The detection was performed using primary and secondary antibodies in accordance to the ABC-method. The interpretation included staining intensity by REMMELE's score of immunreactivity and WEIDNER's micro vessel density measurements. Micro vessel count was performed by light microscopy identifying the individual micro vessels on x200 fields, in areas of the most active neovascularization, previously selected at low power magnification (x40). All immunohistochemical data were compared with the clinical course of the patients.

Results

The immunhistochemical data after staining for CD 31 and VEGF are summarized in Tab. 1 and Tab.2, respectively.

Age Sex Recurrence Staining Intensity Percent positive Cells Immunreactive Score
68 male no 2 2 4
65 male yes 3 3 9
55 female no 2 2 4
66 female no 1 2 2
70 female yes 1 2 2
73 female no 1 2 2
76 female yes 2 2 4
73 female no 1 1 1
82 female no 1 2 2
Tab.1 Clinicopathologic and immunhistochemical data of basal cell carcinoma (staining for CD 31)
 
Age Sex Recurrence Staining Intensity Percent positive Cells Immunreactive Score
68 male no 9 3 3
65 male yes 12 3 4
55 female no 2 1 2
66 female no 4 2 2
70 female yes 6 2 3
73 female no 12 3 4
76 female yes 4 2 2
73 female no 9 3 3
82 female no 2 1 2
Tab.2 Clinicopathologic and immunhistochemical data of basal cell carcinoma (staining for VEGF)

In general, CD 31 showed a poorer staining intensity in comparison to VEGF. The angiogenetic factor and mitogene VEGF presented a partial increased number of hot spots as well as intensive staining intensity in HIPPEL-LINDAU proteins in the case of recurrent tumors. On the other hand, CD 31 showed only a poor capillarization in the centre of the tumors. A basal cell carcinoma with a high density of micro vessels (staining for CD 31) is shown in Fig 1. The clinical course confirmed a recurrence. An example of low micro vessel density (staining for CD 31) is illustrated in Fig. 2.

Fig. 1 Basal cell carcinoma: example of an area from a tumor with higher vascularization. Arrows indicate micro vessels (Immunhistochemical staining for CD 31, original magnification x 200) Fig. 2 Basal cell carcinoma: example of an area from a tumor with lower vascularization. Arrows indicate micro vessels (Immunhistochemical staining for CD 31, original magnification x 200)

The clinicopathological data indicated no recurrence. Fig. 3 shows a high vascularization (staining for VEGF), which is in agreement with a recurrent basal cell carcinoma. Additionally, Fig. 4 presents the comparable poor vessel density in a not recurrent carcinoma (staining for VEGF). Our data agree with the results of Bedlow et al.1999.

Fig. 3 Basal cell carcinoma: example of an area from a tumor with high vascularization. Arrows indicate micro vessels (Immunhistochemical staining for VEGF, original magnification x 200) Fig. 4 Basal cell carcinoma: example of an area from a tumor with low vascularization. Arrows indicate micro vessels (Immunhistochemical staining for VEGF, original magnification x 200)

Discussion and Conclusions

Our pilot investigation at a limited number of cases does not show any direct hint on an influence of vascularization on the growth pattern in basal cell carcinoma despite some positive experience in the literature (Staibano et al.1996, Maiolino et al. 2000). Further investigations should include a big number of cases using fresh frozen specimens and looking for proliferation markers. Vascularization per se seems not to be a significant marker for malignancy in basal cell carcinomas.

Bibliography

  • Bedlow AJ, Stanton AW, Cliff S, Mortimer PS: Basal cell carcinoma -- an in-vivo model for human tumor microcirculation? Exp Dermatol 1999, 8, 222 - 226
  • Maiolino P, De Vico G, Restucci B: Expression of vascular endothelial growth factor in basal cell tumors and in squamous cell carcinomas of canine skin. J Comp Pathol 2000, 123, 141 - 145
  • Staibano S, Boscaino A, Salvatore G, Orabona P, Palombini L, De Rosa G: The prognostic significance of tumor angiogenesis in nonaggressive and aggressive basal cell carcinoma of the human skin. Hum Pathol 1996, 27, 695 - 700

This Poster was submitted by Dr. A. W. Eckert.

Correspondence address:
Dr. A. W. Eckert
Martin-Luther-Universität Halle-Wittenberg
Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie
Große Steinstraße 19
06108 Halle/Saale
Germany