干痛型恶性腹膜间皮瘤的临床分析

Clinical analysis of dry-painful type malignant peritoneal mesothelioma

目的探讨干痛型恶性腹膜间皮瘤(malignant peritoneal mesothelioma,MPeM)患者的临床特点。方法收集我院6.5年来经临床表现、影像学特征及病理确诊的7例干痛型MPeM患者临床资料,对其发病情况、石棉接触史、临床表现、影像学特征、病理类型和免疫组织化学结果等进行回顾性分析。结果7例患者中女性6例,占85.7%,男性1例,占14.3%,年龄在28~71岁之间(平均55.5岁),6例有石棉接触史,占85.7%。临床症状以局部腹痛(7例)、腹部包块(3例)多见。患者CT影像学特点为腹腔内单个(5例)或多个肿块(2例),伴有周围脏器浸润(3例)、局部腹膜增厚(1例)、胸膜斑(3例),无腹水、淋巴结及远处器官转移。剖腹探查是确诊的主要手段,其次为超声引导下腹膜穿刺活检。病理类型主要为上皮型(57.1%),其次为混合型和肉瘤型。结论干痛型MPeM极其少见,临床表现无特异性,石棉接触史及腹部CT可见腹部包块伴石棉斑、局部腹膜增厚提示该病诊断,确诊依靠病理细胞学和免疫组织化学。

Objective To retrospectively analyze the clinical characteristics in patients with dry-painful type（nonascitic）malignant peritoneal mesothelioma（MPeM）.Methods The clinical data of 7cases with dry-painful type MPeM were collected during the past 6.5 years, which were confirmed by clinical manifestations,imaging characteristics and pathologic features.The incidence,asbestos exposure history,clinical manifestations,imaging features,pathological types and immunohistochemical results were analyzed respectively.Results In the 7cases,there were 1male and 6female patients which were accounted for 14.3% and 85.7%,respectively.The average age was 55.5years old（age range from 28 to 71years old）.There was a definite history of significant asbestos exposure in6patients（85.7%）.Local abdominal pain（7cases）and abdominal mass（3cases）were the main clinical symptoms.CT imaging characteristics：abdominal and/or cavity single（5cases）or multiple mass（2cases）,accompanied by the surrounding viscera invasion（3cases）,local peritoneal thickening（1case）,pleural plaque（3cases）,without ascites,lymph node enlargement and distant organ metastasis.Laparotomy was the major means of diagnosis,followed by the peritoneal biopsy guided by ultrasound.Epithelial type was the main pthological type（57.1%）,followed by mixed and sarcoma type.Conclusion Dry-painful type MPeM is extremely rare.and the clinical manifestations are nonspecific.Asbestos exposure history and CT findings with abdominal and/or cavity mass with asbestos plaques and local peritoneal thickening could suggest the possibility of dry-painful type MPeM,However,the confirmed diagnosis depends on pathological cytology and immunohistochemistry.