Masai Kyohei, Sasada Shinji, Izumo Takehiro, Taniyama Tomoko, Nakamura Yukiko, Chavez Christine, Sakurai Hiroyuki, Tsuta Koji, Tsuchida Takaaki
*Department of Endoscopy, Respiratory Endoscopy Division Departments of †Thoracic Surgery ‡Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan.
J Bronchology Interv Pulmonol. 2013 Oct;20(4):345-8. doi: 10.1097/LBR.0000000000000010.
Desmoplastic malignant mesothelioma (DMM) is a rare subtype of malignant pleural mesothelioma (MPM) and is often difficult to distinguish from pleural fibrosis and reactive mesothelial hyperplasia, especially if the biopsy samples are small. We performed full-thickness pleural biopsy on a lesion suspected to be DMM using an insulated-tip diathermic knife-2 (IT knife-2) during flex-rigid pleuroscopy. IT knife-2 is a novel electrosurgical device for endoscopic submucosal dissection in the early gastrointestinal cancer. It consists of a needle knife with 3 short blades at the distal end attached to an insulated ceramic tip. A 54-year-old man presenting with chest wall mass and thickened pleura, in whom a computed tomography-guided percutaneous needle aspiration had remained negative, underwent flex-rigid pleuroscopy for definitive diagnosis. While applying electric current, we used the IT knife-2 to incise the pleura in a circular shape just above the endothoracic fascia. The incised pleura was removed by forceps and examined pathologically. The microscopic examination was compatible with DMM. We discovered that pleuroscopic punch biopsy using IT knife-2 can diagnose DMM. Use of IT knife-2 during flex-rigid pleuroscopy can obtain sufficient samples from densely thickened pleura, which is difficult to diagnose with small biopsies.
促纤维增生性恶性间皮瘤（DMM）是恶性胸膜间皮瘤（MPM）的一种罕见亚型，常难以与胸膜纤维化和反应性间皮细胞增生相鉴别，尤其是活检样本较小时。我们在可弯曲硬质胸腔镜检查期间，使用绝缘头透热电刀-2（IT刀-2）对疑似DMM的病变进行了全层胸膜活检。IT刀-2是一种用于早期胃肠道癌内镜黏膜下剥离术的新型电外科设备。它由一把远端带有3个短刀片的针刀和一个绝缘陶瓷头组成。一名54岁男性，因胸壁肿块和胸膜增厚就诊，计算机断层扫描引导下经皮针吸活检结果为阴性，遂接受可弯曲硬质胸腔镜检查以明确诊断。在施加电流时，我们使用IT刀-2在内侧胸筋膜上方将胸膜环形切开。用钳子取出切开的胸膜并进行病理检查。显微镜检查结果符合DMM。我们发现，使用IT刀-2进行胸腔镜穿刺活检可诊断DMM。在可弯曲硬质胸腔镜检查期间使用IT刀-2可从高度增厚的胸膜获取足够样本，而小活检难以对其进行诊断。
