恶性胸膜间皮瘤六例误诊原因分析  

Analysis of Causes of Misdiagnosis of Malignant Pleural Mesothelioma in 6 Cases

作　　者：李婵 李阔 李娟 LI Chan;LI Kuo;LI Juan(The Third Department of Thoracic Medicine,Liaoning Cancer Hospital&Institute,Shenyang 110042,China;the Second Department of Breast Surgery,Liaoning Cancer Hospital&Institute,Shenyang 110042,China;Department of Gastrointestinal Surgery,the People's Hospital of Liaoning Province,Shenyang 110000,China)

机构地区：[1]辽宁省肿瘤医院胸内科三病区,沈阳110042 [2]辽宁省肿瘤医院乳腺外科二病区,沈阳110042 [3]辽宁省人民医院胃肠外科,沈阳110000

出　　处：《临床误诊误治》2022年第11期14-17,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析恶性胸膜间皮瘤(MPM)的误诊原因,以减少误诊,改善预后。方法回顾性分析2009年1月1日—2019年12月31日收治的6例被误诊MPM的临床资料。结果本组6例均出现单侧胸腔积液,胸闷气短4例,胸痛、咳嗽咳痰各2例,发热、体质量下降各1例,1例无症状(体检时发现);有吸烟史3例,均无石棉接触史。胸部CT检查结果显示,5例出现胸膜增厚,3例出现胸膜结节,2例出现胸膜状肿块,1例出现肺部肿物,1例出现胸壁肿物,4例出现纵隔淋巴结增大,2例出现肺容积缩小。4例结核菌素纯蛋白衍生物试验阳性,2例胸腔积液脱落细胞检测中见肿瘤细胞。4例误诊为结核性胸膜炎,2例误诊为胸膜转移性肺腺癌。误诊时间2~36个月。所有患者经对症治疗后效果欠佳,完善免疫组织化学检测后确诊为MPM,均给予培美曲赛联合铂类药物方案化疗,总生存期22.0~77.5个月。结论MPM的临床表现、实验室检查、胸部CT表现缺乏特异性,易被误诊为结核性胸膜炎和胸膜转移性癌,确诊需依靠组织病理活检及免疫组织化学检查。Objective To analyze the causes of misdiagnosis of malignant pleural mesothelioma(MPM)in order to reduce misdiagnosis and improve prognosis.Methods The clinical data of 6 patients with misdiagnosed MPM admitted from January 1,2009 to December 31,2019 were retrospectively analyzed.Results In this group,all the 6 patients had unilateral pleural effusion,and there was chest shortness of breath in 4 cases,chest pain in 2 cases,cough and sputum in 2 cases,fever in 1 case,reduced body weight in 1 case,and no symptoms(found during physical examination)in 1 case.There were 3 cases with smoking history and no asbestos exposure history.Chest CT examination results showed pleural thickening in 5 cases,pleural nodule in 3 cases,pleural mass in 2 cases,lung mass in 1 case,chest wall mass in 1 case,mediastinal lymph node enlargement in 4 cases,and lung volume reduction in 2 cases.The tuberculin pure protein derivative test was positive in 4 cases,and tumor cells were detected in 2 cases of pleural effusion.Four cases were misdiagnosed as tuberculous pleurisy and 2 cases as metastatic pleural adenocarcinoma.Misdiagnosis lasted from 2 to 36 months.After symptomatic treatment,all patients had poor results and were diagnosed as MPM after improved immunohistochemical detection.All patients were given Pemetrexel combined with platinum-based chemotherapy,with an overall survival of 22.0-77.5 months.Conclusion The clinical manifestations,laboratory examination and chest CT findings of MPM are lack of specificity,and are easily misdiagnosed as tuberculous pleurisy and pleural metastatic carcinoma.The diagnosis of MPM depends on histopathological biopsy and immunohistochemical examination.

关 键 词：间皮瘤 胸膜 误诊 结核 胸膜 胸膜肿瘤 

分 类 号：R734.3[医药卫生—肿瘤]