Perineural invasion

Perineural Invasion (PNI) is a pathological process often associated with cancer, where cancer cells invade the nerves. This process is a significant prognostic factor for many types of cancer, including pancreatic cancer, prostate cancer, and head and neck cancer.

Definition

Perineural Invasion is defined as the presence of neoplastic cells in the perineural space, which is the area surrounding a nerve. This process is often associated with aggressive tumor behavior and poor prognosis.

Mechanism

The exact mechanism of perineural invasion is not fully understood. However, it is believed that cancer cells may be attracted to nerves due to the release of certain neurotrophic factors by the nerves. These factors may promote the survival and growth of cancer cells.

Clinical Significance

Perineural invasion is a significant prognostic factor in many types of cancer. It is associated with increased local recurrence, distant metastasis, and decreased overall survival. In addition, it may also influence treatment decisions, as tumors with perineural invasion may require more aggressive treatment strategies.

Diagnosis

The diagnosis of perineural invasion is typically made by a pathologist on microscopic examination of tumor tissue. The presence of cancer cells in the perineural space is considered diagnostic of perineural invasion.

Treatment

The treatment of tumors with perineural invasion often involves a combination of surgery, radiation therapy, and chemotherapy. The exact treatment strategy depends on the type and stage of the cancer, as well as the patient's overall health.

Research

Research is ongoing to better understand the mechanisms of perineural invasion and to develop new treatment strategies. This includes the study of molecular markers that may predict the presence of perineural invasion, as well as the development of targeted therapies that may inhibit this process.

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  Prostatic adenocarcinoma with perineural invasion

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  Perineural invasion prostate high magnification