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Open Access Research

Inducible nitric oxide synthase expression in gastric adenocarcinoma: impact on lymphangiogenesis and lymphatic metastasis

Nimet Karadayı1, Nilufer Onak Kandemır2*, Dilek Yavuzer1, Taner Korkmaz3, Gonca Gecmen1 and Furuzan Kokturk4

Author affiliations

1 Department of Pathology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

2 Department of Pathology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey

3 Department of Medical Oncology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

4 Department of Biostatistics, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey

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Citation and License

Diagnostic Pathology 2013, 8:151  doi:10.1186/1746-1596-8-151

Published: 17 September 2013

Abstract

Background

Lymphatic metastasis is the most important parameter in the spread of gastric carcinomas. Nitric oxide (NO) is a signaling molecule that plays an important role in inflammation and carcinogenesis. In this study, the possible link between inducible nitric oxide synthase (iNOS) expression with lymphangiogenesis and the clinicopathological parameters of gastric carcinomas was investigated.

Methods

In this study, iNOS expression and D2-40 (lymphatic endothelium-specific marker monoclonal antibody) reactivity were examined immunohistochemically in 41 gastric adenocarcinoma and 20 non-neoplastic gastric tissues. iNOS expression was scored semiquantitatively in the tumor parenchyma and stroma. D2-40-positive lymphatic vessels were used in the determination of lymphatic invasion and intratumoral and peritumoral lymphatic vascular density.

Results

iNOS expression was higher in gastric carcinoma tissue compared with non-neoplastic tissue. Particularly, iNOS expression in tumor cells was found to be closely related to lymphangiogenesis and lymphatic metastasis. The density of lymphatic invasion as well as intratumoral and peritumoral lymphatic vascular density were positively correlated with lymph node metastasis.

Conclusions

Our results suggest that iNOS-mediated NO formation plays an important role in gastric carcinogenesis, tumor lymphangiogenesis, and the development of lymphatic metastases. Inhibition of the NO pathway may be an alternative treatment of gastric carcinomas.

Virtual slides

The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1713572940104388 webcite.

Keywords:
Gastric carcinoma; Inducible nitric oxide synthases; Lymphangiogenesis; Lymph node metastasis