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目的:探讨胸膜恶性肿瘤的病理类型、肿瘤所占比例、临床病理特征及鉴别诊断。方法:结合病理形态学及免疫组化方法对252例胸膜恶性肿瘤进行诊断及鉴别诊断。结果:252例胸膜恶性肿瘤包括胸膜穿刺活检120例,胸腔镜活检25例,伴有胸膜转移的恶性胸水107例;男性143例,女性109例,年龄19-87岁,平均年龄59.9岁。临床主要症状是胸闷、气短、咳嗽、胸痛等。CT表现为胸膜增厚、胸水(90%)、多发或单发胸膜结节和原发器官占位性病变。活检病例中,转移性癌86例(34.1%),包括肺腺癌64例(25.4%),小细胞癌11例(4.4%),鳞癌11例(4.4%),恶性间皮瘤47例(18.7%),滑膜肉瘤9例(3.6%),非霍奇金淋巴瘤3例(1.2%);恶性胸水病例病例中转移性癌95例(37.7%),包括肺腺癌85例(33.7%),小细胞癌6例(2.4%),鳞癌2例(0.8%),乳腺腺癌2例(0.8%),恶性间皮瘤8例(3.2%),非霍奇金淋巴瘤4例(1.6%)。结论:胸膜恶性肿瘤中以转移性腺癌多见,其次为恶性间皮瘤,结合形态学及免疫组织化学检测不同标志物的表达有助于诊断胸膜恶性肿瘤的种类。
Objective: To investigate the pathological types of pleural malignancy, the proportion of tumors, clinical and pathological features and differential diagnosis. Methods: 252 cases of pleural malignant tumors were diagnosed and differentiated by pathomorphology and immunohistochemistry. Results: 252 cases of pleural malignancy including pleural puncture biopsy in 120 cases, thoracoscopic biopsy in 25 cases, pleural metastasis of malignant pleural effusion in 107 cases; 143 males and 109 females, aged 19-87 years, mean age 59.9 years old. The main clinical symptoms are chest tightness, shortness of breath, cough, chest pain and so on. CT showed pleural thickening, pleural effusion (90%), multiple or solitary pleural nodules and primary organ lesions. Among the biopsy cases, 86 (34.1%) had metastatic carcinomas, including 64 (25.4%) of lung adenocarcinomas, 11 (4.4%) of small cell carcinomas, 11 (4.4%) of squamous carcinomas, 47 of malignant mesotheliomas (18.7%), synovial sarcoma in 9 cases (3.6%) and non-Hodgkin’s lymphoma in 3 cases (1.2%). Malignant pleural effusion in 95 cases (37.7% 6 cases of small cell carcinoma (2.4%), 2 cases of squamous cell carcinoma (0.8%), 2 cases of breast adenocarcinoma (0.8%) and 8 cases of malignant mesothelioma 4 cases (1.6%). Conclusion: The most common malignant pleural malignancy is metastatic adenocarcinoma, followed by malignant mesothelioma. Combined with morphological and immunohistochemical detection of different markers, it is helpful to diagnose the malignant pleural tumor.