恶性间皮瘤鉴别诊断方法的探讨

９例恶性间皮瘤（ＭＭ）免疫组化ＣＥＡ染色均呈阴性，对照组３６例肺腺癌３０例阳性。Ｖｉｍｅｎｔｉｎ染色９例ＭＭ中８例阳性，对照组中５例肺腺癌均为阴性。组织化学胶质铁（ＣＩ）染色９例ＭＭ中８例阳性，再行透明质酸酶（ＨＣＩ）胶质铁染色则均呈阴性，对照组５例肺腺癌ＣＩ染色４例阳性，再行ＨＣＩ染色仍为阳性。电镜下ＭＭ瘤细胞表面可见密集成刷状或蓬发样微绒毛，且细而长，浆内见丰富张力微丝，肺腺癌则无。ＡｇＮＯＲ     

CT在恶性胸膜间皮瘤的诊断与鉴别诊断中的价值

目的 分析恶性胸膜间皮瘤的CT表现,提高对该病的诊断水平.方法 回顾性分析60例恶性胸膜问皮瘤的CT表现及临床资料.结果 60例中,59例表现为不同程度的胸膜增厚,其巾弥漫性胸膜增厚42例,局限性胸膜增厚17例;结节状胸膜增厚12例,肿块状胸膜增厚37例,环状增厚10例;胸膜增厚<1 cm者8例,≥1 cm者51例.38例出现胸腔积液.结论 恶性胸膜间皮瘤的CT表现有一定的特征性,CT在恶性胸膜间皮瘤的诊断与鉴别诊断中有重要的价值.     

免疫组化在胸膜上皮性恶性肿瘤鉴别诊断中的价值

背景与目的 胸膜上皮性恶性肿瘤鉴别诊断难度较大,本文旨在探讨免疫组化在胸膜恶性间皮瘤与转移性肺腺癌鉴别诊断中的作用.方法 用免疫组化S-P法检测56例胸膜上皮性恶性肿瘤中波形蛋白、间皮细胞(MC)、钙结合蛋白(CR)、甲状腺转录因子-1(TTF-1)、癌胚抗原(CEA)、表面活性蛋白-B(Sp-B)、细胞角蛋白(CK)的表达情况.结果 用免疫组化方法确定56例胸膜上皮性恶性肿瘤中恶性间皮瘤24例,转移性肺腺癌22例.波形蛋白、MC、CR、TTF-1、CEA、Sp-B在恶性间皮瘤与转移性肺腺癌中表达差异具有显著性(P＜0.001或P＜0.002).结论 用免疫组化方法鉴别胸膜恶性间皮瘤与转移性肺腺癌,波形蛋白、MC、CR、TTF-1、CEA、Sp-B是较为理想的标志物.     

免疫组化对恶性胸膜上皮型间皮瘤与肺腺癌鉴别诊断价值的探讨

目的:探讨免疫组化对恶性胸膜上皮型间皮瘤与肺腺癌鉴别诊断的价值。方法:用免疫组化SP法检测27例胸膜上皮型恶性间皮瘤和30例肺腺癌组织中,Calretinin、WT1、D2-40、CK5/6、CEA、MOC-31和TTF-1的表达情况,并应用受试者工作曲线(ROC)对检查结果分析,选择更合适的一组抗体用于恶性间皮瘤与肺腺癌的鉴别诊断。结果:Calretinin、D2-40、WT-1、CK5/6、CEA、MOC-31和TTF-1在恶性间皮瘤组织中的阳性表达率分别为92.5%(25/27)、92.5%(25/27)、96.3%(26/27)、77.8%(21/27)、11.1%(3/27)、0(0/27)和37.0%(10/27);在腺癌组织中的阳性率分别为13.3%(4/30)、6.7%(2/30)、10.0%(3/30)、26.7%(8/30)、90.0%(27/30)、83.3%(25/30)和96.7%(29/30)。间皮瘤阳性标志Calretinin、D2-40、WT1和CK5/6的ROC曲线下面积(AUC)值分别为0.896、0.930、0.931和0.756,腺癌标志CEA、TTF-1和MOC-31的AUC值分别为0.894、0.917和0.798。结论:免疫组化是鉴别恶性间皮瘤与腺癌最好的方法,Calretinin、WT1、D2-40、CEA和TFF-1是较为理想的标志,可作为恶性间皮瘤和腺癌鉴别诊断中的首选抗体。     

多层螺旋CT在恶性胸膜间皮瘤诊断中的价值

[目的]分析恶性胸膜间皮瘤的CT征象,评价CT平扫及多期增强扫描对该病的诊断价值。[方法]回顾分析39例经组织学及免疫组织化学证实的恶性胸膜间皮瘤的CT征象,全部病例均行多层螺旋CT平扫,其中27例加多期增强扫描。[结果]39例恶性胸膜间皮瘤患者中,35例为弥漫型,其中12例为环状胸膜增厚,17例为弥漫结节型胸膜增厚,6例为弥漫肿块型胸膜增厚;胸廓缩小25例;4例为巨块型,最大直径15cm;胸水32例,肋骨破坏4例,淋巴结肿大13例,增强后病灶呈中度持续强化。36例有石棉接触史,27例同时发现胸膜斑。[结论]恶性胸膜间皮瘤在CT平扫及多期增强扫描中有一定的特征性,CT是恶性胸膜间皮瘤诊断、随访最主要的影像诊断手段。     

EZH2在恶性胸膜间皮瘤中的作用机制研究

摘 要：［目的］ 探讨恶性胸膜间皮瘤中EZH2、Cul4A、Gli1的表达及其相互作用关系。［方法］ Real-time PCR检测恶性间皮瘤细胞株H2452、MSTO-211H以及人正常间皮细胞株Met-5A中EZH2、Cul4A、Gli1 mRNA的表达量;上调或下调EZH2表达后检测Cul4A、Gli1 mRNA的表达变化;利用免疫组化技术检测恶性胸膜间皮瘤患者病理组织中EZH2、Cul4A、Gli1表达并分析其相关性。［结果］ EZH2高表达的H2452细胞中,Gli1呈高表达,而Cul4A表达量与正常细胞无明显差异,抑制EZH2表达可使Gli1表达量下降,但对Cul4A表达无明显影响。EZH2低表达的MSTO-211H细胞中,Gli1呈低表达,导入外源性EZH2基因,可使Gli1表达升高,而Cul4A表达无明显改变。恶性胸膜间皮瘤标本中,EZH2表达阳性率为77.6%（52/67）,Cul4A表达阳性率为76.1%（51/67）,Gli1表达阳性率为65.7%（44/67）,EZH2与Gli1表达呈正相关（r=0.815,P<0.05）,EZH2与Cul4A表达无明显相关性（r=0.145,P>0.05）,Cul4A与Gli1表达呈正相关（r=0.577,P<0.05）。［结论］ 恶性胸膜间皮瘤中EZH2、Cul4A、Gli1呈高表达,并且Gli1表达与EZH2表达存在相关性,可能为EZH2的下游调控基因。     

基于D2-40检测胰腺癌组织中淋巴管密度的价值

[目的]探讨胰腺癌组织中淋巴管密度与肿瘤恶性程度、淋巴转移的相关性。[方法]应用免疫组化方法,采用单克隆抗体D2-40检测经手术切除的33例胰腺癌组织的瘤周淋巴管密度（pLVD）和瘤内淋巴管密度（iLVD）,分析胰腺癌组织pLVD、iLVD与患者临床病理参数之间的关系。[结果]胰腺癌的pLVD明显高于iLVD。胰腺癌的pLVD与肿瘤的分化程度、淋巴结转移及淋巴管累及明显相关,与年龄、性别、肿块大小、发生部位、浸润侵犯无关。[结论]胰腺癌中检测pLVD较iLVD更有价值;上述pLVD可以预测淋巴结转移,有助于判断预后。     

恶性胸膜间皮瘤分子标志物的研究新进展

恶性胸膜间皮瘤是一种与石棉密切相关的复杂疾病,中位生存期只有12个月。由于缺乏精确的生物标志物,对于恶性胸膜间皮瘤的诊断、治疗及预后判断都具有较大的困难。迄今为止,每年都会有一些新的分子标志物被研究者发现,其中具有代表性的包括钙结合蛋白、细胞角蛋白5、肾母细胞瘤蛋白-1等。该文主要就不同分子标志物的特征及作用等进行描述与评价。目前恶性胸膜间皮瘤相关标志物的临床转化情况并不十分令人满意,而更多敏感、无创的分子标志物正处于研究之中,其实际应用价值有待进一步的考量。     

D2-40和生存素在宫颈癌中的表达及与预后的相关性

目的研究D2-40和生存素（survivin）在宫颈癌中的表达及与预后的相关性。 方法采用免疫组织化学方法检测97例宫颈癌中D2-40、survivin的表达,对D2-40标记的LVD进行图像分析。对有随访结果的56例作单、多因素相关生存分析。研究设宫颈上皮内瘤变、慢性炎作为对照组。 结果D2-40标记的LVD值及survivin表达在三组中差异均有统计学意义(P<0.01)。D2-40、survivin在宫颈癌中的表达与浸润深度、组织学类型、FIGO分期及淋巴结转移呈正相关（P<0.01）。D2-40的表达与survivin蛋白的表达呈正相关(P<0.01)。在随访的56例中,单因素分析显示:宫颈癌中D2-40标记的LVD、survivin表达、浸润深度、组织学类型、FIGO分期及淋巴结转移均与患者生存率有关,多因素Cox比例风险分析显示除浸润深度外均具有独立的预后意义。结论D2-40在宫颈癌组织中高表达,提示D2-40与宫颈癌的发生、发展及转移密切相关。D2-40的表达与宫颈癌组织中survivin蛋白的表达密切相关。两者均是影响宫颈癌预后的因素,并有独立的预后意义。     

CD47基因mRNA在人恶性胸膜间皮瘤中的表达及意义

目的:分析CD47基因mRNA在MPM细胞和组织中的表达,并评价其与MPM患者临床病理特征及预后的关系。方法:采用RT-qPCR分析人正常胸膜间皮LP9细胞系和MPM细胞系NCI-H28（上皮样型）、NCI-H2052（肉瘤样型）、NCI-H2452（双相混合型）中CD47基因mRNA表达量;采用RT-qPCR检测12例MPM组织及配对正常胸膜组织中CD47基因mRNA表达量。通过Oncomine数据库对非瘤组织与MPM组织中CD47基因的表达差异进行分析。利用TCGA数据库对CD47基因mRNA表达量与MPM临床病理特征的相关性进行分析。构建Kaplan-Meier模型探讨CD47基因mRNA表达量对MPM患者预后的影响。利用cBioportal在线工具对CD47与MPM肿瘤标志物基因的表达进行相关性分析。结果:RT-qPCR检测和Oncomine数据库检索发现,与配对正常胸膜细胞和组织相比,MPM细胞和组织中CD47基因mRNA的表达量均呈现显著的增加（P＜0.01）。CD47基因表达量与MPM患者肿瘤类型相关（P＜0.05）。CD47基因表达量与MPM患者总生存率和无疾病进展生存率均无显著关联（Logrank P＞0.05）。Cox多因素分析表明,非上皮性型肿瘤是导致MPM患者预后不良的独立危险因素（P＜0.05）。CD47基因表达与EFEMP1、MSLN和CALB2基因的表达具有显著正相关（P＜0.01）。结论:CD47基因mRNA在MPM细胞和组织中均呈现显著增高,其表达量与MPM患者的肿瘤类型相关,但CD47基因mRNA表达量与MPM患者预后之间无显著关联。     

恶性胸膜间皮瘤的诊疗进展

恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)是一种源于胸膜间皮细胞、以局部侵袭为主、恶性度极高的罕见疾病.近年,由于MPM的发病率和病死率逐年增多,针对其诊断和治疗的研究也更多的被报道,本文就此进行相应阐述.     

Malignant Pleural Mesothelioma in Singapore

Aim: To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) inSingapore. Methods and Materials: A retrospective case note review of patients diagnosed with MPM between1997 and 2007. Overall survival (OS), locoregional recurrence-free survival (LRS) and metastasis-free survival(MFS) were estimated using Kaplan Meier method and comparison were done using log rank test. Multivariateanalysis was not done due to the small number of patients. Results: There were 39 patients diagnosed with MPM.Fifty-nine percent of patients presented with Stage III and IV disease. Eight (21%) patients had surgery with2 patients receiving trimodality treatment and adjuvant chemotherapy respectively. Three patients receivedadjuvant RT and one patient had no adjuvant therapy. Twelve patients received palliative RT or chemotherapy.Median follow-up was 27.0 weeks. Median overall survival (OS) for all patients was 8.0 months (95% CI 6.3-9.7).One-year and 2-year OS were 25.6% and 6.4% respectively. Thirty-eight patients died of progressive diseaseand one patient died of other cause. Locoregional recurrences and distant metastases occurred in 3/8 and 5/8surgically treated patients respectively. Overall, distant metastases occurred in 44% of patients. Surgery didnot affect survival outcomes although patients with dual modality treatment showed a trend towards improvedsurvival. Epithelioid tumours had better prognosis (median OS 10.2 months) compared to biphasic (median OS8.0 months) and sarcomatoid tumours (median OS 1.4 months). Conclusion: Future management of MPM willneed to emphasize on both locoregional and systemic control and hence, inclusion of patients in clinical trialsfor multimodality treatment should be encouraged.     

Surgery in Malignant Pleural Mesothelioma

Surgical intervention plays an important role in the diagnosis, staging, and treatment of malignant pleural mesothelioma (MPM) and can be applied with curative or palliative intent. The overall aim of surgery should be, as in any oncologic surgery, the macroscopic complete resection (MCR) of the tumor. Most importantly, the majority of patients with the diagnosis of MPM should be appropriately staged and initially evaluated in a multidisciplinary setting, including medical oncology, radiation oncology, and surgery after histologic diagnosis. Surgical staging, including determination of the histologic subtype and lymph node status, as well as clinical staging with positron-emission tomography–computer tomography scan and determination of cardiopulmonary reserve are crucial. Herein, we summarize the role of surgical resection, specifically macroscopic complete resection, performed as extrapleural pneumonectomy or extended pleurectomy/decortication in multimodality treatment settings and advocate for optimal patient selection for one or the other procedure. In addition, the roles of surgery in diagnosis of MPM and in palliative care are discussed.     

Diagnosis, Staging, and Surgical Treatment of Malignant Pleural Mesothelioma

OPINION STATEMENT: The clinical presentation of malignant pleural mesothelioma (MPM) is nonspecific. The process to obtain the correct diagnosis can be challenging and requires a high index of suspicion. Once the diagnosis is made, there is no universally accepted standard of care and treatment decisions are strongly influenced by physician bias. Physicians who see few numbers of patients tend to treat based on symptoms alone by drainage of the pleural effusion and talc pleurodesis, while physicians at several tertiary referral centers tend to take an aggressive multimodality approach incorporating surgical resection, chemotherapy, and radiation. The primary goal of surgery in this setting is the resection of all gross disease. The choice of operation, extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D), depends on disease stage, pulmonary function, philosophy of the treating physician, and type of planned adjuvant therapy.     

D2-40在浆膜腔积液中的诊断价值

[目的]观察D2—40在浆膜腔积液间皮瘤细胞中的表达情况,并与目前常用的间皮瘤抗体进行比较,探讨其鉴别诊断价值。[方法]采用细胞块技术对88例浆膜腔积液进行免疫组化检测,观察D2．40、Calretinin、CK5／6的表达,并通过受试者工作曲线（ROC）对检查结果分析。根据各指标的AUC值探讨D2．40在浆膜腔积液中的诊断价值。[结果]D2—40、Calretinin、CK5／6在恶性间皮瘤细胞中的阳性表达率分别为89．3％、92．5％、71．4％,转移性癌中表达率分别为8．3％、12．5％、27．0％．增生间皮细胞中阳性率分别为83-3％、83-3％和66．7％。三种标志物在恶性间皮瘤、转移性腺癌及增生问皮细胞表达差异有显著性意义（P〈0．05）。D2—40灵敏度与Calretinin相当,高于CK5／6．特异性高于Calretinin、CK5／6。ROC曲线下显示D2—40的AUC值高于Calretinin和CK5／6。[结论]D2．40有望成为鉴别上皮型间皮瘤和转移性腺癌的有价值的抗体。