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目的探讨腹膜恶性间皮瘤(PMM)的临床病理特征、免疫表型、鉴别诊断、治疗及预后。方法对7例PMM的临床资料、病理特点及免疫组化标记进行研究,并复习相关文献。结果 PMM好发于中老年人,平均年龄为61.5岁,临床主要表现为腹胀、腹痛、腹水、腹部包块等。镜下肿瘤组织形态多样,由上皮样细胞和梭形细胞2种类型组成,具有向上皮和肉瘤样双向分化的特点。免疫组化示calretinin(6例)、AE1/AE3(7例)、EMA(5例)、CK5/6(5例)、HBME-1(6例)、vimentin(7例)均(+),CEA均(-)。随访6～30个月,2例死亡,5例存活。结论 PMM对其确诊需结合临床特征、病理形态及免疫表型,根据肿瘤细胞异型程度、核分裂象多少和核的多形性,恶性间皮瘤可分为低度恶性和高度恶性。且需与腹腔原发或转移的其他肿瘤相鉴别。
Objective To investigate the clinicopathological characteristics, immunophenotype, differential diagnosis, treatment and prognosis of malignant peritoneal mesothelioma (PMM). Methods The clinical data, pathological features and immunohistochemical markers of 7 cases of PMM were studied, and the related literatures were reviewed. The results of PMM occur in the elderly, the average age of 61.5 years old, the main clinical manifestations of abdominal distension, abdominal pain, ascites, abdominal mass and so on. Microscopically, the microstructure of the tumor was diverse and consisted of two types of epithelial-like cells and spindle cells with the characteristics of bidirectional differentiation into epithelium and sarcoma. Immunohistochemistry showed calretinin (6 cases), AE1 / AE3 (7 cases), EMA (5 cases), CK5 / 6 (5 cases), HBME-1 (6 cases) and vimentin (7 cases) CEA (-). After 6 months to 30 months, 2 died and 5 survived. Conclusions PMM should be combined with clinical features, pathological features and immunophenotypes. According to the degree of atypia, the number of mitotic figures and the polymorphism of nucleus, malignant mesothelioma can be divided into low grade and high grade. And need to be differentiated from other tumors that are primary or metastatic to the abdominal cavity.