8例胸膜上皮型恶性间皮瘤临床病理观察

Pleural epithelial malignant mesothelioma： Clinicopathologic observation of 8 cases

目的 探讨胸膜上皮型恶性间皮瘤的临床病理特征、诊断及鉴别诊断.方法 收集胸膜活检标本,分析8例胸膜上皮型恶性间皮瘤的临床资料、病理特点及免疫组化标记.结果 胸膜上皮型恶性间皮瘤好发于中老年人,平均年龄57.75岁,临床表现主要为胸水、胸闷、气短、咳嗽等,影像学CT示胸膜不均匀增厚.镜下形态：瘤细胞呈上皮样,因其分化程度的不同,在组织结构上有很大的差异,表现为腺管状、乳头状或实性排列.免疫组化显示AE1/AE3（8/8）、Vimentin（8/8）、Calretinin（CR）（8/8）、CK5/6（7/8）、CK7（4/8）为阳性,TTF-1全部阴性.结论 胸膜上皮型恶性间皮瘤的确诊需结合临床特征、影像学检查、病理形态及免疫表型,且需与胸膜原发或转移的其他肿瘤相鉴别.

Objective To investigate the clinicopathologic features,diagnosis and differential diagnosis of pleural epithelial malignant mesothelioma （PEMM）.Method Based on pleural biopsy specimens collected,clinical data,pathological features,and immunohistochemical markers in 8 patients with PEMM were analyzed.Results PEMM occurred frequently in the middle-aged and the elderly,with the average age of 57.75 years old.The major clinical manifestations included pleural effusion,chest pain,breathlessness,cough.Irregular thickening of pleura was shown by CT.With different degrees of differentiation,tumor cells differed in histological structure,showing glandular,papillary or solid arrangement.Immunohistochemically,AE1/AE3 （8/8）,Vimentin （8/8）,Calretinin （8/8）,CK5/6 （7/8）,CK7 （4/8） exhibited positive findings,while TTF-1 in all cases exhibited negative findings.Conclusions The accurate diagnosis of PEMM relies on clinical features,imaging examination,pathological morphology,and immunophenotyping tests.And it needs to be distinguished from pleural primary or metastatic tumors.