腹膜淋巴组织细胞样间皮瘤1例并文献复习

Peritoneal lymphohistiocytoid mesothelioma:report of one case and review of literature

目的探讨淋巴组织细胞样间皮瘤的临床病理特征、诊断和鉴别诊断。方法分析1例腹膜淋巴组织细胞样间皮瘤的临床病理资料、病理结果,并复习相关文献。结果患者男,75岁,因"下腹部疼痛伴大便次数减少半月"就诊。肿瘤最大径6 cm,无包膜,切面灰黄、灰白,质硬,局部有黏液感。光镜下肿瘤细胞弥漫分布,大小略不等,呈圆形、卵圆形,部分成短梭形,类似于非典型增生的纤维组织样细胞,泡状核,胞质嗜酸,部分细胞有显著核仁,可见核分裂,肿瘤细胞周边可见大量淋巴细胞浸润。免疫组化示肿瘤细胞vimentin, WT-1强(+),CK、Calretinin灶性(+)。结论淋巴组织细胞样间皮瘤是一种罕见的上皮样间皮瘤,缺乏特异性临床症状和组织学形态,需结合发病部位、影像学资料及免疫组化结果综合诊断。

Objective To explore the clinicopathological features, diagnosis and differential diagnosis of lymphohistiocytoid mesothelioma. Methods We observed a case of abdominal lymphohistiocytoid mesothelioma, and analysed the patient’s clinical data, histopathology, immunohistochemistry and then reviewed all literatures of the lymphohistiocytoid mesothelioma case. Results A 75-year-old man was admitted to hospital with abdominal pain and reduced stool frequency by half a month. The tumor had a maximum diameter of 6 cm, no capsule, and the cut surface was sallow, gray-white and hard, with mucous sensation. Pathologically, the tumor cells were diffusely distributed in slightly different size that were round, oval, and partly short fusiform. It was similar to atypical proliferative fibrous tissue-like cells that showed vesicular nuclei, cytosolic eosinophilic, and part of cells presented significant nucleoli and mitosis. We also found a large number of lymphocytes infiltrated around tumor cells. Immunohistochemistry showed strongly positive expression of vimentin, WT-1 in the tumor cells, and focally positive stain of CK and calretinin. Conclusion Lymphohistiocytoid malignant mesothelioma is an infrequent variant of epithelioid mesothelioma, without specific clinical symptoms. Diagnosis of the lymphohistiocytoid mesothelioma should be based on the combination of symptoms, imaging manifestations and immunohistochemical results.