恶性胸膜间皮瘤的临床病理特点及预后分析  

Clinicopathological characteristics and prognosis of malignant pleural mesothelioma

作　　者：陈文慧[1] 张雪丽[1] 代华平[1] 童朝晖[1] 张予辉[1] 金木兰[2] 

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科,100020 [2]首都医科大学附属北京朝阳医院病理科,100020

出　　处：《中华结核和呼吸杂志》2013年第11期825-828,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 探讨恶性胸膜间皮瘤的临床病理特点及预后.方法 对北京朝阳医院2006年1月至2012年6月确诊的30例恶性胸膜间皮瘤的临床表现、影像学特点、胸腔镜下表现、组织病理学及生存状况进行回顾性分析.结果 30例中男15例,女15例,中位年龄58岁.恶性胸膜间皮瘤最常见的症状是活动后气短（26例）,其次是胸痛（15例）.影像学表现以少量至大量胸腔积液多见（28例）,常伴胸膜肥厚和（或）胸膜结节.30例患者中25例经内科胸腔镜确诊,l例经外科胸腔镜确诊.胸腔镜下显示病变多呈弥漫分布于膈胸膜和壁层胸膜,表现为大小不等的结节,胸膜表面可见白瓷片样物覆盖.组织病理学检查分别为上皮型（24例）、肉瘤样型（5例）和双相型（1例）.免疫组织化学染色钙结合蛋白、间皮细胞和D2-40阳性者分别为27、25和19例.15例患者接受化疗,2例接受胸膜剥脱术,8例给予最佳支持治疗.24例患者随访时间为1个月至6年,6例失访,患者总生存时间为1～54个月,生存超过24个月的患者均接受培美曲塞＋顺铂/卡铂方案化疗或手术治疗.结论 恶性胸膜间皮瘤临床表现无特异性,内科胸腔镜可及早确诊.恶性胸膜间皮瘤的病理诊断需结合免疫组织化学检查,钙结合蛋白、间皮细胞、D2-40等具有阳性诊断价值.恶性胸膜间皮瘤预后差,培美曲塞联合铂类化疗可延长患者生存时间.Objective To investigate the clinicopathological characteristics and prognosis of malignant pleural mesothelioma.Methods Thirty patients with malignant pleural mesothelioma diagnosed between January 2006 and June 2012 in our hospital were studied retrospectively.Clinical manifestations,radiological characteristics,endoscopic features,histopathology,and survival status were analyzed.Results There were 15 males and 15 females,with a median age of 58 years.The commonest clinical symptoms were dyspnea on exertion （26 cases）,followed by chest pain （15 cases）.The main radiological manifestations were small to large amount of pleural effusions （28 cases）,often accompanied by pleural thickening and/or pleural nodules.Of the 30 cases,25 were diagnosed through medical thoracoscopy and 1 through surgical thoracoscopy.Thoracic lesions manifested as nodules of diffuse distribution on the diaphragmatic pleura and parietal pleura.Some pleural surface was covered with lesions like white tiles.Histopathological examination showed epithelial type in 24 cases,sarcomatoid type in 5 and biphasic type in 1 case.Immonohistological examination showed that the positive rates of calretinin,MC,D2 ～40 were 27,25 and 19 cases respectively.Fifteen patients received chemotherapy,2 underwent pleurectomy,and 8 were treated with best supportive care.Twenty-four patients were followed for 1 month to 6 years,and 6 patients were lost.Overall survival time was 1-54 months.Those who survived longer than 24 months received chemotherapy with pemetrexed and cisplatin/carboplatin or pleurectomy.Conclusions Clinical manifestations of malignant pleural mesotheliome were nonspecific,medical thoracoscopy can make early diagnosis.The pathological diagnosis of malignant pleural mesothelioma was based on immunohistochemical examination,calretinin,MC and D2-40 had positive diagnostic value.Malignant pleural mesothelioma had poor prognosis,chemotherapy with pemetrexed and cisplatin/carboplatin could prolong the survival time of the patients.

关 键 词：胸膜肿瘤 胸腔镜 预后 

分 类 号：R734.3[医药卫生—肿瘤]