J Korean Med Sci.  2023 Nov;38(46):e392. 10.3346/jkms.2023.38.e392.

Lymph Node Stations of Pancreas Which Are Identified in Real Color Sectioned Images of a Cadaver With Pancreatic Cancer

• Kim CY
• Jung Y
• Park JS

• KMID: 2548543
• DOI: http://doi.org/10.3346/jkms.2023.38.e392

Abstract

Background
In pancreatic cancer surgery, anatomical understanding of lymph node metastases is required. Distinguishing lymph nodes in computed tomography or magnetic resonance imaging is challenging for novice doctors and medical students because of their small size and similar color to surrounding tissues. This study aimed to enhance our understanding of the clinical anatomy of lymph node stations relevant to pancreatic cancer using newly sectioned images of a cadaver with true color and high resolution and their three-dimensional (3D) models.
Methods
An 88-year-old female cadaver who died of pancreatic cancer was serially sectioned. Among the sectioned images of the whole body (0.05 mm-sized pixel, 48 bits color), images of the abdomen were selected, and examined to identify lymph nodes and nearby structures. 34 structures (9 in digestive system; 1 in urinary system; 2 in cardiovascular system; 22 in lymphatic system) were segmented on the sectioned images. Based on the sectioned and segmented images, volume and surface models were produced.
Results
Among the known 28 lymph node stations, 21 stations were identified through location, size, and color of normal and abnormal structures in the sectioned images and 3D models. Two near the splenic artery could not be separated from the cancer tissue, and the remaining five were not clearly identified. In the surface models, the shape and location of lymph node stations could be confirmed with nearby structures.
Conclusion
The lymph node stations relevant to pancreatic cancer can be anatomically understood by using the sectioned images and 3D models which contain true color and high resolution.

Keyword

Lymphatic Metastasis; Pancreatic Neoplasms; Cross-Sectional Anatomy; Three-Dimensional Image; Visible Human Projects

Figure

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  Fig. 1 Making processes of the sectioned images. (A) A cadaver is fixed by gelatin embedding agent in the embedding box. (B) Embedding box is milled by milling disc to make sectioned surface. (C) The sectioned surface is photographed and checked by anatomist to make sectioned image. Abdominal region in sectioned images of (D) original color and (E) a refined color after adjusting color purity in the image by Vibrance and Brightness/Contrast tools in Adobe Photoshop (Arrow = adipose tissue, Arrow head = parenchymal tissue of pancreas).

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  Fig. 2 Specimen sectioned images from head to toe of female whole body.

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  Fig. 3 Horizontal, coronal, and sagittal sectioned images from abdomen volume model on the MRIcroGL. Only horizontal images are aligned from top (A) to bottom (C) of the pancreas. (A) Both S-5 and S-7 are isolated from cancer tissue of pancreas. A part of cancer tissue of body of pancreas is touched in diaphragm, not stomach (Green arrow). Common bile duct is expanded. (B) S-3, S-5, S-6, S-8a, S-8p, and S-18 are separated whereas S-4, S-9, 12a, and 12b are fused with neighboring structures. There is serious cancer tissue in body of pancreas. (C) S-8p is isolated whereas S-9, S-12a, S-12b, S-14p, and S-17a are fused with cancer tissue of pancreas. S-12a and S-12b are fused together, but they can be divided (Arrow head). The stomach is squashed, due to swelling of the pancreas (Green arrow).‘S-’ is omitted in from S-1 to S-18.a. = artery, v. = vein.

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  Fig. 4 Horizontal, coronal, and sagittal sectioned images from abdomen volume model on the MRIcroGL. Only horizontal images are aligned from top (A) to bottom (C) of the pancreas. (A) S-3 and S-6 are isolated respectively whereas 4, 12b, 12p, 13a, and 17a are fused with one another or pancreas. In the inferior portion of head of pancreas, normal parenchymal tissue is observed. (B) In the inferior portion of head of pancreas, normal tissue is larger than abnormal tissue. S-6 is isolated and S-4, S-12b, S-13a, S-14p, and S-17a are fused. (C) S-4, S-5, and 18 are observed. Duodenum is pressed by S-18. In the case of S-16a2 and 16b1, there were left lumbar nodes (Lateral aortic nodes), intermediate lumbar nodes, right lumbar nodes (postcaval nodes) as anatomical terminology. ‘S-’ is omitted in from S-1 to S-18.a. = artery, v. = vein.

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  Fig. 5 Surface models of abdominal region including pancreatic cancer and its lymph node metastases. (A) Shape and location of structures of the abdominal region are observed opaquely. (B) In anterior view of translucent liver, stomach, small intestine, and large intestine, lymph node stations can be observed. (C) In the anterior view of structures except liver, stomach, small intestine, large intestine, and kidney, lymph node stations around the pancreas are identified in green. (D) In the superior view, lymph node stations around branches of the celiac trunk are identified.a. = artery, v. = vein.aSuperior and bInferior portions of head of pancreas, cBody and tail of pancreas.

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