摘要
目的探讨弥漫性恶性胸膜间皮瘤(MPM)的临床病理学特征。方法回顾性分析6例弥漫性MPM的临床、影像、病理学特征及免疫表型等,并复习相关文献。结果6例MPM中男性3例,女性3例,平均年龄48.3岁,患者以胸痛或胸闷为主诉。影像学均显示胸膜环状增厚、胸腔积液。胸腔积液乳酸脱氢酶(LDH)有5例升高,平均(380.33±196.56)U/L(范围106~245 nU/L),总蛋白6例均升高,平均(48.48±11.46)g/L(范围0~25 g/L),腺苷脱氨酶(ADA)均正常,平均(17.4±4.05)U/L(范围0~40 U/L)。确诊前均按结核性胸膜炎治疗。标本获得方式包括手术部分切除(3/6例)和胸腔镜下活检(3/6例)。大体显示胸膜表面广泛分布大小不一白色或略透明桑葚样结节。镜下组织学亚型均为上皮样型,表现为肿瘤细胞排列成不等比例的管状、乳头状、腺泡状、实性片状或微乳头状,肿瘤细胞呈卵圆形或多边形,胞质嗜酸、丰富,泡状核,可见小核仁。免疫组化结果显示Calretinin、WT-l、CK5/6、D2-40均为阳性,NapsinA、TTF-1、P40均为阴性,4例显示BAP1核缺失表达。结论弥漫性MPM少见,恶性度高,容易误诊为结核等疾病,病理形态学结合相关免疫组化标记可明确诊断。
Objective To investigate the clinicopathological characteristics of diffuse malignant pleural mesothelioma(MPM).Methods The clinical,imaging,pathological features and immunophenotypes were retrospectively analyzed in 6 cases of diffuse MPM with review of the relevant literature.Results Among the 6 cases of MPM,3 were male and 3 were female,with a mean age of 48.3 years,and the patients had chest pain or chest tightness as the main complaint.The imaging findings showed circumferential pleural thickening and pleural effusion.In pleural effusion,lactate dehydrogenase was elevated in 5 cases with a mean of(380.33±196.56)U/L(range 106-245 U/L),total protein was elevated in all cases with a mean of(48.48±11.46)g/L(range 0-25 g/L),and adenosine deaminase was normal in all cases with a mean of(17.4±4.05)U/L(range 0-40 U/L).Patients were treated for tuberculous pleurisy before diagnosis.Specimens were obtained by surgical partial excision(3/6)and thoracoscopic biopsy(3/6).Grossly,the pleural surface showed widely distributed white or slightly transparent mulberry-like nodules of varying sizes.The microscopic histological subtypes were all epithelioid,showing tumor cells arranged in unequal proportions as tubular,papillary,follicular,solid lamellar or micropapillary,with ovoid or polygonal tumor cells,eosinophilic and abundant cytoplasm,vesicular nuclei,and small nucleoli visible.Immunohistochemistry result showed positive for Calretinin,WT-l,CK5/6,D2-40,negative for NapsinA,TTF-1,P40,and BAP1 immunolabeling showed nuclear deletion expression in 4 cases.Conclusion Diffuse MPM is rare and highly malignant,easily misdiagnosed as tuberculosis and other diseases,and the diagnosis can be clarified by pathomorphology combined with relevant immunohistochemical markers.
作者
刘启梁
胡雁
雷美
LIU Qi-liang;HU Yan;LEI Mei(Department of Pathology,Wuhan Pulmonary Hospital,Wuhan 430030,China;Department of Central Lab,Wuhan Pulmonary Hospital,Wuhan 430030,China)
出处
《诊断病理学杂志》
2023年第9期848-851,855,共5页
Chinese Journal of Diagnostic Pathology
关键词
弥漫性恶性胸膜间皮瘤
病理
免疫组化
诊断
Diffuse malignant pleural mesothelioma
Pathology
Immunohistochemistry
Diagnosis
