特殊类型恶性间皮瘤的临床病理分析.docxVIP

特殊类型恶性间皮瘤的临床病理分析 中国编辑。 作者：吴雪辉，于国，王殿军，任刚 【摘要】 　　目的 探讨特殊类型恶性间皮瘤的临床与病理特征。方法 对23例特殊类型恶性间皮瘤进行临床、组织形态学、免疫组化、组织化学及电镜观察并 文献 复习。 结果 恶性间皮瘤的特殊类型包括印戒细胞样型、小细胞型、黏液样型、肌纤维母细胞型、淋巴组织细胞样型、促纤维增生型。免疫组化染色示肿瘤细胞均表达Calretinin、CK5/6、CK及Vimentin。部分病例CI染色阳性，而HCI染色则阴性。19例电镜示瘤细胞表面见细长微绒毛，胞浆内有丰富的张力微丝及桥粒。 结论 特殊类型恶性间皮瘤组织学形态多样，结合临床特征及其免疫组化、组织化学及电镜检测有助于诊断。需与肺腺癌、胃肠道腺癌、恶性淋巴瘤、平滑肌肉瘤及恶性纤维组织细胞瘤鉴别。  【关键词】 恶性间皮瘤；病 理学 ；分类；诊断  Abstract： Objective To investigate the clinical and pathological characteristics of malignant mesothelioma of special A total ofcases of malignant mesothelioma of special types were analyzed by means of histologic, histochemical and immunohistochemical staining and by clinical, light and electron microscopic observation. ThEir clinical and histopathological features were reviewed via related Malignant mesothelioma of the special types included signet ring cell type, small cell type, myxoid type, myofibroblastic type, lymphohistiocytic type and desmoplastic type. Immunohistochemical staining showed that the neoplastic cells were positive for calretinin, CK5/6, CK, vimentin but negative for CEA. Histochemical staining showed that the tumor were positive for CI but negative for HCI. Electron microscopic study of 1cases showed that the neoplastic cells had the mesothelial-type microvilli, lots of tonofilament and desmosomes. Conclusion The malignant mesothelioma of the special types have diversiform histological features. The diagnosis should be established with the combination of clinical manifestation, light and electron microscopic observations and histochemical and immunohistochemical staining. It should be differentiated from adenocarcinoma of lung or gastrointestinal tract, malignant lymphoma, lEIomyosarcoma, and malignant fibrohistiocytoma.  Key words： malignant mesothelioma; pathology; classification; diagnosis  恶性间皮瘤是一种发病较为少见，预后差的恶性肿瘤，但随着 工业 化程度的提高，石棉的广泛应用，MM的发病率在世界许多国家呈上升趋势。以往一般将MM分为上皮型、肉瘤型及混合细胞型，近年来，由于各种新技术的广泛开展，尤其是免疫组化、电镜等，对MM的认