高分化乳头状间皮瘤临床病理分析(附3例报道)

Clinicopathologicanalysis ofwelldifferent papillary mesothelioma: aretrospective study of 3 cases

目的探讨高分化乳头状间皮瘤(well-differentiated papillary mesothelioma,WDPM)的临床病理表现、诊断与鉴别诊断要点,以及有效的治疗方法。方法对3例WDPM患者的临床、组织病理学形态及免疫组化特征进行形态学观察并文献复习。结果 3例患者中2例患者体检时发现盆腔包块,另1例患者因为伴发腹水出现下腹胀痛。肿瘤肉眼特点为大网膜及盆腔腹膜、卵巢、输卵管表面见多个或聚集呈小簇或散在的白色透明的粟粒状小结节,卵巢均呈囊实性,囊腔为主,囊内可见白色透亮的粟粒状小结节。病变的组织学特点为瘤细胞排列呈粗短的乳头状结构,乳头间质为纤维血管轴心,一般无分级,乳头表面被覆单层立方或扁平的上皮细胞,细胞大小一致,无异型性。肿瘤细胞免疫组化检查calretinin、Mesothelial Cell、CK5/6、EMA均为阳性。结论 WDPM是一种可长期带瘤生存并具有独特形态学特点的低度恶性间皮瘤,根据手术情况联合化疗是一种有效的改善预后的手段。

Objective To analyze the clinicopathologic features, diagnosis and differential diagonosis of welldifferentiated papillary mesothelioma （WDPM）, to acquire effective treatment. Methods The clinical symptom, pathologic andimmunohistochemicalcharacteristics were observed, and related literaturesreviewed. Results Enclosed mass were found in cavitas pelvisincidentally of 2 cases in health examination . Abdominal dropsy was found in the other one. Macroseopically, there were many white and lucent lesser tubercles on caul, pelvic peritoneum, ovaries and uterine tube. All tubercles on ovaries were present solid cystic, cystic-based. White and lucent lesser tubercles can be seenin these eystses. Microscopically, tumor cells were ranked as coarse papillary architecture, and the mesenchyme were fibrovascular cores which without bifurcate. The papillae werecovered by uniform euboidal epithelium or pavement epithelium at the same size and with no nuclear atypia or mitoses. The expressions of calretinin, CK5/6, MC, EMA were positive. Conclusions WDPM was thought to be a kind of tumor which specialised in morphology and low malignant potential, the majority patients can survive for a long time with this kind of tumor. Combination of chemotherapy and surgery is an effective method to improve prognose.