胰腺癌513例神经浸润的病理分析

目的 探讨胰腺癌神经浸润的特征及其与其他临床病理参数之间的关系.方法 光镜下观察491例胰腺导管腺癌、22例其他胰腺恶性肿瘤、41例胰腺良性病变和21例慢性胰腺炎组织中的神经浸润状况,分析其与其他病理学指标的相关性.结果 胰腺导管腺癌的神经浸润率为74%,显著高于其他类型恶性肿瘤的23%(P＜0.01).导管腺癌癌细胞通常穿越外周神经中膜到达内部的神经纤维束,有的甚至横断整根神经纤维.但神经浸润与导管腺癌的分化程度无关.52%的胰腺导管腺癌癌旁组织呈慢性炎症改变,且程度严重,远高于其他类型胰腺癌(14%)及胰腺良性病变(15%)的慢性炎症发生率(P＜0.01).胰腺导管腺癌淋巴细胞浸润神经的发生率为65%,远高于其他恶性肿瘤的36%和胰腺良性病变的22%(P＜0.01).胰腺导管腺癌的神经浸润与癌旁慢性胰腺炎症以及淋巴细胞浸润神经均相关,但与淋巴结转移无关.结论 神经浸润是胰腺导管腺癌特征性的生物学行为之一.

Pathologic study on the perineural invasion in 513 cases of pancreatic cancer

Objectives To investigate the characteristics of neural invasion of pancreatic cancer as well as its relationship with other clinicopathological factors. Methods The neural invasion situation of 491 cases of ductal adenocarcinoma and other 22 pancreatic malignancies, 41 cases of benign tumor of pancreas and 21 cases of chronic pancreatitis was observed under light microscope, and its relationship with other clinicopathological factors was analyzed. Results The rate of neural invasion in ductal adenocarcinoma (74%) was much higher than in other types of pancreatic neoplasm (23% ,P ＜ 0.01). Pancreatic ductal adenocarcinoma cell often invaded through peripheral nerve membrane into inner nerve fiber bundle, sometimes even invaded the whole cross-sectional nerve fiber. But neural invasion was not associated with differentiation of the tumor. The occurrence of chronic inflammation in the para-tumoral pancreas (52%) was also higher than that in other types of malignant (14%) or benign lesions (15% ,P ＜0.01). Lymphocytes neural invasion rate in pancreatic ductal adenocarcinoma was 65%, which were significantly higher than those in other types of malignant (36%) or benign lesions (22%, P ＜ 0.01). Neural invasion rate in pancreatic ductal adenocarcinoma was associated with paratumoral chronic pancreatic inflammation and lymphocytes neural invasion, but not with lymph node metastasis. Conclusions Neural invasion was characteristic biological behavior in pancreatic ductal adenocarcinoma.