Kayahara Masato, Nakagawara Hisatoshi, Kitagawa Hirohisa, Ohta Tetsuo
Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Pancreas. 2007 Oct;35(3):218-23. doi: 10.1097/mpa.0b013e3180619677.
Neural invasion is one of the most important modes of tumor extension in pancreatobiliary tract cancer. However, the precise pattern of neural invasion and the relationship between neural invasion and nodal involvement are unknown.
Using 8 surgical specimens from patients with pancreatic cancer, 4973 sections were created and examined histopathologically. A total of 961 sections of VX2 tumor grown in the retroperitoneum of rabbits also were examined histologically. The precise mechanism by which neural invasion occurs and the relationship between nerve fascicle and lymph node involvement were determined by histological examination of serial sections.
Histological evaluation of the surgical specimens revealed continuity between the cancer cells between the inside and the outside of the perineurium. Tumor cells grew mainly in a continuous fashion along the branches of nerves. An advancing tip of the tumor cells was identified. The pattern of tumor spread in the experimental study was similar to that in the clinical study. Continuity was found between the cancer cells inside some lymph nodes and the cancer cells within the perineural space. This finding suggests that neural invasion might be a pathway to lymphatic involvement.
Neural invasion is a common, but not a specific, feature of pancreatic cancer. Tumor cells in the perineural space grow in a continuous fashion and may be responsible for some cases of lymphatic spread.
神经侵犯是胰胆管癌最重要的肿瘤扩散方式之一。然而，神经侵犯的确切模式以及神经侵犯与淋巴结受累之间的关系尚不清楚。
使用来自胰腺癌患者的8份手术标本，制作了4973个切片并进行组织病理学检查。还对在兔腹膜后生长的961个VX2肿瘤切片进行了组织学检查。通过对连续切片的组织学检查确定神经侵犯发生的确切机制以及神经束与淋巴结受累之间的关系。
手术标本的组织学评估显示神经束膜内外的癌细胞之间存在连续性。肿瘤细胞主要沿神经分支呈连续方式生长。确定了肿瘤细胞的推进尖端。实验研究中的肿瘤扩散模式与临床研究中的相似。在一些淋巴结内的癌细胞与神经周间隙内的癌细胞之间发现了连续性。这一发现表明神经侵犯可能是淋巴受累的一条途径。
神经侵犯是胰腺癌的一个常见但非特异性特征。神经周间隙中的肿瘤细胞呈连续方式生长，可能是某些淋巴转移病例的原因。
