Lymphatic and Venous Embolization

Lymphatic embolization is defined as the presence of nests of carcinomatous cells in a lumen with thin walls, without smooth muscle fibers or red blood cells. The same condition with red blood cells or smooth muscle fibers is considered as venous embolization (Fig. 10.3a, b).10,23,32

Venous and lymphatic embolization are two important factors which are able to independently predict the presence of inguinal lymph node metastases. 1 7,20 Patients without lymphatic embolization in the primary tumor demonstrate lymph node metastases in 17-30.6% of cases,20 whereas 62-83.3% of patients with lymphatic embolization have lymph node metastases. In all the published series such differences in the risk of lymph node metastases were statistically significant. Similarly, patients with venous embolization have lymph node metastases in 69-89%, significantly more than the 24-43.8% reported in patients without venous embolization.

The presence of malignant emboli in peritumoral lymphatic vessels has a negative impact on the 5-year survival of penile cancer patients. In 2001, Bezerra et al. reported 5-year survival rates as high as 88% in patients without lymphatic embo-lization and 55% in those with this feature (p = 0.004).10 Similar results were reported by Lopes et al. in 2002 when these authors reported 5-year cancer-specific survival in 65% of patients without and 41.5% in those with lymphatic embolization (p = 0.004).20 However, this parameter failed to be an independent predictor of cancer-specific survival in multivariate analysis.

As regards the impact of venous embolization on survival, Bezerra et al. reported 5-year survival of 73.7% in patients without and 52% in those with venous embolization10 while Lopes et al. in 2002 reported 5-year survival of 56% and 38%, respectively, in those without and with venous embolization.20 Lont et al. reported 5-year cancer-specific survival rates of 83% in patients without and 69% in those with venous embolization.24 Such differences were not significant even in univariate analysis.

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