INTRAPROSTATIC LYMPHATIC VESSELS: NEGLECTED DISTRIBUTION, ORGANISATION AND ONCOLOGICAL CONSEQUENCES.

P. Stoemmer, P. Torres-Galea 1 and C. Neusiedl 2

1)

Forschungslabor Pathologie, Augsburg, Germany

2)

Semmelweiss University Budapest, Hungary

MATERIALS AND METHODS
8 FFPE prostatectomy specimen (each consisting of 40-50 paraffin blocks) were processed for H+E, PAS, endothelial marker CD31 and lymph vessels marker D2-40 and strictly oriented and analysed for localisation, direction and diameter of lymph vessels. CD31(PECAM-1) (SIGNET): Mouse MAb, Clon: JC/70A, 1:100 60min. RT, DCS, Hamburg, Germany D2-40 (SIGNET): Mouse Mab, Clon: D2-40, 1:250 ON RT, DCS, Hamburg, Germany Detection system: alkaline phosphatase (AP); Red = lymph vessels

INTRODUCTION
In spite of century-long research, the zonal architecture of the prostate was first discovered 1968 (Mc Neal); the intraprostatic distribution and organisation of lymphatic vessels resulting in a complex vascular network in normal and neoplastic prostate is largely unknown in spite of their oncological importance in advanced prostatic carcinomas (Soh et al 2005). The rarity of lymphnode metastasis in early cases may be due to the destruction of local lymphatic vessels by the tumour.

RESULTS
Selected cases with small carcinomas: their lymph
vessels are drawn (black) in the pictures; distribution in the horizontal sections.

a b

Capsular (a) and Subcapsular (b) Prostatatic Area and the Paravesicular Region:
Circumferentially and vertically oriented intermediate and large lymphatic vessels within walls; they are oriented parallel to the main direction of the smooth muscle cells. Only small and few subcapsular lymphatic vessels in the anterior fibromuscular part of the gland. No broad connections between right and left side of the prostate. Cavernous and large sinusoidal periprostatc lymph vessels between and around the seminal vesicles and deferential ducts.

c
c

Peripheral Zone (c) of the Prostate:

Radiary and oblique oriented small to intermediate lymphatic vessels. Few lymphatic vessels in the anterior fibromuscular zone.

Cs

d
Cs e

Central Zone (d) of the Prostate:

Vertically and (less radiary) oriented small lymphatic vessels in connection to the vessels of the peripheral prostatic zone.

Transitional and Paraurethral Zone (e) of the Prostate:

Lymphatics of the Colliculs seminalis parallel to the ejaculatory duct.

Prostatectomy Specimen with small cancer (->) in horizontally oriented 4mm broad slices: Lymphatic
vessels are too small, to be seen macroscopically and are therefore mapped by indian ink in the pictures according to their location and shape in the histologic slides.

Cs

Vertically oriented small and intermediate lymphatic vessels, parallel to the urethra. Their diameter and density increases near the prostatic apex and near them basis, where there is a connection to the small vessels of the pelvis and the bladder
(FUKIUDA et al 2000).

CONCLUSIONS AND CONSEQUENCES

Preliminary Model of the Lymph Vessel Organisation in the Prostate:
Centrifugal and Circumferential Pathway (red): Lymphatic vessels of central and peripheral zone drain radiary (centrifugally) and oblique via sub- and pericapsular lymphatics to the large sinusoidal lymphatic sinus and vessels between and around of the seminal vesicles and, from here, connnect to the pelvic lymphatics: a reason for the worse prognosis of prostatic carcinomas infiltrating seminal and periseminal tissue. Dorsal Pathway (blue): Lymph vessels of the Colliculus seminalis directly drain to the intervesicular space; perhaps a reason for the bad prognosis of prostatic ductal adenocarcinomas (HUMPHREY 2003). Vertical Pathway Paraurethral (yellow) : Connecting the lymphatic vessels of the transition zone and the paraurethral zone to lymph vessels of the bladder wall and the prostatic apex. Urothelial carcinomas of the transitional zone tend to be associated with invasive bladder cancer ( FUKIUDA et al 2000).
Extraprostatic lymphatic vessels and lymphnodes (Gray`s Anatomy, since 1858)

References
Soh S Ishii T, Sato E, Akishima Y, Ito K, Baba S. Topographic distribution of lymphatic vessels in the normal human prostate. Prostate 005 Jun 1; 63(4): 330-5. TROJAN,L., M.S. MICHEL, F. RENSCH, D.G. JACKSON, P.ALKEN, R.GROBHOLZ: LYMPH AND BLOOD VESSEL ARCHITECTURE IN BENIGN AND MALIGNANT PROSTATIC TISSUE. The Journal of Urology, July 2004 (Vol. 172, Issue 1, Pages 103-107). Fukuda H, Yamada T, Kamata S, Saitoh H. Anatomic distribution of intraprostatic lymphatics: implications for the lymphatic spread of prostate cancer-a preliminary study. Prostate 2000 Sep 1; 44(4): 322-7.