Yao Weigen, Yang Hanqing, Huang Guolai, Yan Yang, Wang Honglin, Sun Dongfang
Department of Radiology, The People's Hospital of Yuyao Yuyao 315400, P. R. China.
Int J Clin Exp Med. 2015 Oct 15;8(10):18367-74. eCollection 2015.
Our study analyzed the clinical symptoms and computed tomography (CT) manifestations of massive localized malignant pleural mesothelioma (LMPM) patients to improve the knowledge and diagnosis of this disease.
Our study collected 6 massive LMPM patients pathologically confirmed by CT in the department of Radiology of the People's Hospital of Yuyao, Zhejiang Province, from January, 2007 to June, 2013; data of patients were also collected. The clinical symptoms, clinicopathological characteristics, CT manifestations, treatments and prognosis of enrolled patients were analyzed.
Our study enrolled 6 LMPM patients (2 males; 4 females) classified to epitheliated type (n = 4) and sarcomatous type (n = 2) with mean age of 62.7 ± 7.4, and 5 of them had a history of asbestos exposure. CT manifestations revealed that large soft-tissue mass close to pleura, which was smooth and lobulated, was discovered in all patients with maximum diameter of 10~15 cm and mean diameter of 13.67 ± 1.15 cm; The mean value of CT was 36.29 ± 2.62 HU; after enhancement, the mean value was increased to 76.36 ± 7.73 HU; patients showed zones of small patchy necrosis and large patchy necrosis. The following presentations were founded: enlargement of tumor vessel which showed arborization (2 patients), mass wrap around the descending aorta in left lower chest (1 patient), strips of fat density in mediastinum superior (1 patient), pleural tail sign (3 patients). Among 6 patients, pleural effusion (n = 4), mediastinal lymph node enlargement (n = 3), invasion and destruction of local ribs (n = 2). Median survival time of patients were 20 months (2 cases conducted operation), 24 (2 cases chose combined radiotherapy and chemotherapy) and less than 6 months (2 cases underwent chemotherapy).
To sum up, CT showed important diagnostic values on massive LMPM patients; patients with a history of asbestos exposure, large soft-tissue mass of pleura with an abundant blood supply and wrap around large vessels might increase the risk of massive LMPM.
本研究分析大量局限性恶性胸膜间皮瘤（LMPM）患者的临床症状和计算机断层扫描（CT）表现，以提高对该疾病的认识和诊断水平。
本研究收集了2007年1月至2013年6月在浙江省余姚市人民医院放射科经CT病理确诊的6例大量LMPM患者；同时收集患者的数据。分析纳入患者的临床症状、临床病理特征、CT表现、治疗方法及预后情况。
本研究纳入6例LMPM患者（男性2例；女性4例），分为上皮型（n = 4）和肉瘤型（n = 2），平均年龄62.7±7.4岁，其中5例有石棉接触史。CT表现显示，所有患者均发现靠近胸膜的巨大软组织肿块，肿块光滑且呈分叶状，最大直径为10~15 cm，平均直径为13.67±1.15 cm；CT平均值为36.29±2.62 HU；增强后，平均值增至76.36±7.73 HU；患者出现小片状坏死区和大片状坏死区。还发现以下表现：肿瘤血管增粗呈树枝状（2例），左下胸部肿块包绕降主动脉（1例），上纵隔条片状脂肪密度影（1例），胸膜尾征（3例）。6例患者中，胸腔积液（n = 4），纵隔淋巴结肿大（n = 3），局部肋骨受侵破坏（n = 2）。患者的中位生存时间分别为20个月（2例行手术治疗）、24个月（2例选择放化疗联合）和小于6个月（2例接受化疗）。
综上所述，CT对大量LMPM患者具有重要的诊断价值；有石棉接触史、胸膜巨大软组织肿块且血供丰富、包绕大血管的患者可能增加大量LMPM的发病风险。
