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Detection of Lymphovascular Invasion by D2-40 (Podoplanin) Immunoexpression in Endometrial Cancer
  1. Sarah K. Weber, MD*,
  2. Axel Sauerwald, MD*,
  3. Martin Pölcher, MD*,
  4. Michael Braun, MD*,
  5. Manuel Debald, MD*,
  6. Nuran Bektas Serce, MD,
  7. Walther Kuhn, MD*,
  8. Giesela Brunagel-Walgenbach, MD and
  9. Christian Rudlowski, MD*
  1. *Department of Gynecology and Obstetrics,
  2. Institute for Clinical Chemistry and Pharmacology, and
  3. Institute of Pathology, Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
  1. Address correspondence and reprint requests to Christian Rudlowski, MD, Department of Obstetrics and Gynecology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. E-mail: christian.rudlowski{at}
  1. Parts of this work were presented as oral presentation at the International Gynecologic Cancer Society’s 13th Biennial Meeting, Prague, Czech Republic, October 2010.


Background Lymph node involvement is a major feature in tumor spread of endometrial cancer and predicts prognosis. Therefore, evaluation of lymph vessel invasion (LVI) in tumor tissue as a predictor for lymph node metastasis is of great importance. Immunostaining of D2-40 (podoplanin), a specific marker for lymphatic endothelial cells, might be able to increase the detection rate of LVI compared with conventional hematoxylin-eosin (H-E) staining. The aim of this retrospective study was to analyze the eligibility of D2-40–based LVI evaluation for the prediction of lymph node metastases and patients’ outcome.

Patients and Methods Immunohistochemical staining with D2-40 monoclonal antibodies was performed on paraffin-embedded tissue sections of 182 patients with primary endometrioid adenocarcinoma treated in 1 gynecologic cancer center. Tumors were screened for the presence of LVI. Correlations with clinicopathological features and clinical outcome were assessed.

Results Immunostaining of D2-40 significantly increased the frequency LVI detection compared with conventional H-E staining. Lymph vessel invasion was identified by D2-40 in 53 (29.1%) of 182 tumors compared with 34 (18.3%) of 182 carcinomas by routine H-E staining (P = 0.001). D2-40 LVI was detectable in 81.0% (17/21) of nodal-positive tumors and significantly predicted lymph node metastasis (P = 0.001). Furthermore, D2-40 LVI was an independent prognostic factor for patients overall survival considering tumor stage, lymph node involvement, and tumor differentiation (P < 0.01). D2-40–negative tumors confined to the inner half of the myometrium showed an excellent outcome (5-year overall survival, 97.8%).

Conclusions D2-40–based LVI assessment improves the histopathological detection of lymphovascular invasion in endometrial cancer. Furthermore, LVI is of prognostic value and predicts lymph node metastasis. D2-40 LVI detection might help to select endometrial cancer patients who will benefit from a lymphadenectomy.

  • Endometrial cancer
  • D2-40
  • Lymphovascular invasion
  • Lymph node Metastasis
  • Prognosis

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  • The authors declare no conflict of interest.