Perineural invasion of hilar cholangiocarcinoma in Chinese population: One center’s experience

Figure 1 Perineural invasion in human hilar cholangiocarcinoma. A: Tumor cells (arrow) located within the peripheral nerve sheath in clusters [Hematoxylin-eosin (HE) staining, ×100]; B: Tumor cells (arrow) from glandular elements in perineural space (HE staining, ×100); C: Tumor cells invaded more than 33% of the circumference of the nerve (HE staining, ×100); D: Modes of perineural invasion (arrows) in one patient (HE staining, ×100).

Figure 2 Correlation of perineural invasion and microvessel. A: Tumor cells (arrow) invaded microvessel (CD34, original magnification ×400); B: Tumor cell clump (arrow) in the microvessel (CD34, original magnification ×400); C, D: Tumor cells (arrow) invaded nerve fiber (N) with vascular proliferation (CD34, original magnification ×100).

Figure 3 Correlation between perineural invasion and lymphatics. A: Lymphatic microvessel (arrow) was stained brown (D2-40, original magnification ×400); B: A great of lymph ducts were observed in primary tumor (D2-40, original magnification ×100); C, D: Tumor cells (arrow) invaded nerve fiber and lymph ducts (arrowhead) were stained (D2-40, original magnification ×100).

Figure 4 Distribution of nerve plexus around hepatic portal. A: Delineation of cutting parts; B: Transection of hepatoduodenal ligament including common hepatic duct [Hematoxylin-eosin (HE) staining, original magnification ×200]; C: Figure B without fibrous connective tissue and adipose tissue; D: Transection of the beginning part of Glisson’s sheath, including left hepatic duct (HE staining, original magnification ×200); E: Transection of the beginning part of Glisson’s sheath, including right hepatic duct (HE staining, original magnification ×200); F: Transection of furcation of right hepatic duct (HE staining, original magnification ×200). CHD: Common hepatic duct; PV: Portal vein; PHA: Proper hepatic artery; N: Nerve plexus; LHD: Left hepatic duct; LPV: Left branch of portal vein; LHA: Left hepatic artery; RHD: Right hepatic duct; RPV: Right branch of portal vein; RFID: Right front hepatic duct; RPHD: Right posterior hepatic duct.