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目的探讨高分化乳头状间皮瘤的临床病理学特点和鉴别诊断。方法回顾复习1例高分化乳头状间皮瘤的临床资料、组织学形态和免疫组化表型结果。结果患者女性,63岁。间断胸闷、憋气2周。胸腔镜见右胸腔壁层、脏层灰白色弥漫性散在结节,直径0.2～1cm。巨检:淡黄色片状组织2块,总体积2.5cm×1.5cm×0.2cm大小;镜检:肿瘤由乳头状结构组成,乳头表面被覆单层立方上皮样细胞,其中纤维组织和血管轴心构成乳头,其大小和形态较一致。核呈圆形或卵圆形,位于细胞中央,染色质匀细,核仁不明显,无核分裂象;胞质中等量,嗜伊红色。部分乳头表面上皮样细胞呈巢状及片状增生并向间质中相互吻合,形成索状、梁状、腺样和迷路样结构,异型性不明显。免疫组化:mesothelial cell(),vimentin(+),Ki-67阳性细胞约20%。结论高分化乳头状间皮瘤是一种罕见的低度恶性潜能的间皮肿瘤,可被误诊为恶性间皮瘤、孤立性纤维性肿瘤、转移性腺癌、交界性浆液性肿瘤、腺瘤样瘤等肿瘤。
Objective To investigate the clinicopathological characteristics and differential diagnosis of well-differentiated papillary mesothelioma. Methods Review the clinical data, histological morphology, and immunohistochemical phenotypes of one case of well-differentiated papillary mesothelioma. Results Female patient, 63 years old. Intermittent chest tightness, hernia for 2 weeks. Thoracoscopy see the right chest wall, dirty layer of diffuse diffuse scattered nodules, diameter of 0.2 ~ 1cm. Giant examination: 2 pieces of light yellow flaky tissue, total volume 2.5cm × 1.5cm × 0.2cm size; microscopic examination: the tumor consists of a papillary structure, the surface of the nipple covered by a single layer of cubic epithelioid cells, including fibrous tissue and vascular axis Composition of nipples, their size and shape are more consistent. The nucleus is round or oval, located in the center of the cell, with fine chromatin, inconspicuous nucleoli, and anatomic division; moderate cytoplasm and eosinophilia. Part of the nipple surface epithelial-like cells showed nest-like and platy hyperplasia to the interstitial in line with each other, the formation of cord-like, beam-like, adenoid and labyrinth-like structure, is not obvious atypia. Immunohistochemistry: Mesothelial cell (), vimentin (+), Ki-67 positive cells approximately 20%. Conclusions Poorly differentiated papillary mesothelioma is a rare mesothelioma with low malignant potential. It can be misdiagnosed as malignant mesothelioma, solitary fibrous tumor, metastatic adenocarcinoma, borderline serous tumor, adenomatous tumor. Tumors and other tumors.