Domínguez-Malagón Hugo, Cano-Valdez Ana María, González-Carrillo Carlos, Campos-Salgado Yelitza Esmeralda, Lara-Garcia Alejandra, Lopez-Mejia Mariana, Corona-Cruz Jose Francisco, Arrieta Oscar
a Pathology Department , Instituto Nacional de Cancerología , Tlalpan , Mexico City , Mexico.
b Thoracic Oncology Unit , Instituto Nacional de Cancerología , Tlalpan , Mexico City , Mexico.
Ultrastruct Pathol. 2016 Sep-Oct;40(5):254-60. doi: 10.1080/01913123.2016.1195469. Epub 2016 Jul 12.
The diagnosis of malignant pleural mesothelioma (MPM) is challenging and requires immunohistochemistry or electron microscopy assays to specifically differentiate MPM from lung adenocarcinoma. An ultrastructural study of fresh tissue is considered to be the "gold standard." In most cases, the first diagnostic approach is performed on pleural effusion, and in some patients, this is the only available sample for diagnosis. The aim of the present study is to evaluate if an examination of pleural effusion samples based on electron microscopy (EMpe) is a useful tool for the differential diagnosis of MPM and lung adenocarcinoma. An EMpe study was performed in 25 pleural effusion samples. Histological and immunohistochemical markers confirmed the diagnosis of either mesothelioma (5) or adenocarcinoma (20). Of the five cases that were diagnosed with mesothelioma, two samples (40%) showed cells with "bushy" microvilli, which are characteristic of mesothelioma, by EMpe, and three were acellular (60%). Of the 20 cases of adenocarcinoma, EMpe showed cells with short microvilli in 9 (45%), and 11 were acellular (55%). EMpe identifies unequivocal morphological changes that are useful for the differential diagnosis of MPM or adenocarcinoma when the pleural effusion sample contains evaluable tumor cells.
恶性胸膜间皮瘤（MPM）的诊断具有挑战性，需要免疫组织化学或电子显微镜检测来明确区分MPM与肺腺癌。对新鲜组织进行超微结构研究被认为是“金标准”。在大多数情况下，首先对胸腔积液进行诊断性检查，在一些患者中，这是唯一可用于诊断的样本。本研究的目的是评估基于电子显微镜检查胸腔积液样本（EMpe）是否是MPM和肺腺癌鉴别诊断的有用工具。对25份胸腔积液样本进行了EMpe研究。组织学和免疫组化标记物证实诊断为间皮瘤（5例）或腺癌（20例）。在诊断为间皮瘤的5例病例中，2份样本（40%）通过EMpe显示出具有间皮瘤特征的“浓密”微绒毛的细胞，3份样本无细胞（60%）。在20例腺癌病例中，EMpe显示9例（45%）细胞有短微绒毛，11例无细胞（55%）。当胸腔积液样本含有可评估的肿瘤细胞时，EMpe可识别出明确的形态学变化，这对MPM或腺癌的鉴别诊断有用。
