Department of Pathology, Jeju National University Medical School, Jeju, Korea.
Pathol Int. 2011 Dec;61(12):756-61. doi: 10.1111/j.1440-1827.2011.02732.x. Epub 2011 Sep 12.
Mucin-positive epithelial mesothelioma has been reported in the peritoneum only once, and that mainly involved the stomach wall. We report the second peritoneal case and this is the first case mainly involving the small bowel wall. A 65-year-old man showed diffuse involvement from the duodenum to the ileum and metastatic masses in the left adrenal gland. Segmental resection of the small bowel was performed; 2 months later the patient died. Light microscopy showed diffusely anaplastic epithelioid cell proliferation and foci of glandular formation with granular mucinous materials in the cytoplasmic vacuoles or within glandular lumina. Histochemically, these mucin materials were PAS-positive and diastase-resistant. Immunohistochemically, the various mesothelial markers were positive, and a few adenocarcinoma markers were focally positive. Ultrastructurally, the tumor cells showed long slender microvilli on the apical surface, consistent with mesothelioma. Electron microscopy can play a decisive role in the case of ambiguous histochemical and immunohistochemical results.
仅报道过一次黏液阳性上皮性间皮瘤发生于腹膜，主要累及胃壁。我们报道了第二例发生于腹膜的病例，这也是首例主要累及小肠壁的病例。一名 65 岁男性表现为从十二指肠至回肠弥漫性受累，并伴有左肾上腺转移灶。行小肠节段切除术；2 个月后患者死亡。光镜下可见弥漫性间变上皮样细胞增生，并可见灶性腺形成，细胞质空泡内或腺腔内有颗粒状黏液物质。组织化学染色显示这些黏蛋白物质 PAS 阳性且耐淀粉酶。免疫组化染色显示各种间皮标志物阳性，少数腺癌标志物灶性阳性。超微结构上，肿瘤细胞在顶端表面显示长而细的微绒毛，符合间皮瘤。在组织化学和免疫组化结果不明确的情况下，电子显微镜可以发挥决定性作用。
