15例弥漫性恶性胸膜间皮瘤的临床病理特征及诊断分析
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摘要
目的分析弥漫性恶性胸膜间皮瘤的临床病理特征,探讨诊断思路,以期提高早期诊断率。方法回顾性分析2015年1月至2017年7月明确诊断的15例弥漫性恶性胸膜间皮瘤患者的临床资料及诊断方法。结果胸痛、胸闷为全组患者的主要症状。影像学检查显示,15例反复出现胸腔积液(红色胸腔积液8例),13例胸膜呈环状增厚,7例纵隔淋巴结增大。11例行胸腔积液检查的患者中10例黏蛋白定性(Rivalta)试验阳性,2例癌胚抗原(CEA)阳性,1例腺苷脱氢酶(ADA)阳性。15例患者中,血清CEA检查阳性1例,结核菌素实验(PPD试验)阳性2例。确诊前10例患者行抗结核治疗,5例行抗感染治疗,仅1例患者短期内明确诊断。15例患者发病至明确诊断时间为(266.7±210.0)天,其中6例经外科手术(包括经胸腔镜及开胸)行胸膜活检确诊,7例经CT穿刺行胸膜活检确诊,2例经彩超穿刺胸膜活检确诊。14例患者确诊前经多次胸腔积液病理、胸膜活检检查。结论弥漫性恶性胸膜间皮瘤的临床症状、实验室检查、影像学检查缺乏特异性,确诊时间较长,对于反复出现胸腔积液及胸膜增厚的患者需引起重视。单纯胸腔积液病理诊断率极低,对原因不明的胸膜疾病,需尽早行胸膜活检,外科胸腔探查是其主要手段之一。
Objective To analyze the clinicopathological characteristics of diffuse malignant pleural mesothelioma and explore the diagnostic ideas in order to improve early diagnosis rate. Methods The clinical data and diagnostic methods of 15 patients with diffuse malignant pleural mesothelioma from January 2015 to July 2017 were retrospectively analyzed. Results The main symptoms were chest pain and chest tightness of 15 patients. Imaging examination showed 15 cases with pleural effusion(8 cases of red pleural effusion),13 cases with pleural thickening and 7 cases with mediastinal lymph node enlargement. There were 10 positive of Rivalta test,2 positive of CEA,and 1 positive of ADA in 11 patients with pleural effusion examination. Among 15 patients underwent serum examination,CEA was positive in 1 patients and tuberculin experimentation was positive in 1 patient. Ten patients were treated with anti-tuberculosis treatment,5 cases received anti-infection and symptomatic support treatment,and only 1 patient was diagnosed in a short time. The average time from onset of symptoms to diagnosis was(266. 7±210. 0) days. Among them,6 cases were diagnosed by pleural biopsy through surgical operation (including thoracoscopy and thoracotomy),7 cases were diagnosed by pleural biopsy by CT puncture,and 2 cases were diagnosed by color doppler ultrasound biopsy. Fourteen patients were examined by pleural biopsy and pleural biopsy before diagnosis. Conclusion Diffuse malignant pleural mesothelioma is characterized by lack of specificity in clinical symptoms,laboratory examination and imaging examination. It takes a long time to diagnose,and attention should be paid on recurrent pleural effusion and pleural thickening. The pathological diagnosis rate of pure pleural water examination is very low. Pleural biopsy is needed as early as possible for unexplained pleural disease,and the surgical thoracic exploration is one of the main methods.
Objective To analyze the clinicopathological characteristics of diffuse malignant pleural mesothelioma and explore the diagnostic ideas in order to improve early diagnosis rate. Methods The clinical data and diagnostic methods of 15 patients with diffuse malignant pleural mesothelioma from January 2015 to July 2017 were retrospectively analyzed. Results The main symptoms were chest pain and chest tightness of 15 patients. Imaging examination showed 15 cases with pleural effusion(8 cases of red pleural effusion),13 cases with pleural thickening and 7 cases with mediastinal lymph node enlargement. There were 10 positive of Rivalta test,2 positive of CEA,and 1 positive of ADA in 11 patients with pleural effusion examination. Among 15 patients underwent serum examination,CEA was positive in 1 patients and tuberculin experimentation was positive in 1 patient. Ten patients were treated with anti-tuberculosis treatment,5 cases received anti-infection and symptomatic support treatment,and only 1 patient was diagnosed in a short time. The average time from onset of symptoms to diagnosis was(266. 7±210. 0) days. Among them,6 cases were diagnosed by pleural biopsy through surgical operation (including thoracoscopy and thoracotomy),7 cases were diagnosed by pleural biopsy by CT puncture,and 2 cases were diagnosed by color doppler ultrasound biopsy. Fourteen patients were examined by pleural biopsy and pleural biopsy before diagnosis. Conclusion Diffuse malignant pleural mesothelioma is characterized by lack of specificity in clinical symptoms,laboratory examination and imaging examination. It takes a long time to diagnose,and attention should be paid on recurrent pleural effusion and pleural thickening. The pathological diagnosis rate of pure pleural water examination is very low. Pleural biopsy is needed as early as possible for unexplained pleural disease,and the surgical thoracic exploration is one of the main methods.
引文
[1]廖美琳.恶性胸膜间皮瘤[M].上海:上海科技教育出版社,2005:7-106.
[2]吴小燕,于学燕.恶性胸膜间皮瘤的临床特点及鉴别诊断[J].中国老年学杂志,2016,36(15):3747-3748.
[3]浙江省抗癌协会肺癌专业委员会胸壁(膜)、纵隔肿瘤学组.恶性胸膜间皮瘤诊疗共识(试行)[J].肿瘤学杂志,2017,23(11):1047-1050.
[4]俞珊,李净,陈红兵.胸膜间皮瘤误诊为结核性胸膜炎一例并文献复习[J].中国防痨杂志,2014,36(11):989-994.
[5]肖奎,夏莹,胡成平,等.胸膜间皮瘤39例临床分析[J].中华结核和呼吸杂志,2007,30(6):472.
[6]Steenland K,Burnett C,Lalich N,et al.Dying for work:The magnitude of US mortality from selected causes of death associated with occupation[J].Am J Ind Med,2003,43(5):461-482.
[7]Boffetta P,Autier P,Boniol M,et al.An estimate of cancers attributable to occupational exposures in France[J].J Occup Environ Med,2010,52(4):399-406.
[8]卢敏,杨春鹿,胡永校,等.胸膜间皮瘤的诊断与治疗[J].中国医科大学学报,2003,32(3):261-262.
[9]程龙,辛华,卢万朋,等.恶性胸腔积液误诊为结核性胸膜炎的原因分析[J].中国实验诊断学,2015,19(4):668-669.
[10]朱华晨,周剑,杨蓉,等.胸膜间皮瘤CT影像与临床预后的相关性分析[J].中华医学杂志,2014,94(25):1970-1972.
[11]罗虎,宫亮,周向东.胸腔积液ADA值在结核性胸膜炎中的诊断价值及临界值探讨[J].重庆医学,2012,41(35):3718-3722.
[12]姜淑娟,牟晓燕,张嵩,等.内科胸腔镜术对不明原因胸腔积液的诊断价值[J].中华结核和呼吸杂志,2013,36(5):337-340.
[13]车德海,于雁,张华,等.培美曲塞与卡铂静脉化疗联合榄香烯乳胸腔灌注治疗恶性胸膜间皮瘤的临床观察[J].临床肿瘤学杂志,2011,16(4):356-358.
[2]吴小燕,于学燕.恶性胸膜间皮瘤的临床特点及鉴别诊断[J].中国老年学杂志,2016,36(15):3747-3748.
[3]浙江省抗癌协会肺癌专业委员会胸壁(膜)、纵隔肿瘤学组.恶性胸膜间皮瘤诊疗共识(试行)[J].肿瘤学杂志,2017,23(11):1047-1050.
[4]俞珊,李净,陈红兵.胸膜间皮瘤误诊为结核性胸膜炎一例并文献复习[J].中国防痨杂志,2014,36(11):989-994.
[5]肖奎,夏莹,胡成平,等.胸膜间皮瘤39例临床分析[J].中华结核和呼吸杂志,2007,30(6):472.
[6]Steenland K,Burnett C,Lalich N,et al.Dying for work:The magnitude of US mortality from selected causes of death associated with occupation[J].Am J Ind Med,2003,43(5):461-482.
[7]Boffetta P,Autier P,Boniol M,et al.An estimate of cancers attributable to occupational exposures in France[J].J Occup Environ Med,2010,52(4):399-406.
[8]卢敏,杨春鹿,胡永校,等.胸膜间皮瘤的诊断与治疗[J].中国医科大学学报,2003,32(3):261-262.
[9]程龙,辛华,卢万朋,等.恶性胸腔积液误诊为结核性胸膜炎的原因分析[J].中国实验诊断学,2015,19(4):668-669.
[10]朱华晨,周剑,杨蓉,等.胸膜间皮瘤CT影像与临床预后的相关性分析[J].中华医学杂志,2014,94(25):1970-1972.
[11]罗虎,宫亮,周向东.胸腔积液ADA值在结核性胸膜炎中的诊断价值及临界值探讨[J].重庆医学,2012,41(35):3718-3722.
[12]姜淑娟,牟晓燕,张嵩,等.内科胸腔镜术对不明原因胸腔积液的诊断价值[J].中华结核和呼吸杂志,2013,36(5):337-340.
[13]车德海,于雁,张华,等.培美曲塞与卡铂静脉化疗联合榄香烯乳胸腔灌注治疗恶性胸膜间皮瘤的临床观察[J].临床肿瘤学杂志,2011,16(4):356-358.