Perineural invasion in pancreatic cancer

• Published in: Pancreas Vol. 24; no. 1; pp. 15 - 25
• Main Authors: HIRAI, Ichiro, KIMURA, Wataru, OZAWA, Koichiro, KUDO, Shun, SUTO, Koichi, KUZU, Hiroshi, FUSE, Akira
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2002
• Subjects: Biological and medical sciences; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Connective Tissue - metabolism; Digestive system; Humans; Immunohistochemistry; Investigative techniques, diagnostic techniques (general aspects); Lymphatic Metastasis; Medical sciences; Neoplasm Invasiveness; Neoplasm Recurrence, Local - pathology; Pancreas - innervation; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prognosis; Survival Rate; Tumor Suppressor Protein p53 - analysis; Human; Immunohistochemistry; Fibroblast growth factor; Recurrence; Prognosis; Neural cell adhesion molecule; Enzyme; Cytokine; Peripheral circuit; Metalloendopeptidases; Malignant tumor; Gelatinase B; Pathology; Peptidases; Neuron; Polypeptide; Digestive diseases; Hydrolases; Pancreas; Growth factor; Pancreatic disease
• ISSN: 0885-3177; 1536-4828
• DOI: 10.1097/00006676-200201000-00003

Perineural invasion is regarded as a factor associated with local recurrence of pancreatic cancer.
To examine perineural invasion of pancreatic cancer pathologically and clinically.
In 24 cases of surgically resected pancreatic cancer, correlations among the degree of perineural invasion, differentiation, interstitial connective tissue, lymph node metastasis, and survival rate were examined. Consecutive 5-microm serial sections (n = 1072) were made in six cases that showed characteristic mode of perineural invasion.
Perineural invasion was observed in 17 cases (70.8%; ne0-7; ne1-6; ne2-9; and ne3-2 cases). Perineural invasion was absent in three of five cases of papillary carcinoma, but was observed in 12 of 14 cases of moderately differentiated carcinoma. The survival rate for ne0 was better than that of the other groups, with the 3-year survival rate being 57.1%. Perineural cancer glands had developed discontinuously in two cases.
Perineural invasion is an important prognostic factor in pancreatic cancer, increasing as the cancer becomes undifferentiated. Even if there are no cancer cells at the margin of the pancreas at the time of surgery, the cancer cells may spread further to the noncancerous pancreas or retroperitoneum. Sufficient dissection of the neural plexus or intraoperative radiation may be required.