Pusiol Teresa, Zorzi Maria Grazia, Morichetti Doriana, Piscioli Irene, Scialpi Michele
Institute of Anatomic Pathology, S.Maria del Carmine Hospital, Rovereto - Rovereto - Trento, Italy.
Department of Radiology, Budrio Hospital, via Benni 44, 40054 Budrio (BO), Italy.
World J Oncol. 2010 Aug;1(4):179-181. doi: 10.4021/wjon230w. Epub 2010 Aug 29.
Psammoma bodies (PBs) are observed most commonly in papillary thyroid carcinoma, meningioma, and papillary serous cystadenocarcinoma of the ovary. We report one case of peritoneal malignant mesothelioma (PMM) with massive deposition of PBs. A 72-years-old man presented with abdominal swelling and marked weight loss. Contrast enhanced computed tomography showed fluid diffuse in peritoneal recesses, thick septa with micronodules in the greater omentum and adjacent enhancement of the thickened peritoneum. The explorative laparoscopy showed diffuse minute parietal peritoneal nodules. The peritoneal biopsy revealed a superficial papillary growth of malignant epithelial-like cells with diffuse involvement of submesothelial tissues. Massive deposition of PBs was observed. Nuclear and cytoplasmic calretinin immunoreactivity was present in neoplastic cells along with membranous D2-40 and membranous/cytoplasmic cytokeratin 5 staining. The patient was treated with chemotherapy (gemcitabine, vinorelbine, cisplatin). PBs may represent an active biologic process ultimately leading to degeneration/death of tumor cells and retardation of growth of the neoplasm. It may also serve as a barrier against the spread of tumor. Psammomatous malignant mesothelioma may simulate serous psammocarcinoma of the peritoneum. The behavior of serous psammocarcinoma is more closely similar to borderline serous tumor than to serous carcinoma. Further studies are necessary to establish if massive deposition of PBs may define a new variant of psammomatous malignant mesothelioma with a favorable impact to the prognosis of usual psammomatous malignant mesothelioma, as well as in serous psammocarcinoma of the peritoneum.
砂粒体（PBs）最常见于甲状腺乳头状癌、脑膜瘤和卵巢乳头状浆液性囊腺癌。我们报告一例腹膜恶性间皮瘤（PMM）伴有大量砂粒体沉积。一名72岁男性，出现腹部肿胀和明显体重减轻。增强计算机断层扫描显示腹膜隐窝内液体弥漫，大网膜有增厚的间隔伴微小结节，增厚的腹膜有周边强化。腹腔镜探查显示弥漫性微小的壁层腹膜结节。腹膜活检显示恶性上皮样细胞呈浅表乳头状生长，亚间皮组织弥漫受累。观察到大量砂粒体沉积。肿瘤细胞中存在核和细胞质钙视网膜蛋白免疫反应性，同时有膜性D2-40和膜性/细胞质细胞角蛋白5染色。患者接受了化疗（吉西他滨、长春瑞滨、顺铂）。砂粒体可能代表一个活跃的生物学过程，最终导致肿瘤细胞变性/死亡和肿瘤生长迟缓。它也可能作为肿瘤扩散的屏障。砂粒状恶性间皮瘤可能模拟腹膜浆液性砂粒体癌。浆液性砂粒体癌的行为与交界性浆液性肿瘤更相似，而不是浆液性癌。有必要进一步研究大量砂粒体沉积是否可能定义一种新的砂粒状恶性间皮瘤变体，对普通砂粒状恶性间皮瘤以及腹膜浆液性砂粒体癌的预后产生有利影响。
