摘要
目的探讨睾丸鞘膜恶性间皮瘤(malignant mesothelioma)的临床病理学特征及诊断、鉴别诊断要点。方法对3例睾丸鞘膜恶性间皮瘤进行临床病理学分析、免疫组化EnVision两步法染色及超微结构观察,并结合文献对该病的临床表现、组织形态学特点、免疫表型、超微结构特点和预后进行探讨。结果 3例患者临床症状均为阴囊肿块伴或不伴鞘膜积液,大体观察肿瘤呈结节状,直径0.4~5.0 cm,切面实性或囊实性,灰白,质韧。光镜下见肿瘤细胞形态多样,呈巢状、束状、编织状、实性片状或腺管状排列,瘤细胞胞质空淡或淡红染,核圆形、卵圆形或不规则形,核仁明显,核分裂象可见。免疫表型:瘤细胞均表达CKpan、Calretinin、EMA、vimentin、calponin、CK7、Villin;部分表达CK5/6、WT-1、CEA、SMA、S-100蛋白、CD34、CEA;D2-40、HBME-1、CD30、desmin、CD117和CK20均阴性;Ki-67增殖指数10%~30%。电镜观察细胞表面可见多量细长的微绒毛,细胞间可见细胞间连接,包括桥粒和连接复合体,胞质内见多量细胞丝,包括张力原纤维及一定数量的糖原。结论睾丸鞘膜恶性间皮瘤较罕见,临床诊断较困难。确诊需根据其光镜病理形态特征,辅以免疫组化标记和(或)电镜检查。病理学上应与间皮增生、腺瘤样瘤、睾丸网腺癌、浆液性乳头状肿瘤等鉴别。该肿瘤完全切除后预后较好,以随访为主,可行放、化疗等辅助治疗。
Purpose To study the clinicopathological features of malignant mesothelioma (MM) of the tunica vaginalis testis and pro- vide useful imformation for the diagnosis and differential diagnosis of the tumor. Methods The morphology features of 3 malignant mesotheliomas of the tunica vaginalis testis were observed by gross observation, HE staining and electron microscopy. Immunohisto- chemisty was used to identify the immunophenotype. We also reviewed the literatures to further analyze the clinical manifestations, his- topathologieal features, immunohistochemisty, treatment and prognosis of MM. Results The three cases presented with scrotal masses with or without hydroeele. Macroseopically, the tumors are nodular, 0. 4 - 5.0 cm in diameter. On the cut surface, the tumors are sol- id or cystic-solid, gray-white and texture tough. Microscopically, tumor cells arranged in varied patterns: nested, faseicular, storiform, solid sheets and glandular. Cytoplasm is pale or light. Nucleus is round, oval or irregular in shape, with prominent nucleoli, and mi- totic figures can be seen. Immunohistochemically, the tumor cells expressed CKpan, Calretinin, EMA, vimentin, ealponin, CK7 and Villin. Some of the tumor cells expressed CK5/6, WT-1, CEA, SMA, S-100, CD34 and CEA. While D2-40, HBME-1, CD30, desmin, CD117 and CK20 were negative. Proliferation index was 10% -30%. By electron microscope, there were a lot of elongated microvilli on tumor cells surface. Intercellular junctions were also observed between tumor cells, including desmosome and junctional complex. There were a lot of cytofilaments in the cytoplasma, including tonofilaments and a certain amount of glycogen. Conehlsions Malignant mesothelioma of the tuniea vaginalis testis is rare, and it can be difficult to diagnosis clinically. The definite diagnosis re- quires light microscopy plus immunohistology and (or) electron microscopy. The differential diagnosis including mesothelial hyperplasi- a, adenomatoid tumor, adenocarcinoma of the fete testis, and papillary
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2013年第1期40-44,共5页
Chinese Journal of Clinical and Experimental Pathology
关键词
恶性间皮瘤
睾丸鞘膜
鉴别诊断
超微结构
malignant mesotheliom
tunica vaginalis testis
differential diagnosis
ultrastructure