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Podoplanin & its role in diagnosis of cancer invasion

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Podoplanin & its role in diagnosis of cancer invasion Podoplanin & its role in diagnosis of cancer invasion Presentation Transcript

  • PODOPLANIN IN TUMOR INVASION – A PROMISING NEW APPROACH DR RATNADEEP GANGULY MD, DNB, MIAC, MNAMS Consultant Surgical Pathologist DR TIBAR BANNERJEE MS, MCh Consultant Plastic Surgeon THE MISSION HOSPITAL Durgapur, INDIA
  • PATIENT #1 42y/male, papillomatous growth, right side of cheek Leukoplakia, left side
  •  
  • DIAGNOSIS Papillomatous growth Microinvasive squamous cell carcinoma, max depth of invasion 2mm from BM Leukoplakia Squamous hyperplasia, keratosis without dysplasia, no invasive ca
  • PATIENT #2 38y/male, ulceroproliferative growth in oral cavity
  •  
  • DIAGNOSIS Ulceroproliferative growth – Squamous cell carcinoma, appearing moderately differentiated in this biopsy
  • DIAGNOSTIC PITFALLS WITH ONLY HISTOMORPHOLOGICAL EXAMINATION
    • Well oriented sections as opposed tangential sections
    • Inflammation, edema & fibrosis around invasive nests
    • Certain parameters subjective
    • Detached nests of benign mucosa
    • Dysplastic mucosa in head/neck may be a little thickened appearing like a mass
    • Squamous mucosa forming in salivary acini
  • PATTERNS OF TISSUE INVASION
    • SINGLE CELL INVASION
    • Mimics early developmental process (epithelial-mesenchymal transition)
    • Loss of E-cadherin expression
    • COLLECTIVE CELL MIGRATION
    • Less well understood
    • Podoplanin expression
    • Upregulated at the edges of large tumor masses eg. SCC of lip, oral cavity, ovarian granulosa cell tumor, mesothelioma
  • SINGLE CELL INVASION LOSS OF E-cadherin(BROWN) NO PODOPLANIN COLLECTIVE CELL MIGR N NO LOSS OF E-cadherin PODOPLANIN(RED) AT ADVANCING EDGE
  • WHAT IS PODOPLANIN ?
    • Protein expressed in most human tissues
    • Upregulated in tumor edges
    • Bypasses epithelial-mesenchymal transformation in carcinogenesis
    • Promotes tumor cell spreading, migration & invasion
  • WHAT IS PODOPLANIN ? – contd.
    • SCC, CNS tumors & germinal neoplasms are +ve
    • Collective cell migration - +ve
    • Invasion of single cells / small cell groups (Adenocarcinomas) - –ve
    • Good adjunct in detection of equivocal invasion / microinvasion in SCC of skin, lip, oral cavity
  • OTHER MEANS TO DETECT TUMOR INVASION
    • DEMONSTRATION OF BASEMENT MEMBRANE / BASAL CELL LAYER BY:
    • Cytochemistry:
    • Methenamine silver stain (black reticulin fibers)
    • PAS reaction (magenta)
    • Immunohistochemistry:
    • Collagen type IV & VII
    • Laminin
    • High mol wt cytokeratin (HMWCK - 34E  12) – Basal layer
    Basement membrane Basement membrane
  • COLLAGEN TYPE IV IN BLOOD VESSEL - IMMUNOHISTOCHEMISTRY
  • THANK YOU