Morphologic patterns of clinically negative cervical lymph nodes and their association with tumor-induced lymphangiogenesis in oral squamous cell carcinoma: A retrospective cohort study.

INTRODUCTION: Oral Squamous Cell Carcinoma (OSCC) is a common epithelial malignancy with a persistently poor prognosis, largely influenced by regional lymph node status. Current treatment of OSCC relies on the TNM staging system, which does not include the molecular characteristics of the neoplasm. This study aimed to evaluate lymph node morphologic patterns and molecular markers of lymphangiogenesis to support biologically informed pathologic risk stratification.

METHODOLOGY: A retrospective cohort study was conducted on 128 cases and divided into two groups: Group I (clinically and histopathologically negative lymph nodes) and Group II (clinically negative but histopathologically positive lymph nodes). Immunohistochemical assessments of lymphangiogenesis in primary tumor were performed using VEGF-C and D2-40. Morphological patterns in lymph nodes were evaluated, and statistical analyses were conducted to correlate these patterns with clinicopathologic parameters.

RESULTS: Significant differences (p < 0.001) in lymph node morphology were observed between groups, with higher ILVD values in Group II. One-way ANOVA revealed significant differences between the mean VEGF-C categories and D2-40 immunoexpressions. ROC curve analysis indicated that D2-40 had higher sensitivity and specificity compared to VEGF-C. Key morphological changes in lymph nodes were identified as features suggestive of pre-metastatic changes.

CONCLUSION: The findings suggest that lymph node morphologic patterns reflect biologic and immunologic alterations associated with tumor lymphangiogenesis in clinically node-negative OSCC. Integration of lymph node histomorphology with molecular markers may provide complementary pathologic information for risk stratification and prognostic assessment, pending validation in prospective studies.