腹膜蜕膜细胞样型弥漫性恶性间皮瘤1例并文献复习
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摘要
目的因蜕膜细胞样型弥漫性恶性间皮瘤罕见,本文旨在探讨其临床病理特征、免疫组化及鉴别诊断要点,以减少漏诊及误诊。方法回顾性分析1例腹膜蜕膜细胞样型弥漫性恶性间皮瘤的临床资料、病理学特点并复习相关文献进行讨论。结果临床表现腹胀痛腹泻、大量腹水。抽吸腹水送细胞病理学检查,查见恶性肿瘤细胞。遂术中探查送病检,镜下见肿瘤细胞呈实体片状、巢团状或单个散在分布于纤维结缔组织中。瘤细胞类似蜕膜细胞,体积大,圆形、卵圆形或多角形,边界清楚。胞核圆形、卵圆形,居中,可见双核,偶见多核;核染色质大部分细腻,核仁明显;胞质丰富,嗜酸性,呈毛玻璃样改变或灰白透明。核分裂象0~2个/10HPF。免疫组织化学结果示Vim+,D2-40+,CK5/6局部+,CR灶+,WT-1灶+,AE1/AE3+,EMA+,E-cadherin-,HCG-,Inhibin-。病理诊断腹膜蜕膜细胞样型弥漫性恶性间皮瘤。结论蜕膜细胞样型弥漫性恶性间皮瘤临床罕见,免疫组织化学检测是诊断该肿瘤及鉴别其他病变的重要手段。常用间皮瘤标记有CK5/6、CR、Thrombomodulin、HBME-1、D2-40、WT-1、Vim、EMA等。预后与肿瘤染色体缺失数量有关。
Objective To study and discuss the clinicopathologic features and differential diagnosis of deciduoid mesothelioma with the purpose of correct diagnosis.Methods Review the clinical data,pathologic features of one pleural deciduoid methothelioma,and discuss with literanture review.Results The clinical manifestations include abdominal pain,diarrhea and abundant ascites.The gynecologic doctors carried on the ascites puncture to the patient,the celluar result was the malignant.Then intraoperative exploration and biopsy were performed and was diagnosed as diffuse malignant peritoneal mesothelioma with deciduoid features.Histologic examination showed that the tumor was composed of large round,ovoid or polygonal cells with sharp cellular outlines,abundant glassy eosinophilic cytoplasm,and round,ovoid nuclei with prominent eosinophilic nucleoli.Binucleated and multinucleated forms were occasionally present.Mitotic activity was low(0-2 per 10 HPF).The cells were arranged in solid sheets,nestlike and scattered patterns.Immunohistochemical examination showed positive for vimentin,AE1/AE3 and D2-40,and foal reactivity for CK5/6,caretinin and WT-1.No staning was seen for E-cadherin,HCG,inhibin.Conclusion Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma,immunohistochemical study play an essential role in arriving at a correct diagnosis.The panels composed of cytokeratin5/6,calretinin,thrombomodullin,HBME-1,D2-40,WT-1,vimentin and EMA have been showed to be the most useful markers which are commonly expressed in mesotheliomas.The prognosis depends on the number of chromosomal losses.
Objective To study and discuss the clinicopathologic features and differential diagnosis of deciduoid mesothelioma with the purpose of correct diagnosis.Methods Review the clinical data,pathologic features of one pleural deciduoid methothelioma,and discuss with literanture review.Results The clinical manifestations include abdominal pain,diarrhea and abundant ascites.The gynecologic doctors carried on the ascites puncture to the patient,the celluar result was the malignant.Then intraoperative exploration and biopsy were performed and was diagnosed as diffuse malignant peritoneal mesothelioma with deciduoid features.Histologic examination showed that the tumor was composed of large round,ovoid or polygonal cells with sharp cellular outlines,abundant glassy eosinophilic cytoplasm,and round,ovoid nuclei with prominent eosinophilic nucleoli.Binucleated and multinucleated forms were occasionally present.Mitotic activity was low(0-2 per 10 HPF).The cells were arranged in solid sheets,nestlike and scattered patterns.Immunohistochemical examination showed positive for vimentin,AE1/AE3 and D2-40,and foal reactivity for CK5/6,caretinin and WT-1.No staning was seen for E-cadherin,HCG,inhibin.Conclusion Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma,immunohistochemical study play an essential role in arriving at a correct diagnosis.The panels composed of cytokeratin5/6,calretinin,thrombomodullin,HBME-1,D2-40,WT-1,vimentin and EMA have been showed to be the most useful markers which are commonly expressed in mesotheliomas.The prognosis depends on the number of chromosomal losses.
引文
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[3]Henley J,Loehrer P,Ulbright T.Deciduoid Mesothelioma of the Pleura After Radiation Therapy for Hodgkin’s Disease Presenting as a Mediastinal Mass[J].AM J Surg Pathol,2001,25(4):547-548.
[4]Attanoos RL,Gibbs AR.Primary malignant gonadal mesotheliomas and asbestos[J].Histopathology,2000,37(2):150-159.
[5]Reis-Filho JS,Pope LZ,Milanezi F,et al.Primary epithelial malignant mesothelioma of the pericardium with deciduoid features:cytohistologic and immunohistochemical study[J].Diagnostic Cytopathology,2002,26(2):117-122.
[6]Ahmed S,Menon S,Desai S.Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features:An unusual malignancy clinically masquerading an inguinal hernia[J].Indian J Pathol Microbiol,2012,55(1):89-91.
[7]Huang CC,Michael CW.Deciduoid mesothelioma:cytologic presentation and diagnostic pitfalls[J].Diagnostic Cytopathology,2013,41(7):629-635.
[8]Nishikawa T,Takahashi M,Mori M,et al.Deciduoid Mesothelioma[J].Kyobu Geka,2016,69(3):214-217.
[9]Scattone A,Pennella A,Gentile M,et al.Comparative genomic hybridisation in malignant deciduoid mesothelioma[J].J Clin Pathol,2006,59(7):764-769.
[10]Ordonez NG.What are the current best immunohistochemical markers for the diagnosis of epithelioid mesothelioma?A review and update[J].Hum Pathol,2007,38(1):1-16.
[11]回允中.女性生殖道病理学[M].北京:北京大学医学出版社,2005:795-797.
[12]Heatley MK,Maxwell P,Toner PG.The immunophenotype of human decidua and extra-uterine decidual reactions[J].Histopathology,1996,29(5):437-442.
[13]Maeda S,Hosone M,Katayama H,et al.Deciduoid mesothelioma in the pelvic cavity[J].Pathol Int,2004,54(1):67-72.
[14]Mourra N,de Chaisemartin C,Goubin-Versini I,et al.Malignant deciduoid mesothelioma:a diagnostic challenge[J].Arch Pathol Lab Med,2005,129(3):403-406.
[15]Nelson G,Ordonez.Deciduoid mesothelioma:report of21 cases with review of the literature[J].Mordern Pathology,2012,25(11):1481-1495.
[2]Nascimento AG,Keeney GL,Fletcher CD.Deciduoid peritoneal mesothelioma.An unusual phenotype affecting young females[J].Am J Surg Pathol,1994,18(5):439-445.
[3]Henley J,Loehrer P,Ulbright T.Deciduoid Mesothelioma of the Pleura After Radiation Therapy for Hodgkin’s Disease Presenting as a Mediastinal Mass[J].AM J Surg Pathol,2001,25(4):547-548.
[4]Attanoos RL,Gibbs AR.Primary malignant gonadal mesotheliomas and asbestos[J].Histopathology,2000,37(2):150-159.
[5]Reis-Filho JS,Pope LZ,Milanezi F,et al.Primary epithelial malignant mesothelioma of the pericardium with deciduoid features:cytohistologic and immunohistochemical study[J].Diagnostic Cytopathology,2002,26(2):117-122.
[6]Ahmed S,Menon S,Desai S.Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features:An unusual malignancy clinically masquerading an inguinal hernia[J].Indian J Pathol Microbiol,2012,55(1):89-91.
[7]Huang CC,Michael CW.Deciduoid mesothelioma:cytologic presentation and diagnostic pitfalls[J].Diagnostic Cytopathology,2013,41(7):629-635.
[8]Nishikawa T,Takahashi M,Mori M,et al.Deciduoid Mesothelioma[J].Kyobu Geka,2016,69(3):214-217.
[9]Scattone A,Pennella A,Gentile M,et al.Comparative genomic hybridisation in malignant deciduoid mesothelioma[J].J Clin Pathol,2006,59(7):764-769.
[10]Ordonez NG.What are the current best immunohistochemical markers for the diagnosis of epithelioid mesothelioma?A review and update[J].Hum Pathol,2007,38(1):1-16.
[11]回允中.女性生殖道病理学[M].北京:北京大学医学出版社,2005:795-797.
[12]Heatley MK,Maxwell P,Toner PG.The immunophenotype of human decidua and extra-uterine decidual reactions[J].Histopathology,1996,29(5):437-442.
[13]Maeda S,Hosone M,Katayama H,et al.Deciduoid mesothelioma in the pelvic cavity[J].Pathol Int,2004,54(1):67-72.
[14]Mourra N,de Chaisemartin C,Goubin-Versini I,et al.Malignant deciduoid mesothelioma:a diagnostic challenge[J].Arch Pathol Lab Med,2005,129(3):403-406.
[15]Nelson G,Ordonez.Deciduoid mesothelioma:report of21 cases with review of the literature[J].Mordern Pathology,2012,25(11):1481-1495.