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目的探讨胸膜上皮型恶性间皮瘤的临床病理特征及免疫组化表达。方法回顾性分析2009年1月—2013年12月56例经病理证实的胸膜上皮型恶性间皮瘤患者的临床资料。应用免疫组化S-P法检测CK5/6、CK8/18、CEA、TTF1、MC、Cal、D2-40、NapsinA的表达水平。结果56例间皮瘤患者中,46例有明确石棉接触史,临床表现胸痛24例,胸腔积液38例,胸闷憋气47例;双侧弥漫增厚型9例,单侧局限型47例,粟粒结节型42例,局部肿块型5例。随访45例,双侧弥漫型生存期3~6个月,局限型生存期均<2年,平均生存期8个月。病理类型全部为上皮型,免疫组化阳性表达率分别为CK5/6(100%)、CK8/18(98%)、D2-40(98%)、Cal(95%)、MC(93%)、CEA(3.5%)、NapsinA(0%)、TTF1(0%)。结论本组恶性间皮瘤患者的发病与石棉接触密切相关,呈上皮型病理特征。CK5/6、CK8/18、CEA、TTF1、MC、Cal、D2-40、Napsin A联合检测能够解决胸膜上皮型恶性间皮瘤的诊断和鉴别诊断问题。
Objective To investigate the clinicopathological features and immunohistochemical expression of pleural epithelial malignant mesothelioma. Methods The clinical data of 56 patients with pathologically confirmed pleural epithelial malignant mesothelioma from January 2009 to December 2013 were analyzed retrospectively. The expression of CK5 / 6, CK8 / 18, CEA, TTF1, MC, Cal, D2-40 and NapsinA were detected by immunohistochemical S-P method. Results 56 cases of mesothelioma patients, 46 patients had a clear history of exposure to asbestos, clinical manifestations of chest pain in 24 cases, 38 cases of pleural effusion, chest tightness and suffocation in 47 cases; bilateral diffuse thickening in 9 cases, 47 cases of unilateral confinement, 42 cases of miliary nodules, local mass in 5 cases. Follow-up 45 cases, bilateral diffuse survival of 3 to 6 months, localized survival were less than 2 years, the average survival of 8 months. All of the pathological types were epithelial type. The positive expression rates of CK5 / 6 (100%), CK8 / 18 (98%), D2-40 , CEA (3.5%), NapsinA (0%), TTF1 (0%). Conclusion The incidence of malignant mesothelioma in this group is closely related to asbestos exposure, showing epithelial pathological features. The combined detection of CK5 / 6, CK8 / 18, CEA, TTF1, MC, Cal, D2-40 and Napsin A can solve the diagnosis and differential diagnosis of pleural epithelial malignant mesothelioma.