Dirschmid K, Lang A, Mathis G, Haid A, Hansen M
Institut fur Pathologie, Vorarlberg, Austria.
Hum Pathol. 1996 Nov;27(11):1227-30. doi: 10.1016/s0046-8177(96)90319-6.
In reported studies of extramural venous invasion (EVI) by colorectal carcinoma (CRC) in which conventional preparations involving a sectioning plane perpendicular to the tumor were used, an incidence as high as 36% has been found for unselected surgical material from patients operated on for cure. However, with this preparation technique, not all of the veins that exit the bowel wall roughly at right angles can be examined adequately. We investigated whether preparation of the adjacent vascular connective tissue with tangential sectioning might not result in different EVI rates. A total of 100 unselected surgical specimens of the bowel bearing 103 CRCs were prepared using a previously undescribed method, and EVI was found in 54.1% of the cases considered to have been treated curatively. To assess EVI fully, a complete study of all the vessels draining the tumor would be required yet the conventional preparation technique is associated with the distinct possibility of sampling error, because only a few vessels in each block are sectioned in the longitudinal axis. This sampling error might well be the explanation for the considerably higher incidence of EVI in our cases than in the reports in the literature. In all patients with EVI, the possibility of hematogenous metastases exists, and this has a significant bearing on the question of selecting patients for adjuvant chemotherapy.
在已报道的关于结直肠癌（CRC）壁外静脉侵犯（EVI）的研究中，使用涉及与肿瘤垂直的切片平面的传统标本制备方法，在接受根治性手术的患者的未筛选手术材料中发现高达36%的发生率。然而，采用这种标本制备技术，并非所有大致以直角穿出肠壁的静脉都能得到充分检查。我们研究了采用切线切片制备相邻血管结缔组织是否可能导致不同的EVI发生率。使用一种此前未描述的方法制备了总共100份带有103个CRC的未筛选肠手术标本，在被认为接受了根治性治疗的病例中，54.1%发现有EVI。为了全面评估EVI，需要对引流肿瘤的所有血管进行完整研究，但传统标本制备技术存在明显的抽样误差可能性，因为每个组织块中只有少数血管在纵轴上被切片。这种抽样误差很可能是我们的病例中EVI发生率比文献报道高得多的原因。在所有有EVI的患者中，存在血行转移的可能性，这对选择辅助化疗患者的问题有重大影响。
