Harwood T R, Gracey D R, Yokoo H
Am J Clin Pathol. 1976 Feb;65(2):159-67. doi: 10.1093/ajcp/65.2.159.
Six cases of primary lung cancer that closely mimic malignant pleural mesothelioma clinically and anatomically are compared with four proven cases of malignant pleural mesothelioma. Findings on roentgenograms of the chest, clinical history, and gross examination of the lung specimens are not helpful in distinguishing between these two neoplasms. Microscopic examination of the hematoxylin and eosin-stained tissues is often inconclusive. Tissues were stained with hematoxylin and eosin, PAS with and without diastase treatment (DPAS), mucicarmine, alcian blue, toluidine blue, and colloidal iron with and without digestion by testicular hyaluronidase. Among these histochemical methods, DPAS was found to be particularly useful in distinguishing the primary lung cancers from the mesotheliomas. All primary lung cancers except one showed DPAS-positive material (mucin) in both the cytoplasm of the cancer cells and within the lumina of neoplastic glands. In contrast, none of the mesotheliomas showed the presence of DPAS-positive material. Histologically, all lung cancers were glandular. Five were classified as bronchiolar carcinoma, the remaining one as poorly differentiated adenocarcinoma. In two of the bronchiolar carcinomas, a small subpleural primary focus was demonstrated. This finding suggests a possible origin of these cancers as a small subpleural tumor that became widely disseminated via the subpleural lymphatics. This form of primary lung cancer possesses sufficient gross and microscopic characteristics that recognition should be given to it as a variant of primary lung cancer, with emphasis on differentiating it from pleural mesothelioma.
将6例临床和解剖学上酷似恶性胸膜间皮瘤的原发性肺癌与4例经证实的恶性胸膜间皮瘤进行比较。胸部X线片表现、临床病史及肺标本大体检查对鉴别这两种肿瘤并无帮助。苏木精和伊红染色组织的显微镜检查往往难以得出结论。组织用苏木精和伊红、有无淀粉酶处理的过碘酸雪夫染色（DPAS）、黏液卡红、阿尔辛蓝、甲苯胺蓝以及有无经睾丸透明质酸酶消化的胶体铁染色。在这些组织化学方法中，发现DPAS对鉴别原发性肺癌和间皮瘤特别有用。除1例原发性肺癌外，所有原发性肺癌在癌细胞胞质和肿瘤性腺体管腔内均显示DPAS阳性物质（黏液）。相比之下，间皮瘤均未显示DPAS阳性物质。组织学上，所有肺癌均为腺性。5例为细支气管癌，其余1例为低分化腺癌。在2例细支气管癌中，发现一个小的胸膜下原发性病灶。这一发现提示这些癌症可能起源于一个小的胸膜下肿瘤，通过胸膜下淋巴管广泛播散。这种原发性肺癌具有足够的大体和显微镜特征，应将其视为原发性肺癌的一种变异型，重点是将其与胸膜间皮瘤区分开来。
