VEGF expression and microvascular density in relation to high-risk-HPV infection in cervical carcinoma – An immunohistochemical study

AbstractBackgroundThe poor outlook of cervical carcinoma, a human papillomavirus (HPV)-related cancer mandates the search for new treatment modalities. Therapeutic targeting of tumor vasculature is a promising strategy. The aim was to study angiogenesis in cervical carcinoma in terms of VEGF expression and assessment of microvascular density (MVD) in relation to HPV antigen expression.MethodsThirty paraffin blocks of cervical carcinoma were studied for the immune expression of VEGF and MVD utilizing CD34 monoclonal antibody. Statistical analysis of these immunophenotypes in relation to tumor type, grade and HPV antigen expression was performed.ResultsThis retrospective study comprised of 17 squamous cell carcinomas, 11 adenocarcinomas and two adenosquamous carcinomas. Eleven cases were low grade and 19 were high-grade cases. VEGF expression was detected in 100% of cases. The relation between carcinoma grade and VEGF expression and MVD was statistically significant. There was no relation between VEGF intensity and tumor type although more intense VEGF staining tended to occur in cervical adenocarcinomas. VEGF density was significantly lower in squamous cell carcinomas compared to adenocarcinomas. Mean MVD was 50.37±20.0. The relation between MVD and VEGF expression was statistically significant. HPV immune expression was detected in 93.33% of cases. The relation between HPV antigen expression and each of tumor histotype and grade was not statistically significant. There was a statistically significant relation between HPV antigen expression and each of MVD and VEGF intensity. Multivariate statistical analysis showed MVD as an independent predictor of carcinoma grade.ConclusionVEGF was expressed in 100% of studied cervical carcinoma. There was a statistically significant relation between VEGF expression and MVD. Since HPV antigen expression was significantly correlated with MVD and VEGF staining intensity, we provide evidence that HPV infection may augment tumor angiogenesis in cervical carcinoma. MVD emerged as an independent predictor of cervical carcinoma grade and hence of progressive behavior