Lymphatic Anatomy

Lymphatic vessels of the pancreas originate from the interlobular network in the pancreatic parenchyma.5,6 They form collecting trunks that follow the pancreatic and peripancreatic blood vessels and drain into the regional lymph nodes according to the pancreatic regions.9 Lymphatic drainage of the body and the tail of the pancreas drains into the nodes at the splenic hilum and follows the splenic artery to the celiac node, which is the principal nodal group.

The lymphatic drainage of the anterior cephalad portion of the head of the pancreas follows lymphatic vessels along the anterior SPDA to the pyloric (or "subpyloric") nodal group, which consist of several lymph nodes along the GDA where it originates from the CHA. This nodal group is located behind the pylorus and anteriosuperior to the head of the pancreas. Posteriorly, the lymphatic drainage of the cephalad portion follows the bile duct to drain into the nodes along the bile duct posterior to the portal vein in the hepatoduodenal ligament and can continue to the hepatic hilar node. The alternate route is to follow the posterior SPDA to the pyloric node. These pathways can also be defined as the superior or ascending pathways, and they drain into the celiac node as their principal node.9

The lymphatic drainage of the caudal portion of the head of the pancreas and the uncinate process follows the inferior pancreaticoduodenal vessels to the superior mesenteric artery lymph node and drains into the ret-

roperitoneal paraaortic lymph node. This pathway can be defined as the inferior or descending pathway.9

Several classification systems, including those from the Japanese Pancreatic Society4 and our institution,10 have been adopted to define the precise location of nodal stations based on surgical pathologic specimens. The systems usually describe nodal station in relationship to the pancreas and the peripancreatic vessels. The anterior and posterior pancreaticoduodenal nodes are those nodes near the pancreaticoduodenal groove anterior and posterior to the pancreas. The superior nodes are those nodes cephalad to the plane of the main pancreatic duct from the neck of the pancreas to the ampulla, and caudal to that plane are the inferior nodes. These systems are not practical to apply on cross-sectional imaging studies such as CT because the plane of the pancreatic duct is oriented obliquely. However, nodal groups along the GDA, pancreaticoduodenal arcades, and IPDA can be defined with a proper helical scanning technique.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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