慢性纤维包块型胰腺炎与胰腺导管腺癌癌旁组织的病理学及免疫组化特征

Pathological and immunohistochemical characteristics of fibrous mass-forming chronic pancreatitis and pancreatic ductal adenocarcinoma adjacent tissues

目的 比较慢性纤维包块型胰腺炎（FMCP）及胰腺导管腺癌（PDAC）癌旁组织基本病理变化特征,试从间质微环境角度探讨FMCP在促进PDAC发生、发展中的可能作用.方法 对48例FMCP及62例PDAC的癌旁组织HE切片进行镜下观察比较,观察内容包括导管上皮内瘤变（PanIN）、导管复合体形成（TC）、纤维结缔组织增生、炎细胞浸润及神经炎等病理变化.免疫组化法检测神经纤维增生和微血管形成状况.结果 FMCP及PDAC癌旁组织中PanlN的发生率分别为97.9％ （47/48）和91.4％ （53/58）,其中PanIN-3在PDAC癌旁组织内发生率为20.8％,显著高于FMCP的4.3％（P=0.031）;TC的发生率分别为58.3％ （28/48）和65.0％ （40/62）,差异无统计学意义（P =0.508）.FMCP促纤维结缔组织增生程度重于PDAC癌旁组织,以中、重度为主（P =0.037）.两种组织的炎细胞浸润程度差异无统计学意义（P=0.754）；神经炎发生率分别为81.3％和66.1％,差异亦无统计学意义（P=0.077）.FMCP及PDAC癌旁组织内细小无髓神经纤维数目明显增加,发生率分别为68.8％ （33/48）和63.3％ （38/60）,200倍视野下计数分别为（12.08±3.72）根和（11.14±4.70）根,差异无统计学意义（P=0.537）；微血管密度（MVD）分别为（39.69±22.88）个和（44.89±16.83）个,差异亦无统计学意义（P=0.605）.结论 FMCP及PDAC癌旁呈现较为相似的病理变化,提示FMCP在PDAC发生、发展过程中提供了可能的微环境,FMCP可能是重要的PDAC癌前病变.

Objective To compare the pathological characteristics of fibrous mass-forming chronic pancreatitis （FMCP） with pancreatic ductal adenocarcinoma （PDAC） adjacent tissues,and investigate the possible role of FMCP in the development and promotion of PDAC.Methods The HE sections of 48 cases of FMCP and 62 cases of PDAC adjacent tissues were observed and compared,and the observed pathology included pancreatic ductal intraepithelial neoplasia （PanlN）,tubular complexes formation （TC）,fibrous connective tissue hyperplasia,inflammatory cell infiltration and neuritis.Immunohistochemical method was used to detect nerve fiber hyperplasia and angiogenesis situation.Results The incidence of PanlN in FMCP and PDAC adjacent tissues was 97.9% （47/48） and 91.4% （53/58）.The incidence of PanlN-3 in the PDAC adjacent tissues was 20.8%,which was significantly higher than that of FMCP （4.3%,P =0.031）.The incidence of TC in FMCP and PDAC adjacent tissues was 58.3% （28/48） and 65.0% （40/62）,respectively,the difference was not statistically significant （P =0.508）.The promotion of fibrous connective tissue hyperplasia in FMCP was more severe than that in the PDAC adjacent tissues,which was mainly moderate to severe （P =0.037）.The difference between the two groups in terms of degree of inflammatory cell infiltration was not significant （P =0.754）,the incidence of neuritis in FMCP and PDAC adjacent tissues was 81.3% and 66.1%,respectively,there was no significant difference （P =0.077）.The number of small unmyelinated nerve fibers was obviously increased in the FMCP （68.8%,33/48） and PDAC adjacent tissues （63.3%,38/60）,and the count number under 200 magnification was 12.08 ±3.72 and 11.14 ±4.70,and there was no significant difference （P =0.537）.The microvessel density （MVD） of FMCP and PDAC adjacent tissues was 39.69 ± 22.88 and 44.89 ± 16.83,and there was no significant differences （P =0.605）.Conclusions The pathological changes of FMCP and PDAC adjacent tissues are similar,which suggests the possible function of FMCP＇s microenvironment in PDAC development.FMCP may be an important precancerous lesion of PDAC.