Governa M, Amati Monica, Bellis Donata, Bichisecchi Elisabetta, Santarelli Lory
Dipartimento di Patologia Molecolare e Terapie Innovative, Facolta di Medicina e Chirurgia, Area di Medicina del Lavoro, Università Politecnica delle Marche, Ancona.
Med Lav. 2006 May-Jun;97(3):463-74.
A revision of criteria for diagnosis of asbestos-related pathological conditions was performed studying specially asbestosis, pleural plaques and malignant mesothelioma, also taking into account the problems connected with histopathology. As regards the histological diagnosis of asbestosis, it requires the presence of diffuse interstitialfibrosis in a well inflated tissue remote from the site of a tumour or other large lesion, plus the presence of two or more asbestos bodies in a 1 cm2 section. As regards the imaging diagnosis, the HRTC 4-point scale proposed by Paris et al. (2004) has been adopted:--0 images not suggestive of interstitial pneumonia;--1 modest unilateral or bilateral interstitial abnormalities, involving restricted areas if bilateral;--2 interstitial abnormalities of limited extent, but consistent with a diagnosis of asbestosis, i.e. honeycombing, even without other parenchymal changes and even though unilateral, or else any two abnormal findings among thickened interlobular septa, intralobular lines or subpleural curved lines;--3 numerous bilateral changes on several slices involving more than 2/3 of the posterior third of each hemi thorax. Only points 2 and 3 were considered consistent with the diagnosis of lung fibrosis. Such HRCT findings are not specific for asbestosis, changes in the pleural wall such as diffuse plaques and thickenings contribute to the diagnosis of asbestosis. As regards the pleural plaques and asbestos bodies we remark that they are merely exposition markers. We also discussed the problems the pathologist may encounter in diagnosing mesothelioma; in this field the prospects are encouraging as microarray analysis are beginning to identify new molecular markers for mesothelioma.
对石棉相关病理状况的诊断标准进行了修订，特别研究了石棉肺、胸膜斑和恶性间皮瘤，同时也考虑了与组织病理学相关的问题。关于石棉肺的组织学诊断，需要在远离肿瘤或其他大病变部位的充分膨胀组织中存在弥漫性间质纤维化，并且在1平方厘米的切片中存在两个或更多的石棉小体。关于影像学诊断，采用了巴黎等人（2004年）提出的HRTC 4分制：——0分：图像不提示间质性肺炎；——1分：轻度单侧或双侧间质异常，双侧时累及范围有限；——2分：间质异常范围有限，但符合石棉肺诊断，即蜂窝状改变，即使没有其他实质改变且为单侧，或者在小叶间隔增厚、小叶内线或胸膜下曲线中出现任意两项异常表现；——3分：多个层面出现大量双侧改变，累及每个半侧胸腔后三分之一的超过2/3。只有2分和3分被认为与肺纤维化诊断相符。这些HRCT表现并非石棉肺所特有，胸膜壁的改变如弥漫性斑块和增厚有助于石棉肺的诊断。关于胸膜斑和石棉小体，我们指出它们仅仅是暴露标志物。我们还讨论了病理学家在诊断间皮瘤时可能遇到的问题；在这个领域前景令人鼓舞，因为微阵列分析开始识别间皮瘤的新分子标志物。
