腹膜低度恶性囊性间皮瘤的病理学研究  

Low-grade malignant cystic mesothelioma of the peritoneum: a clinical and pathological study

作　　者：巴恩平[1] 毛永平[1] 宋志刚[1] 于国[1] 

机构地区：[1]解放军总医院病理科,北京100853

出　　处：《解放军医学杂志》2011年第10期1083-1085,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨腹膜低度恶性囊性间皮瘤的病理形态学特点、病理诊断方法及预后情况。方法收集解放军总医院1981年6月-2010年12月手术切除的腹膜低度恶性囊性间皮瘤标本36例及尸检标本2例,采用光镜、电镜、组织化学及免疫组化等方法进行观察,并结合临床资料评价其治疗效果及预后。结果 38例腹膜低度恶性囊性间皮瘤患者中,男9例,女29例,年龄1.5～83岁,平均38.9岁。大体观察肿瘤可分为3种类型,即局限囊性肿块型、多发性囊性结节型、弥漫囊性结节型。光镜观察可见肿瘤微囊衬以单层立方状或扁平状细胞,瘤细胞有轻度异型性。电镜观察显示15例瘤细胞表面可见蓬发样细长微绒毛,胞质内见大量张力微丝,并见较多桥粒,超微结构形态测量显示微绒毛长宽比值平均为12.1。组织化学染色显示38例均呈不同程度的CI染色阳性,而HCI染色均呈阴性。免疫组化染色显示肿瘤细胞对CK5、CK、EMA、Vimentin及抗间皮细胞抗原均呈阳性。38例患者中,1例瘤组织转变成传统性恶性间皮瘤,4例瘤组织局灶性侵及肠壁肌层,10例肿瘤复发。结论腹膜低度恶性囊性间皮瘤是一种低度恶性肿瘤,具有独特的临床及病理特点,手术治疗效果良好。Objective To investigate the pathomorphological features,diagnostic methods and prognosis of peritoneal low-grade malignant cystic mesothelioma.Methods Thirty-six surgically resected specimens of peritoneal low-grade malignant cystic mesothelioma,collected from Jun.1981 to Dec.2010,and 2 autopsy specimens were studied by light microscopy,transmission electron microscopy,histochemistry and immunohistochemistry methods,and the therapeutic effects and prognosis were evaluated by combining the findings with the clinical data.Results Of the 38 cases,9 were male and 29 were female,age ranged from 1.5 to 83 years with a mean of 38.9 years.According to the general observation,the morphology of the tumors might be described as localized cystic mass,multiple cystic nodules or diffuse cystic nodules.Observation by light microscopy revealed that the microcystic walls were lined by single layer of cubic or flat cells with mild atypia.Study with electron microscopy in 15 cases,it was revealed that there were profuse slender microvilli on the tumor cell surface,with a large amount of microfilaments in the cytoplasm,and abundant desmosomes.Utrastructural morphometry showed the mean ratio of length/wide of microvilli was 12.1 in 15 cases.Histochemical staining showed positive CI and negative HCI in all 38 cases.Immunohistochemical staining showed that the tumor cells were positive for CK5,CK,EMA,Vimentin,and anti-mesothelial cell antigen.Among 38 cases,1 finally developed into traditional malignant mesothelioma,4 with local infiltration of intestinal muscular layer,and 10 with tumor recurrence.Conclusion Peritoneal low-grade malignant cystic mesothelioma is a low-grade malignant tumor with special clinical and pathological features,and the surgical resection may give rise to a good result.

关 键 词：腹膜肿瘤 间皮瘤 囊性 病理学 临床 

分 类 号：R735.502.2[医药卫生—肿瘤] R730.262.7[医药卫生—临床医学]