Tangjitgamol Siriwan, Warnnissorn Malee, Attakettaworn Kwananong, Puripat Napaporn
Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, University of Bangkok Metropolis, Bangkok, Thailand.
J Med Assoc Thai. 2013 Jan;96(1):107-11.
Peritoneal malignant mesothelioma (PMM) is less commonly found in female than male. The most important differential diagnosis of PMM in female patient is primary ovarian carcinoma because of their similar symptoms e.g. dyspepsia, abdominal discomfort from ascites, palpable abdominal mass, etc. However common clinical presentation of PMM is diffuse spread of peritoneal lesions without dominating tumor mass while primary ovarian tumor usually presents with large pelvic mass and smaller exta-ovarian metastatic lesions. The surgeon may make a provisional intraoperative diagnosis of PMM if both ovaries are clearly identified Unfortunately, both conditions frequently elicit fibrosis and adhesion that the exact location or the origin of tumor cannot be clearly stated. Histopathologic diagnosis of PMM is also difficult because it has three patterns of histopathology as biphasic tumors composed of epithelial and sarcomatous components or it may be monophasic of either type. When only the epithelial component is found, serous ovarian carcinoma is the important differential diagnosis while the biphasic mesothelioma must be differentiated from malignant mesodermal mixed tumor or carcinosarcoma of the ovary. The pathologist generally requires immunohistochemical study to achieve a correct diagnosis. The clinical feature and detailed histopathologic findings of the patient with PMM will be discussed
腹膜恶性间皮瘤（PMM）在女性中的发病率低于男性。女性患者中PMM最重要的鉴别诊断是原发性卵巢癌，因为它们有相似的症状，如消化不良、腹水引起的腹部不适、可触及的腹部肿块等。然而，PMM的常见临床表现是腹膜病变的弥漫性扩散，没有占主导地位的肿瘤肿块，而原发性卵巢肿瘤通常表现为盆腔大肿块和较小的卵巢外转移病变。如果双侧卵巢都能清楚识别，外科医生可能会在术中做出PMM的初步诊断。不幸的是，这两种情况都经常引发纤维化和粘连，无法清楚说明肿瘤的确切位置或起源。PMM的组织病理学诊断也很困难，因为它有三种组织病理学模式，即由上皮和肉瘤成分组成的双相肿瘤，或者可能是单相的任何一种类型。当仅发现上皮成分时，浆液性卵巢癌是重要的鉴别诊断，而双相间皮瘤必须与卵巢恶性中胚叶混合瘤或癌肉瘤相鉴别。病理学家通常需要进行免疫组织化学研究以做出正确诊断。将讨论PMM患者的临床特征和详细的组织病理学发现。
