恶性胸膜间皮瘤概述

恶性间皮瘤是罕见的高度侵袭性肿瘤，起源于胸膜、腹膜和心包腔的被覆间皮细胞。恶性胸膜间皮瘤为最常见类型，约占所有恶性间皮瘤70％。恶性间皮瘤在全世界范围内发病率逐渐升高，因为致病因素石棉仍在广泛应用。这是医学界和公众都在关注的问题。     

28例恶性胸膜间皮瘤的病理诊断

<正>弥漫性胸膜间皮瘤来源于胸膜的间皮细胞及胸膜下间皮组织,是一种较少见的胸部恶性肿瘤。该病常常被误诊为肺癌,发病率有逐年增加的趋势。现将笔者对28例恶性胸膜间皮瘤临床病理诊断和鉴别诊断分析报告如下。     

恶性胸膜间皮瘤35例误诊原因分析与对策

目的探讨恶性胸膜间皮瘤患者的临床误诊原因。方法分析本院2000年1月至2009年8月35例恶性胸膜间皮瘤的误诊经过。结果恶性胸膜间皮瘤临床较少见,不能充分重视,首次就诊误诊率高。结论恶性胸膜间皮瘤临床表现多样化,易与其他疾病相混淆;只有提高对该疾病的认识,才能提高确诊率。     

恶性胸膜间皮瘤71例诊断分析

恶性胸膜间皮瘤是原发于胸膜间皮组织的一种罕见胸膜肿瘤,其恶性程度高,预后差。早期诊断是治疗恶性胸膜间皮瘤的关键,但此病的误诊率较高。现将我院2003年3月—2008年3月收治的71例恶性胸膜间皮瘤的诊断情况进行分析,报告如下。     

恶性胸膜间皮瘤22例CT表现分析

目的：探讨恶性胸膜间皮瘤的CT表现特点。方法：对22例经病理证实的恶性胸膜间皮瘤进行回顾性分析。结果：22例恶性胸膜间皮瘤中,9例为局限型,13例为弥漫型。CT胸部检查诊断为恶性胸膜间皮瘤16例,诊断符合率为72．73％。结论：CT诊断恶性胸膜间皮瘤与病理符合率较高,能为临床诊断提供有价值的依据,但最后确诊有赖于病理证实。     

胸膜间皮瘤治疗新进展--礼来全国胸膜间皮瘤研讨会

2005年9月3日,礼来全国胸膜间皮瘤论坛在成都拉开帷幕,参加此次会议的国内肿瘤研究领域的众多专家学者汇聚一堂,并且由中国医学科学院肿瘤医院的孙燕院士担任大会主席.在会上,朱雄增教授、张国桢教授、廖美琳教授、张力教授先后就“恶性胸膜间皮瘤病理学诊断回顾与进展”、“恶性胸膜间皮瘤影像学诊断回顾与进展”、“恶性胸膜间皮瘤治疗综述与回顾”、“恶性胸膜间皮瘤治疗新突破与未来展望”等专题进行了报告,这次会议是国内首次就胸膜问皮瘤这一课题最新治疗方案和进展召开的全国性专题学术研讨会。     

局限性胸膜间皮瘤的诊断与外科治疗

目的探讨局限性胸膜间皮瘤的诊断和手术治疗方法。方法对14例(经术后病理证实的)局限性胸膜间皮瘤患者分别进行胸膜切除术、胸膜全肺切除术,并对部分恶性胸膜间皮瘤患者进行术后化疗,所有患者均进行术后随访。结果14例患者中,9例术后病理证实为局限性良性纤维间皮瘤,其中2例分别于术后2年3个月和3年复发,第二次术后病理报告为恶性间皮瘤;5例术后病理报告恶性间皮瘤。手术加化疗6例生存10个月~5年,平均22.3个月,另1例患者术后生存11个月。结论早期诊断、彻底切除病变是治疗胸膜间皮瘤的有效手段,恶性胸膜间皮瘤患者术后进行化疗可明显改善患者的局部症状和远期预后。     

胃壁恶性间皮瘤一例

恶性间皮瘤是罕见的高度侵袭性肿瘤,起源于胸膜、腹膜和心包腔的被覆间皮细胞,属中胚层来源[1-2].恶性间皮瘤发病年龄多在40岁以上,以男性为主,发生于胸膜最为常见,占70%,其次是腹膜,占30%,而发生于胃壁的极为罕见.我院收治胃壁恶性间皮瘤1例,现报告如下.     

恶性胸膜间皮瘤的临床特点及病理学改变

目的：探讨恶性胸膜间皮瘤的临床特点及病理学改变。方法：对1985～2009年在本院诊治的35例恶性胸膜间皮瘤患者的临床表现及病理资料进行分析。结果：28例（80%）患者首发症状为胸痛、咳嗽和气促,伴胸腔积液。X线片有局限性胸膜增厚,CT可显示胸膜增厚伴不规则的结节状内缘,胸腔积液出现恶性瘤细胞,病理切片有双向分化的特点。结论：对中年人胸部剧烈疼痛伴有胸腔积液时,应首先考虑本瘤,该瘤的确诊应依赖临床表现、影像学及细胞病理学综合判断。     

恶性胸膜间皮瘤的影像学诊断

恶性胸膜间皮瘤（MPM）是起源于胸膜间皮细胞一种罕见肿瘤，该病无典型表现，恶性程度较高，预后较差。影像学检查在MPM的诊断、分期及病情评估中起重要作用。现就恶性胸膜间皮瘤的影像学表现，以及各种影像学检查方法对恶性胸膜间皮瘤诊断、分期、预后判断的价值作一综述。     

恶性胸膜间皮瘤的最新治疗进展

有报道称恶性胸膜间皮瘤中位生存期≤1年,5年生存率≤1％,以至于多年来对恶性胸膜间皮瘤治疗持一种虚无的态度（Ceresoli GL,Locati LD,Ferreri AJ,et al．2001）。然而随着对其有关分子异常的认识,该病生物学特性也逐渐被了解。伴随着分子生物学、免疫学的发展,以及临床实践本身的发展,该病的治疗又有了新的希望。     

胸膜间皮瘤的诊断与治疗(附2例报告)

报告了2例经手术治疗并经病理证实的恶性胸膜问皮瘤,就其诊断与治疗进行讨论。指出胸膜问皮瘤应依据X线、胸水细咆学、胸膜活检及免疫组化等明确诊断,采用以手术为主,放、化疗结合的综合治疗。就手术方法及注意事项进行了论述。     

弥漫性胸膜间皮瘤的CT诊断

目的总结弥漫性胸膜间皮瘤的CT表现及诊断方法,提高对此病的认识及诊断的正确率。方法回顾性分析我院自1997-2008年收治的13例经组织学证实的弥漫性胸膜间皮瘤的临床及CT影像资料。结果右侧胸腔7例,左侧胸腔6例。所有的病例CT均表现为不同程度的弥漫性胸膜增厚（〉1 cm）：呈广泛性、结节样、瘤样、不规则状、盔甲样增厚、大量胸水等征象。结论CT在弥漫性胸膜间皮瘤的诊断中具有重要地位。能发现和显示病变、确定病变的范围,为选择治疗方法及判断预后提供重要参考。     

Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology

Objective: Due to some historical (and inaccurate) reports that asbestos might be present in some cosmetic talc products, questions are occasionally raised regarding the potential pleural mesothelioma risks associated with cosmetic talc products. Our objective was to determine the incidence of pleural mesothelioma of individuals exposed to cosmetic talc.

Materials and methods: We conducted a systematic review of the epidemiological literature for cosmetic talc miners and millers and found three occupational cohort studies that evaluated pleural mesothelioma incidence in workers in Italy, Norway, France, and Austria. We conducted a second literature review to evaluate the incidence and mortality of pleural mesothelioma among patients who received talc pleurodesis treatments before 1965 and found retrospective clinical studies including over 300 patients with follow-up ranging from 14 to 40?years.

Results: There were no mesotheliomas reported in any of the cosmetic talc miner and miller cohorts. A pooled analysis of data from the cohort mortality studies indicated that four mesothelioma deaths would have been expected from the 90,022 person-years of observation, and this was associated with 84% and 67% statistical power to observe a 3-fold or 2.5-fold increase in pleural mesothelioma mortality, respectively. None of the patients who received talc pleurodesis treatments developed mesothelioma.

Conclusion: We conclude that there is no epidemiological evidence to support the hypothesis that exposure to cosmetic talc is associated with the development of pleural mesothelioma.     

Can pemetrexed help in malignant mesothelioma?

Mesothelioma is a cancer that originates in the pleura or, more rarely, the peritoneum, and is almost always due to exposure to asbestos fibres. It is typically fatal, with a median survival of about 8-14 months after diagnosis. Conventional treatment options have not improved this poor outlook. Also, the number of deaths attributable to malignant mesothelioma has been rising rapidly in the UK since the late 1960s, and is set to peak at about 1,950-2,450 per year between 2011 and 2015. It is against this background that pemetrexed (pronounced pe-me-treks-ed) (Alimta - Lilly) has recently become available for use with cisplatin for the treatment of patients with unresectable malignant pleural mesothelioma who have not previously been treated with chemotherapy. Currently, this is the only chemotherapy regimen licensed for patients with malignant pleural mesothelioma in the UK. Here we review the care of patients with malignant pleural mesothelioma, focusing on what, if anything, pemetrexed might offer such individuals.     

Five years update on relationships between malignant pleural mesothelioma and exposure to asbestos and other elongated mineral particles

ABSTRACT

Despite the reduction of global asbestos consumption and production due to the ban or restriction of asbestos uses in more than 50 countries since the 1970s, malignant mesothelioma remains a disease of concern. Asbestos is still used, imported, and exported in several countries, and the number of mesothelioma deaths may be expected to increase in the next decades in these countries. Asbestos exposure is the main risk factor for malignant pleural mesothelioma, but other types of exposures are linked to the occurrence of this type of cancer. Although recent treatments improve the quality of life of patients with mesothelioma, malignant pleural mesothelioma remains an aggressive disease. Recent treatments have not resulted in appreciable improvement in survival, and thus development of more efficient therapies is urgently needed. The development of novel therapeutic strategies is dependent on our level of knowledge of the physiopathological and molecular changes that mesothelial cells acquired during the neoplastic process. During the past 5 years, new findings have been published on the etiology, epidemiology, molecular changes, and innovative treatments of malignant pleural mesothelioma. This review aims to update the findings of recent investigations on etiology, epidemiology, and molecular changes with a focus on (1) attributable risk of asbestos exposure in men and women and (2) coexposure to other minerals and other elongated mineral particles or high aspect ratio nanoparticles. Recent data obtained on genomic and gene alterations, pathways deregulations, and predisposing factors are summarized.     

Increased mesothelioma incidence in New Zealand: the asbestos-cancer epidemic has started

AIMS: To examine the incidence and mortality patterns for malignant mesothelioma and pleural cancer in New Zealand between 1962-1996, and relate these to past use of asbestos. METHODS: Data concerning cases of mesothelioma 1962-1996, deaths from pleural and lung cancers 1974-1996, and data on imports of raw asbestos and asbestos products were obtained from government registers and publications. Time trends were analysed using different models. RESULTS: Mesothelioma incidence rates have increased progressively in New Zealand since the 1960s, and reached 25 per million for men in 1995. The increase follows an exponential model departing from a crude 'background rate' of 1-2 per million in 1984, and is particularly steep in males 50 to 60 years of age. The incidence is expected to double by 2010. CONCLUSION: New Zealand has entered an unrivalled period of occupational cancer deaths resulting from past workplace exposure to airborne asbestos fibres. The steep rise in mesothelioma incidence is likely to be accompanied by increases in other asbestos related diseases such as lung cancer. The unique causal association between mesothelioma and asbestos may be used to monitor changes in the public health impact of these exposures. The notification by medical practitioners of all potential asbestos related conditions/exposures to the Occupational Safety and Health (OSH) service is of great importance.     

生化参数对于胸腔积液鉴别诊断的意义

目的研究不同类型胸腔积液中各项生化参数的诊断价值。方法收集65例恶性胸腔积液患者,32例结核性胸腔积液患者和35例炎性胸腔积液患者的血液和胸腔积液标本。采用日立7150型生化自动分析仪测定腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、总蛋白、白蛋白和葡萄糖的水平,进行统计学分析。结果结核组胸腔积液ADA水平高于恶性和炎性组(P<0.01);恶性组胸腔积液和血清中LDH水平高于结核组和炎性组(P<0.05);本组肺癌患者胸腔积液和血清LDH水平高于间皮瘤患者(P<0.05),间皮瘤患者胸腔积液中ADA水平高于肺癌患者(P<0.05)。结论胸腔积液高LDH水平和低ADA水平是恶性胸腔积液的特征;高ADA水平是结核性胸腔积液鉴别诊断的标志。     

Docetaxel and irinotecan (CPT-11) in the treatment of malignant pleural mesothelioma--a feasibility study

We chose to treat malignant pleural mesothelioma with a combination of docetaxel and irinotecan (CPT-11), because there have been preliminary reports that CPT-11 is active against mesothelioma, and docetaxel and CPT-11 were the most active agents in our in vitro experiments in human mesothelioma cell lines. Fifteen previously untreated patients with pleural mesothelioma (IMIG Stage III-IV) were given docetaxel 60 mg/m2 followed by CPT-11 190 mg/m2 on day 1, repeated every 3 weeks. All the patients were evaluable for toxicity and 13 patients were evaluated for response. No objective responses (complete or partial) were achieved, but there were two minor responses (overall response rate 15%) each of a duration of 4 months. Three patients had stable disease (23%); median time to progression was 7 months. Median survival in all the patients was 8.5 months from the first chemotherapy cycle and 11 months from diagnosis. Toxicity was severe with seven of 15 patients suffering neutropenic fever and six of 15 patients grade 3-4 diarrhea. The trial was discontinued because of toxicity and lack of activity. We do not recommend the combination of docetaxel and CPT-11 using the schedule presented here for further investigation in malignant mesothelioma. However, CPT-11 and docetaxel, individually, still warrant further study in this disease, especially in combination with cisplatin.