胰腺癌神经丛微转移的双重免疫组化研究

Dual Immunohistochemical Staining in Neuroplexus Micrometastasis of Pancreatic Duct Adenocarcinoma

目的利用双重免疫组化染色技术研究胰腺癌神经丛微转移机理。方法我院2006年1月至2007年1月期间对44例胰腺导管腺癌患者施行胰腺癌扩大根治术,采用D2-40和CK19双重免疫组化染色方法,对胰周神经丛中淋巴管微转移、周围神经丛侵犯等进行观察。结果 D2-40标记淋巴管呈棕黄色管腔样结构。胰周神经丛组织内淋巴管多与血管及神经束伴行,而胰周神经束附近的淋巴管均呈明显管腔样结构。CK19染色使胰腺癌细胞胞浆呈红色,清晰显示毛细淋巴管内肿瘤细胞侵犯现象。胰周神经丛侵犯30例(68.2%),21例(47.7%)在胰腺癌周围神经丛组织中的淋巴管内发现肿瘤细胞侵犯,胰周神经侵犯现象与其中的淋巴管侵犯现象存在明显相关性(P=0.003)。结论应重视胰腺导管腺癌术中对可能受侵的神经丛,尤其是肠系膜上动脉周围神经丛的廓清。此外,联合D2-40和CK19的双重免疫组化技术为研究胰腺癌周围神经丛微转移机理提供了新的方法。

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.