J Pathol Transl Med.  2022 May;56(3):134-143. 10.4132/jptm.2022.02.22.

Expression of prostate-specific membrane antigen in the neovasculature of primary tumors and lymph node metastasis of laryngeal squamous cell carcinomas

• Erkılınç G
• Yasan H
• Kumbul YÇ
• Sivrice ME
• Durgun M

• KMID: 2529804
• DOI: http://doi.org/10.4132/jptm.2022.02.22

Abstract

Background
Prostate-specific membrane antigen (PSMA) expression is encountered in tumor-associated neovascularization.
Methods
PSMA-antibody was applied to the paraffin blocks of 51 patients who were diagnosed with squamous cell carcinoma of the larynx and underwent laryngectomy and one who underwent lymph node dissection. The percentage of vascular expression in tumoral and extratumoral stroma and lymph nodes and intensity score in tumoral epithelium were evaluated and divided into groups according to the level of PSMA expression. Final PSMA expression was determined by multiplying intensity and percentage scores.
Results
The mean age was 61±10 years. Patients with perineural invasion, cartilage invasion, and local invasion exhibited higher PSMA expression scores. Age, tumor differentiation, tumor diameter, perineural invasion, tumor localization, capsular invasion, depth of invasion, surgical margin status, local invasion, nodal metastasis, TNM classification, and stage were similar in high and low PSMA expression groups. There was no PSMA expression in extratumoral vascular stroma. Significantly higher PSMA expression was observed in the vascular endothelium of metastatic lymph nodes compared with reactive lymph nodes. Patients with advanced-stage disease exhibited higher PSMA vascular expression scores compared to those with earlier stages (p<.001). PSMA expression was not correlated with overall survival, disease-specific survival, or disease-free survival (p>.05).
Conclusions
Our study suggests that higher PSMA expression is associated with cartilage invasion, local invasion, and advanced-stage of disease. PSMA expression can be utilized for detection of lymph node metastasis and has some predictive role in cases of neck metastasis.

Keyword

Prostate-specific membrane antigen; Larynx; Lymph nodes; Neovascularization; Immunohistochemistry

Figure

• 

  Fig. 1. Hematoxylin and eosin (H&E) and immunohistochemistry (IHC) staining of tumoral and nontummoral tissues. (A) Primary squamous cell carcinoma and respiratory epithelium (arrow) in the neighborhood of the tumor (H&E). (B) High prostate-specific membrane antigen (PSMA) expression score in the epithelium of the primary squamous cell carcinoma, no PSMA expression in the normal respiratory epithelium (arrow). (C) CD34 expression in the vessels of the tumoral stroma (red arrow) and non-tumoral stroma (black arrow). (D) High PSMA expression score in the vessels of the tumoral stroma (red arrow) and no expression of PSMA in the vessels of the normal tissue (black arrows). (E) PSMA expression in the vessels of the primary tumor (F) and expression in the vessels of the metastatic lymph node. (G) CD31 expression in the stromal vessels of the metastatic focus (red arrows) and non-metastatic focus (black arrow) of the same lymph node. (H) PSMA expression in the stromal vessels of the metastatic focus (red arrows) and no expression in the vessels of the non-metastatic focus (black arrow) of the same lymph node.

• 

  Fig. 2. PSMA expression scores in tumoral and nontumoral tissues. (A) Prostate-specific membrane antigen (PSMA) percentage score of 1 in the vessels of the tumoral stroma. (B) PSMA percentage score of 2 in the vessels of the tumoral stroma. (C) PSMA percentage score of 3 in the vessels of the tumoral stroma. (D) PSMA intensity score of 1 in the vessels of the tumoral stroma. (E) PSMA intensity score of 2 in the vessels of the tumoral stroma. (F) PSMA intensity score of 3 in the vessels of the tumoral stroma.

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  Fig. 3. Overall survival analysis in patients with high and low prostate-specific membrane antigen (PSMA) expression scores according to disease stage. (A) Comparison of overall survival in stage 1 patients according to PSMA expression. (B) Comparison of overall survival in stage 2 patients according to PSMA expression. (C) Comparison of overall survival in stage 3 patients according to PSMA expression. (D) Comparison of overall survival in stage 4 patients according to PSMA expression.

• 

  Fig. 4. Disease-specific survival (A) and disease-free survival (B) analyses in patients with high and low prostate-specific membrane antigen (PSMA) expression scores.

Reference

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