Nakao A, Ichihara T, Nonami T, Harada A, Koshikawa T, Nakashima N, Nagura H, Takagi H
Second Department of Surgery, Nagoya University School of Medicine, Japan.
Ann Surg. 1989 Feb;209(2):181-7. doi: 10.1097/00000658-198902000-00008.
Clinicohistopathologic and immunohistochemical studies of intrapancreatic development of duct cell carcinoma of the head of the pancreas to the body and tail were done in 34 cases in which total pancreatectomy accompanied by portal vein resection were performed from July 1981 to June 1987. In studies of hematoxylin and eosin (HE) staining, intrapancreatic development from the head to the body or tail was observed in 14 cases of 34 cases (41.1%). Multicentricity or skip development was observed in two of 14 cases. However, by using immunostaining of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and DUPAN2, small cancer nests surrounded by dense fibrous connective tissues could be easily and accurately diagnosed, and finally, in 25 of 34 cases (73.5%), intrapancreatic continuous development from the head to body or tail was observed. The intrapancreatic development correlated with portal invasion and perineural invasion of carcinoma, hardness of body and tail, obstruction of the main pancreatic duct, and irregular pancreaticogram. The intraoperative quick immunostaining on the cryostat sections, together with HE staining, is useful to determine the intrapancreatic development of the carcinoma. The indication of total pancreatectomy or pancreatoduodenectomy for carcinoma of the head of the pancreas can be determined by these results.
对1981年7月至1987年6月期间接受全胰切除术并同时切除门静脉的34例患者进行了胰头至胰体和胰尾导管细胞癌胰腺内发展的临床组织病理学和免疫组织化学研究。在苏木精和伊红（HE）染色研究中，34例中有14例（41.1%）观察到从胰头向胰体或胰尾的胰腺内发展。14例中有2例观察到多中心性或跳跃性发展。然而，通过癌胚抗原（CEA）、糖类抗原19-9（CA19-9）和DUPAN2的免疫染色，可以轻松准确地诊断出被致密纤维结缔组织包围的小癌巢，最终，34例中有25例（73.5%）观察到从胰头到胰体或胰尾的胰腺内连续性发展。胰腺内发展与癌的门静脉侵犯、神经周围侵犯、胰体和胰尾硬度、主胰管梗阻以及胰腺造影不规则相关。术中对冷冻切片进行快速免疫染色并结合HE染色，有助于确定癌的胰腺内发展情况。这些结果可用于确定胰头癌行全胰切除术或胰十二指肠切除术的适应证。
