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目的探讨肌纤维母细胞型恶性间皮瘤的病理诊断、鉴别诊断及预后。方法观察并分析肌纤维母细胞型恶性间皮瘤的病理形态特点、免疫组化染色及电镜,并复习相关文献。结果本组3例肌纤维母细胞型恶性间皮瘤中仅1例有胸痛,其他临床症状及体征不明显。光镜下见瘤细胞呈弥漫分布,梭形、胖梭形或短梭形,大小略不等,可见核分裂象,部分细胞胞质丰富呈红染或粉染。1例电镜下瘤细胞表面见少量微绒毛,胞质内可见较多张力微丝。免疫组化:肿瘤细胞CK5/6、calretinin、抗间皮抗原、vimentin和actin(pan)均(+)。结论肌纤维母细胞型恶性间皮瘤是一种少见的特殊类型的肉瘤型恶性间皮瘤,其免疫组化及电镜检测有助于诊断。需与恶性孤立性纤维性肿瘤、平滑肌肉瘤、低度恶性肌纤维母细胞肉瘤和纤维肉瘤等鉴别。
Objective To investigate the pathological diagnosis, differential diagnosis and prognosis of myofibroblastic malignant mesothelioma. Methods The pathological features of myofibroblastic malignant mesothelioma were observed and analyzed. Immunohistochemical staining and electron microscopy were performed. The related literatures were reviewed. Results The group of 3 cases of myofibroblastic malignant mesothelioma in only 1 case of chest pain, other clinical symptoms and signs are not obvious. Light microscope, see tumor cells were diffuse distribution, fusiform, fat fusiform or short fusiform, slightly different size, showing mitotic figures, part of the cytoplasm of rich red dye or dye. A case of electron microscopy showed a small amount of microvilli on the surface of the tumor cells, showing more tension in the cytoplasm. Immunohistochemistry: tumor cells CK5 / 6, calretinin, anti-mesothelial antigens, vimentin and actin (pan) were (+). Conclusion Myofibroblastic malignant mesothelioma is a rare special type of malignant mesothelioma of the sarcoma. Immunohistochemistry and electron microscopy may be helpful for the diagnosis. Need to distinguish with malignant solitary fibrous tumor, leiomyosarcoma, low grade myofibroblastic sarcoma and fibrosarcoma.