The apron of the greater omentum of gastric cancer patients contains various lymphoid structures including lymph nodes

Abstract

Purpose: To gain more insight into the pattern of peritoneal cancer dissemination and optimize cancer treatment, it is important to improve our understanding of the omental lymphatic system. Although omental milky spots (OMSs) are considered the only lymphoid structures in the omentum, clinical studies mention the presence of lymph nodes (LNs) as well. This discrepancy may be explained by the fact that OMSs are highly dynamic structures and may erroneously be mistaken for LNs. The aim of this study was to evaluate the lymphoid structures, and mainly the presence of lymph nodes, in the apron of the greater omentum. Basic procedures: In this study, diagnostic samples of the greater omentum of 17 gastric cancer patients that were previously reported to contain LNs were re-evaluated for their presence. Paraffin embedded omental samples were stained with Picrosirius red, smooth muscle actin and CD20 and CD3, and microscopically re-examined according to predefined criteria to distinguish OMSs from LNs. Main findings: Pathology records reported 47 LNs in 17 patients. Upon re-evaluation, 20/47 LNs could be classified as true LNs and were located in both the upper and lower quadrants of the greater omentum. The other 27 structures could not be classified as LNs or OMSs and were defined as intermediate lymphoid structures. Conclusions: The omental apron of gastric cancer patients contains LNs and intermediate lymphoid structures, the latter most likely representing activated OMSs. These observations underline that our understanding of the lymphatic system of the greater omentum is incomplete and requires additional studies to gain further insight in its structure and function in both health and disease.