Morphological study and comprehensive cellular constituents of milky spots in the human omentum.

Objective: To analyze morphological features of omental milky spots (MS).

Method: Hematoxylin-eosin staining and immunohistochemistry technique were used to study the omental MS of gastric cancer (GC) patients and rectal cancer (RC) patients. We focused on morphological features of MS and conducted quantitative analysis on the cells number and cellular constituents. Differences in MS parameters between GC and RC were also analyzed.

Results: Various shapes of MS were mainly round, oval, irregular form in the adipose and perivascular annular. The median MS perimeter was 2752 (range 817~7753) computer-based pixels. The median value of immune cells in one MS was 141 (43~650), comprising T lymphocytes (46.1%), B lymphocytes (28.4%), macrophages (12.4%) and other immune cells (13.1%). Relatively high density of vessels in MS could be calculated by micro-vessel density (MVD) as 4 (0~13). The median value of mesothelial cells loosely arranged in the surface layer was 5 (0~51). There were no significant differences in MS perimeter, MVD, the number of mesothelial cells, total immune cells, T lymphocytes and macrophages between GC and RC (P>0.05), while the number of MS B lymphocytes in RC was significantly higher than that in GC (P<0.001).

Conclusion: MS are primary immune tissues in the omentum and structural bases for development and progression of peritoneal dissemination of GC and RC. Analyzing the morphology and cellular constituents could help understanding the mechanism of peritoneal metastasis.