恶性间皮瘤的诊断现状-《癌症进展》杂志编辑部恶性间皮瘤的

#1000212%5%70%80%19912CTMRI50%34%16%125.86.18418R730.262.R730.6ARecentdevelopmentsofdiagnosisformalignantmesotheliomaWangHongyuZhangXiangruQuFenglianetalCancerInstitute&HospitalCAMS&PUMCBeijing100021ChinaAbstractMalignantmesotheliomaMMisnowusedforalldiffusemalignantprimarytumorsthatde-velopfromthemesenchymawhethermesothelialorfibroblasticalikesubmethelialcells.Themajorprimarysiteisofpleuraloriginfollowedbyperitonealpericardiumandtunicavaginalis.Themalignantpleuralmesothe-liomaMPMisararemalepredominantcancerMPMaccoutingfornomoretha2%to5%orallpleuralmalignancies.Asbestosexposureisthecausein70%80%cases.ThemostMPMpatientstypicallypresentwithdyspneachestpainorpleuraleffusion.Theexpectedsurvivalrangeforpatientswithofwithoutinvolve-mentofvisceralpleuraisrespectively19and912months.Peritonealandpericaridalmalignantmesotheli-omaaremuchlesscommon.Patientswithperitonealmalignantmesotheliomawhopresentedwithdiffuseabdom-inalpainabdominalenlargementvomitusdyspneaweightlosswithorwithoutapalpableabdominalmassandascites.Histologicallyepithelialcelltypeisthemajority50%followedbysarcomatous34%andbiphasic16%.Patientswithepithelioidsubtypeshadlongersurvivaltimethanthosewithmixedand#CorrespondingauthorPhone:010-87788519sarcomatoidsubtypes.ObtainingadiagnosisofMMhasbenngreatlyassistedbyvideo-assistedsurgeryandtheuseofimmunohistochemistryPAS-DhyaluronidasevimentineCEAkeratinesandelectronmicroscopictechniqueswhichhelpdistinguishMMfromothertumorpathologiessuchasadenocarcinoma.Computedto-mographyandmagneticresonanceimaginghavebeenalsousefulfordeterminingtumorburdenandresectability.Malignantmesotheliomaisnosatisfactorytreatment.Mostofthesepatientssurvivelessthan12monthsirrespec-tiveofthetreatmentmodality.Themeansurvivaltimefromtimeofsymptomonsetis5.86.18monthsamediansurvivalrangingfrom4to18monthsinuntreatedpatients.KeywordsmalignantmesotheliomadiagnosisOncolProg20042Suppl450600.20005%194520006329.59.8.;10.9.;35.4.11973199952669.7.=1.80.4219581996105625918460.17%:1287:55810.10%461.440334.3160594.5%96.4%3.3%;61.3%29.3%9.4%;60.4;13.516.913.15.5;73%84.8%37.870%4197520008151792.3%;85.8%5079;73.1%61.1%22.1%16.4%321517198.1%2019.9%5199525.5%300040070%80%50%60%20%;5SV-404181.364060=3175%11%32%60%80%3.450%60%32Horner10%20%Coombs10.2%3.2%;Horner7CT83030557523910CTCTMRIMRIBPETFDG-PETFDG-PET18F-FDG-PETCT:1cmCT90%91%100%80%90%BXCT9.5%30%60%84%20%70%1.31.25%93%5%CEAEMAB72.3EMA73%B72.3G-CSF11KristenrasK-rasPCRK-ras12Wilms1Wilms113PAS-D50%60%30%50%keratinCEAvimentinEMAkeratinvimentinCEACKEMARer-EP4VimentinCEAmesothelialcellHBME1thrombomodulinTMcalretinincytokeratin5.6CD44HHBME189%TM67%HBME-1TM12CEALeu-M1CA-125Ber-EP4CEA100%CEACEAB72.3CEAB72.3100%88%;99%97%CEAB72.3Leu-M174%CEALeu-M1B72.3Ber-EP490%CEABg8Ber-EP4CA19-949%CA19-9calretininthrombomodulincytokeratin5.6CD44HCEALeu-M1calretinin88%100%Ber-EP495%91%CA-12595%67%25%calretininBer-EP4CA-125thrombomodulincytokeratin5.6CD44HCEALeu-M113CEA:CEACEACEA;CA19-9;CA125:;PAS-;Leu-M1:IgMR-SBT80%88%;B72.3:;BerEP4epithelialantigen:;HMFG2humanmilkfatglobules:keratinvimen-tin:kera-tin43%vimentin70%;HBME1mesothelialcell:HBME1;Calretinin:025%25%50%50%75%75%calretininHBME-1;thrombomodulinTM;ME11.PatriciaHendrieLeighetal.MalignantmesotheliomainAustralia19452000.AmJIndMed20024131882.VerschraegenC.Mesothelioma:Incidenceandsurvivalratesintheunitedstates2003ASCOProc34953.MuraiY.MalignantmesotheliomainJapan:Analysisofregis-teredautopsycasesArch-EnvironHealth2001561844.NeumannVGuntheSMulleKMetal.Malignantmesothe-lioma-Germanmesotheliomaregister19871999.Int-Arch-Oc-cup-Environ-Health.20017463835.SuzukiY.Pathologyofhumanmalignantmesothelioma-prelimi-naryanalysisof1517mesotheliomacasesIndHealth20013921836.JeanBignonPatrickBrochardJean-ClaudePairon.Mesothe-lioma:Causeandfiber-relatedmechanism.InComprehensivetextbookofthoraciconcology.USA:Williamswilkins19967357.GonzalezMorenoSantiagoYanHuietalMalignanttrans-formationofbenigncysticmesotheliomaoftheperitoneumJSurgOncol20027942438.KojimaKeitarouTamakiMasayoshiMaedaShinichietal.Acaseofprimarymalignantretroperitonealmesotheliomaneededtodifferentiateadrenaltumor.HinyokikaKiyo20024831839.FerriEAzzoliniNSebastioNetalUnusualcaseofme-sotheliomaofthetunicavaginalisassociatedwithprostaticadeno-carcinoma.MinervaUrolNefrol20005213310.IshiyamaYHisanagaSAsadaYetal.Malignantme-sotheliomaofthepleurawithalargetumorembolusintheleftat-rium:AnautopsycaseInternMed199837761411.Kasuga-I;Ishizuka-S;Minemura-K;etal.Malignantpleuralmesotheliomaproducesfunctionalgranulocyte-colonystimulatingfactor.Chest2001119398112.NakamotoM;TeramotoHMatsumotoSetal.K-rasandrhoAmutationsinmalignantpleuraleffusionIntJOncol2001Nov;195971-613.HechtJonathanLLeeBenjaminHPinkusJackLetal.ThevalueofThisimmunohistochemicalstudyevaluatestheeffec-tivenessofWT1asamarkerformalignantmesotheliomainpar-affinsectionsofcellblockpreparationsderivedfromeffusionspecimens.Cancer200225962105717.FossellaFV.DeVoreRKerrRNetal.Randomizedphasetrialofdocetaxelversusvinorelbineorifosfamideinpatientswithadvancednon-smallcelllungcancerpreviouslytreatedwi