Michael, As I understand it, perineural involvement means the tumor has included some nerves or part of a nerve. Which means the cancer has more chance of travelling elsewhere through your nervous system. Angiolymphatic invasion means it has included blood vessels or small lymphatic pathways )again, this is my best understanding. Your doctor will have a better one). Again, indicating more of a possibility of cells travelling elsewhere.

It's definitely an indicator you should get the most aggressive treatment available. I had both of these in the path report from my tumor too, even though I didn't have any lymph nodes positive.