Dual Immunohistochemical Staining in Neuroplexus Micrometastasis of Pancreatic Duct Adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENG Peng , JIN Gang , HU Xiangui , ZHANG Yijie , LIU Rui , SHAO Chenghao , HE Tianlin , LI Gang , JING Wei , SONG Bin.

Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, ChinaCorresponding Author: JIN Gang, E-mail: jingang@sohu.com;

Corresponding author：

Keywords：

Pancreatic neoplasm; Peripancreatic nerve plexus; Micrometastasis; Dual immunohistochemical staining; Lymphangiogenesis

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Objective 　To reveal the significance of D2-40/CK19 dual immunohistochemistry for micrometastasis of peripancreatic neural plexus in patients with pancreatic cancer.
Methods 　Between January 2006 and January 2007, 44 patients with pancreatic duct adenocarcinoma underwent extended radical resection. Conventional hematoxylin/eosin staining and double immunohistochemical staining using CK19 and D2-40 were used to determine peripancreatic neural invasion and lymphatic vessel invasion (LVI) in peripancreatic neural plexus tissues.
Results　 D2-40 immunohistochemistry showed brown-yellow tube-like lymph vessels. The lymph vessel of peripancreatic nerve plexus followed vascular and perineurium, and the lymph vessel adjacent to peripheral nerve fascicles owned tube-like structure. CK19 immunohistochemistry showed cytoplasm of pancreatic cancer cell was red. The LVI was observed in lymphatic capillaries. Peripancreatic neural plexus invasion was found in 30 cases (68.2%), tumor cell invading presented in lymph vessels of peripancreatic neural plexus in 21 patients (47.7%) with pancreatic cancer. The peripancreatic neural plexus invasion was associated with LVI (P=0.003). The plexus of pancreatic capitalis and celiac plexus were respectively confirmed to be the spot with the highest lymphatic vessel density and the maximal incidence of neural plexus invasion simultaneously.
Conclusions 　Patients with pancreatic cancer should be given the opportunity of radical operation combining related peripancreatic neural plexus as far as possible. The dual immunohistochemical staining with anti-CK19 and anti-D2-40 monoclonal antibodies should be a new method in research of perineural invasion of pancreatic cancer, exhibiting both the pancreatic cancer cells and lymph vessels clearly and distinctly.

Citation： CHENG Peng,JIN Gang,HU Xiangui,ZHANG Yijie,LIU Rui,SHAO Chenghao,HE Tianlin,LI Gang,JING Wei,SONG Bin.. Dual Immunohistochemical Staining in Neuroplexus Micrometastasis of Pancreatic Duct Adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(10): 1067-1070. doi: Copy

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13.	Jin G, Sugiyama M, Tuo H, et al. Distribution of lymphatic vessels in the neural plexuses surrounding the superior mesenteric artery [J]. Pancreas, 2006; 32(1): 62-66.
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1. 　Zhu Z, Kleeff J, Kayed H, et al. Nerve growth factor and enhancement of proliferation, invasion, and tumorigenicity of pancreatic cancer cells [J]. Mol Carcinog, 2002; 35(3): 138-147．.
2. 　Mohammed RA, Martin SG, Gill MS, et al. Improved methods of detection of lymphovascular invasion demonstrate that it is the predominant method of vascular invasion in breast cancer and has important clinical consequences [J]. Am J Surg Pathol, 2007; 31(12): 1825-1833.
3. 　Laser J, Cangiarella J, Singh B, et al. Invasive lobular carcinoma of the breast: role of endothelial lymphatic marker 　D2-40 [J]. Ann Clin Lab Sci, 2008; 38(2): 99-104.
4. 　Japan Pancreas Society. Classification of pancreatic cancer 　[M]. 2nd ed. Tokyo: Kanehara, 2003.
5. 　Ohno M, Nakamura T, Kunimoto Y, et al. Lymphagenesis correlates with expression of vascular endothelial growth factor-C in colorectal cancer [J]. Oncol Rep, 2003; 10(4): 939-943.
6. 　Hirai I, Kimura W, Ozawa K, et al. Perineural invasion in pancreatic cancer [J]. Pancreas, 2002; 24(1): 15-25.
7. 　Roma AA, Magi-Galluzzi C, Kral MA, et al. Peritumoral lymphatic invasion is associated with regional lymph node metastases in prostate adenocarcinoma [J]. Mod Pathol, 2006; 19(3): 392-398.
8. 　Kurahara H, Takao S, Maemura K, et al. Impact of vascular endothelial growth factor-C and -D expression in human pancreatic cancer: its relationship to lymph node metastasis [J]. Clin Cancer Res, 2004; 10(24): 8413-8420.
9. 　Choi WW， Lewis MM， Lawson D， et al. Angiogenic and lymphangiogenic microvessel density in breast carcinoma: correlation with clinicopathologic parameters and VEGF-family gene expression [J]. Mod Pathol, 2005; 18: 143-152.
10. 　Padera TP, Kadambi A, di Tomaso E, et al. Lymphatic metastasis in the absence of functional intratumor lymphatics [J]. Science, 2002; 296(5574): 1883-1886.
11. 　金钢，胡先贵，刘瑞, 等. 胰腺癌组织淋巴管分布及密度的临床病理学 [J]. 中国医学科学院学报， 2005; 27（5）: 583-586, T0001.
12. 　程鹏, 金钢, 胡先贵, 等. 新生淋巴管在胰腺导管腺癌周围神经丛微转移过程中的机制研究 [J]. 中华胰腺病杂志, 2009; 9(6): 363-366.
13. 　Jin G, Sugiyama M, Tuo H, et al. Distribution of lymphatic vessels in the neural plexuses surrounding the superior mesenteric artery [J]. Pancreas, 2006; 32(1): 62-66.
14. 　Zhu Z, Friess H, diMola FF, et al. Nerve growth factor expression correlates with perineural invasion and pain in human pancreatic cancer [J]. J Clin Oncol, 1999; 17(8): 2419-2428.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Dual Immunohistochemical Staining in Neuroplexus Micrometastasis of Pancreatic Duct Adenocarcinoma

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