Kobayashi Masashi, Ishibashi Hironori, Takasaki Chihiro, Imai Sachiko, Kirimura Susumu, Okubo Kenichi
Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan.
J Thorac Dis. 2019 Mar;11(3):717-723. doi: 10.21037/jtd.2019.02.54.
Radical pleurectomy/decortication (P/D) is applied as a surgical treatment of resectable malignant pleural mesothelioma (MPM). Although P/D removed visceral pleura, dissection plain was not histologically explored previously. We examined a pathological evaluation of surgically removed visceral pleura in P/D.
Twenty-five patients with MPM who underwent P/D at the Tokyo Medical and Dental University Hospital between April 2010 and April 2018 were studied. The 25 cases included 20 with epithelioid tumors, 4 with a biphasic tumor and 1 with desmoplastic tumors. Nine, 1, 11 and 4 patients had mesotheliomas of stages I, II, III and IV, respectively. We analyzed the site of the visceral pleural lesions using the HE & Elastica van Gieson (EVG) staining. The tumor involvement of the pleura and the surgical dissection plane were defined using the depth criteria, D0-3. We added survival analyses according to the depth criteria.
Ninety-nine lesions in total 45 lobes: 20 upper right, 14 middle, 20 lower, 22 upper left, and 23 lower were examined. Based on the depth D 0-3 criteria, there were 21 type D0, 18 type D1, 22 type D2 and 38 type D3 lesions. The growth of tumor cells in the pleura was partially diffuse or nodular in all cases. While 38 lesions which invaded the lung parenchyma were excised, another 61 lesions that reached within the pleura were dissected from lung parenchyma. Type D2&3 showed poor survivals than type D0&1.
The lung parenchyma was always the dissection plane in P/D, regardless of tumor involvement in the visceral pleura. The depth criteria would help us in classifying pleural invasion histologically and possibly predicting the prognosis.
根治性胸膜切除术/胸膜剥脱术（P/D）被用作可切除性恶性胸膜间皮瘤（MPM）的外科治疗方法。尽管P/D切除了脏层胸膜，但此前尚未对手术剥离层面进行组织学研究。我们对P/D术中切除的脏层胸膜进行了病理学评估。
对2010年4月至2018年4月期间在东京医科齿科大学医院接受P/D手术的25例MPM患者进行研究。这25例患者中，20例为上皮样肿瘤，4例为双向型肿瘤，1例为促纤维增生型肿瘤。分别有9例、1例、11例和4例患者的间皮瘤处于I期、II期、III期和IV期。我们使用苏木精-伊红（HE）染色和弹性纤维-van Gieson（EVG）染色分析脏层胸膜病变的部位。根据深度标准D0-3定义胸膜的肿瘤累及情况和手术剥离层面。我们根据深度标准进行了生存分析。
共检查了45个肺叶中的99个病变：右上叶20个、中叶14个、下叶20个、左上叶22个和左下叶23个。根据深度D0-3标准，有21个D0型病变、18个D1型病变、22个D2型病变和38个D3型病变。所有病例中，胸膜肿瘤细胞的生长部分呈弥漫性或结节状。虽然38个侵犯肺实质的病变被切除，但另外61个位于胸膜内的病变从肺实质中剥离。D2型和D3型病变的生存率低于D0型和D1型。
无论脏层胸膜是否有肿瘤累及，肺实质始终是P/D术中的剥离层面。深度标准有助于我们从组织学上对胸膜侵犯进行分类，并可能预测预后。
