Perineural and Lymph Node Tumor Invasion in a Gastric Carcinoma

in STEMGeeks6 months ago

Perineural and Lymph Node Invasion in a Gastric Carcinoma
Invasion of the perineural and intraneural area signifies poor prognosis and rapid spread towards other organs. Usually, gastric carcinomas are discovered late or as incidental finding which makes them hard to manage when they actually start showing signs in patient. It’s no surprise to see some lymph nodes turned out positive for tumor involvement upon further dissection.

The case was from a mixed gastric carcinoma showing tubulopapillary and discohesive components. I didn’t take a photomicrograph of the tubular to papillary gland component. If you're curious about the grossing of the specimen, here's a link to a different case of poorly cohesive carcinoma of the stomach.

Showing you the typical gross image of these specimens. The photomicrographs below came from a different case but still a stomach specimen.

Taken at Scanner View (40X)

Perineural Invasion Poorly Cohesive Carcinoma Scan.png

You can see a strand of nerve in a sagittal section surrounded by discohesive neoplastic cells. This was taken from a case of a poorly cohesive carcinoma of the stomach. Discohesive neoplastic cells can come in signet-ring looking type to non-signet ring looking (shown in this case).

Taken at Low Power View (100x)

Perineural Invasion Poorly Cohesive Carcinoma LPF.png

Taken at High Power View (400x)

Perineural Invasion Poorly Cohesive Carcinoma HPF.png

When a tumor metastasizes to different parts, they vaguely take form to something as close to the main tumor. That means if they look like glands from the main source, they will attempt to form like glands on any other parts they spread to. The morphology during the spread also gives us a clue where the tumor may have come from like signet-ring cells present in the ovary may have come from the colorectal or gastric part.

Here is what metastasis to regional lymph nodes look like (taken from the same case). You can see the tumor cells (red) invading the remnants of the normal lymph node architecture (green). The neoplastic cells try to form discohesive sheets to tubular glands though it’s not as prominent on the images below.

Taken at Low Power View (100x)

Lymph Nodes.png

Taken at Low Power View (100x)

Lymph Nodes 2.png

We look for several lymph nodes in the specimen and see how many are positive then how large are the tumor deposits. This affects the prognostic staging of the patient. We use the TNM classification for staging.

If you made it this far reading, thank you for your time.

Posted with STEMGeeks


Stomach Cancer is bad news, I had a close friend died from it aged just 42. Too late to do anything when they finally diagnosed it. Until that time, he'd just had increasingly bad gastric reflux, leading to an inability to eat large meals and within 3 months he'd died.
Life is a pretty random game to play.

Hope you're having a great week fella :-)

I'm sorry to hear about your friend. I have come to a point where I approach the sign of cancer as a curiosity for academic reasons compared to thinking there's a person that is going to read the report at the end of the day. It makes work bearable. Just this other time recently the patient I'm following up finally received confirmation on the stains requested as to his tumor status. He doesn't have much time to live and I'm probably better off not seeing a sad reaction in his face when he reads the report.

 6 months ago 

So, what's the prognosis of this particular patient?

!discovery 37

Stage IV and doing palliative care. Folks aren't aggressive with treatment and the patient just entered his retirement years. We don't get to hear the outcome unless it's going to be discussed on follow up / case presentation / mortality and morbidity presentations.

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