Cagle P T, Truong L D, Roggli V L, Greenberg S D
Department of Pathology, Methodist Hospital, Houston, Texas.
Am J Clin Pathol. 1989 Nov;92(5):566-71. doi: 10.1093/ajcp/92.5.566.
A sizable proportion of pleural malignant mesotheliomas are sarcomatoid (22%) or biphasic (24%) and may need to be distinguished from other spindle cell neoplasms that occur as primary or metastatic tumors of the chest wall or lungs. To determine the utility of immunohistochemistry in the differentiation of sarcomatoid malignant mesotheliomas from other spindle cell neoplasms, the authors studied the immunostaining patterns of nine antibodies in four sarcomatoid mesotheliomas, one desmoplastic mesothelioma, two epithelial mesotheliomas, four spindle cell squamous carcinomas, and eight sarcomas of various differentiation. Three of the four sarcomatoid mesotheliomas and the desmoplastic mesothelioma had positive results for cytokeratin, which distinguishes them from sarcomas but not from spindle cell squamous carcinomas. The immunostaining pattern of 14 examples of benign spindle cell mesothelial proliferation was similar to that of the sarcomatoid mesotheliomas, which supports the theory that these tumors are mesothelial in origin. Although other antibodies occasionally may be helpful, depending on the differentiation of the sarcoma, cytokeratin immunostaining appears to be the best method to discriminate sarcomatoid mesotheliomas from sarcomas.
相当一部分胸膜恶性间皮瘤为肉瘤样（22%）或双向型（24%），可能需要与作为胸壁或肺部原发性或转移性肿瘤出现的其他梭形细胞瘤相鉴别。为了确定免疫组织化学在鉴别肉瘤样恶性间皮瘤与其他梭形细胞瘤中的作用，作者研究了9种抗体在4例肉瘤样间皮瘤、1例促纤维增生性间皮瘤、2例上皮样间皮瘤、4例梭形细胞鳞状细胞癌以及8例不同分化程度肉瘤中的免疫染色模式。4例肉瘤样间皮瘤中的3例以及促纤维增生性间皮瘤细胞角蛋白呈阳性结果，这使其与肉瘤相鉴别，但不能与梭形细胞鳞状细胞癌相鉴别。14例良性梭形细胞间皮增生的免疫染色模式与肉瘤样间皮瘤相似，这支持了这些肿瘤起源于间皮的理论。尽管根据肉瘤的分化情况，其他抗体偶尔可能会有帮助，但细胞角蛋白免疫染色似乎是鉴别肉瘤样间皮瘤与肉瘤的最佳方法。
