Clinicopathological significance of lymphovascular invasion in urothelial carcinoma

Lymphovascular invasion is an important prognostic marker in the assessment of bladder cancer, including both cystectomy and transurethral resection of the bladder specimens, and should routinely be reported upon in the pathological report. Strict criteria must be utilized in establishing a diagnosis of lymphovascular invasion in urothelial carcinoma to distinguish it from peritumoral stromal retraction, a common finding that often mimics a vascular space. The use of immunohistochemistry (CD31, CD34, D2-40) for the diagnosis of intravascular invasion in urothelial carcinoma should be used only in selected histologically equivocal cases for confirmation. Routine use of immunohistochemistry for endothelium as a screening test in all cases cannot be recommended.