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Pancreatic
cancer is one of the most aggressive human cancers. The most common
histological type is invasive ductal adenocarcinoma, characterized by
infiltrative growth and fibrous cancer stroma. The fibrous cancer stroma
contains a lot of active fibroblasts called cancer-associated fibroblasts
(CAFs) and is thought to promote the aggressive cancer growth and invasion.
Histologically, the cancer cells/stroma ratio is various depending on the cases.
This morphological diversity of pancreatic cancer is one of our
pathophysiological issues. On the other hand, contrast-enhanced computed
tomography (CECT) is useful clinical modality because it enables to observe the
internal properties of tumors without invasive procedures. In this study, we
examined whether the preoperative clinical image correlates with the
histological diversity of pancreatic cancer. We reviewed pancreatic cancer
cases without preoperative chemotherapy which were histologically diagnosed as
invasive ductal adenocarcinoma. All cases were performed with dynamic CECT in
Hirosaki University Hospital. We evaluated the density of cancer cells and the
positive rate of immunoreactive α-smooth muscle actin (αSMA), a marker of the
cancer stroma. Then, we analyzed dynamic CECT images, and draw out the time
intensity curve of pancreatic cancer. Dynamic CECT images consist of
non-contrast phase, arterial phase, portal phase and equilibrium phase. Time
intensity curve represented the changes of CECT image value. We also examined
the correlations between the histopathological findings and the dynamic CECT
images. There were significant correlations between the CT value at arterial
phase and theαSMA positivity which indicating the cancer stroma. In contrast,
there were no correlations between the cancer cells and CT values at any
phases. We tried to clarify molecular/histological mechanisms why the αSMA
positivity was significantly correlated with the time intensity curve of CECT.
The contrast medium of CECT infiltrates into the αSMA-positive cancer stroma. A
lot of active CAFs regulate the pancreatic cancer microenvironment and play an
important role in the contrast medium infiltration.
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