The Separation of Benign and Malignant Mesothelial Proliferations
The Separation of Benign and Malignant Mesothelial Proliferations
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DOI：
10.5858/arpa.2012-0112-ra
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发表时间：
2012-10-01
影响因子：
4.6
通讯作者：
Galateau-Salle, Francoise
中科院分区：
文献类型：
--
作者：
Churg, Andrew;Galateau-Salle, Francoise
背景。-良性与恶性间皮增生的分离是至关重要的病人管理，但往往是一个难题的病理学家。审查的病理特征，允许从恶性间皮瘤增殖良性分离，强调新的发现。数据来源。-文献综述和作者的经验。结论。侵袭仍是恶性肿瘤最可靠的指标。增殖中的间皮细胞的分布和数量在区分良恶性方面是重要的，角蛋白染色是有价值的，因为它们突出了间皮细胞的分布。苏木精-伊红检查仍然是金标准，免疫组化的作用是非常有争议的，我们认为，目前没有可靠的免疫组化标记的恶性肿瘤在这种情况下。间皮瘤原位是一种诊断，目前不能准确地作出任何类型的组织学检查。促纤维增生性间皮瘤的特征是角蛋白阳性的梭形细胞在S100阳性的脂肪细胞之间向下生长;一些机化性胸膜炎的病例可以模拟脂肪的参与，但这些脂肪样空间实际上是S100阴性的伪影，平行于胸膜表面排列。荧光原位杂交组织切片上寻找纯合p16基因缺失是偶尔有用的，但许多间皮瘤不显示纯合p16缺失。可疑活检标本应诊断为非典型间皮增生，如果临床医生认为该过程是恶性的，则需要另一次活检。(Arch Pathol Lab Med. 2012; 136：1217-1226; doi：10.5858/arpa.2012-0112-RA）
Context.-The separation of benign from malignant mesothelial proliferations is crucial to patient management but is often a difficult problem for the pathologist.Objective.-To review the pathologic features that allow separation of benign from malignant mesothelioma proliferations, with an emphasis on new findings.Data Sources.-Literature review and experience of the authors.Conclusions.-Invasion is still the most reliable indicator of malignancy. The distribution and amount of proliferating mesothelial cells are important in separating benignity from malignancy, and keratin stains can be valuable because they highlight the distribution of mesothelial cells. Hematoxylin-eosin examination remains the gold standard, and the role of immunochemistry is extremely controversial; we believe that at present there is no reliable immunohistochemical marker of malignancy in this setting. Mesothelioma in situ is a diagnosis that currently cannot be accurately made by any type of histologic examination. Desmoplastic mesotheliomas are characterized by downward growth of keratin-positive spindled cells between S100-positive fat cells; some cases of organizing pleuritis can mimic involvement of fat, but these fatlike spaces are really S100-negative artifacts aligned parallel to the pleural surface. Fluorescence in situ hybridization on tissue sections to look for homozygous p16 gene deletions is occasionally useful, but many mesotheliomas do not show homozygous p16 deletions. Equivocal biopsy specimens should be diagnosed as atypical mesothelial hyperplasia and another biopsy requested if the clinicians believe the process is malignant. (Arch Pathol Lab Med. 2012; 136: 1217-1226; doi: 10.5858/arpa.2012-0112-RA)