Watanabe M, Kimura N, Kato M, Iwami D, Takahashi M, Nagura H
Department of Pathology, Tohoku University, School of Medicine, Sendai, Japan.
Pathol Int. 1994 Oct-Nov;44(10-11):785-92. doi: 10.1111/j.1440-1827.1994.tb02927.x.
An autopsy case of malignant mesothelioma with asbestosis caused by asbestos exposure for 17 years is reported. Autopsy revealed that mesothelioma spread extensively in all serosal tissues including pleura, pericardium, diaphragm, peritoneum and tunica vaginalis testis. Histopathologically, most of the tumor showed an epithelial form, but sarcomatous and microcystic patterns were also observed. The tumor cells had abundant glycogen and hyaluronic acid and, immunohistochemically, they were positive for cytokeratin, vimentin and epithelial membrane antigen (EMA). Long, slender microvilli were characteristically observed in these tumor cells. All of these data were compatible with malignant mesothelioma. Procollagen type I (procol.l) immunostaining was performed to reveal the mesenchymal character of mesothelioma. Both epithelial-type cells and sarcomatous-type cells showed positive staining for procol.l, although the latter showed stronger immunoreactivity. Immunostaining for procol.l was found to be one of the useful tools for distinguishing mesothelioma from adenocarcinoma. Using an extraction method for asbestos fibers, asbestos bodies were found in many tissues including lymph nodes, liver, small intestine, spleen, kidney, testis and pleura, in addition to lung parenchyma. Although multiple tumor metastases from an undetermined primary site is not ruled out, 'multifocal tumorigenesis' is suspected from the widespread deposit of asbestos fibers.
报告一例因接触石棉17年导致恶性间皮瘤合并石棉沉着病的尸检病例。尸检显示间皮瘤广泛扩散至所有浆膜组织，包括胸膜、心包、膈肌、腹膜和睾丸鞘膜。组织病理学上，大部分肿瘤呈上皮型，但也观察到肉瘤样和微囊型。肿瘤细胞含有丰富的糖原和透明质酸，免疫组化显示，它们对细胞角蛋白、波形蛋白和上皮膜抗原（EMA）呈阳性。在这些肿瘤细胞中特征性地观察到长而细的微绒毛。所有这些数据均与恶性间皮瘤相符。进行I型前胶原（procol.l）免疫染色以揭示间皮瘤的间充质特征。上皮型细胞和肉瘤型细胞对procol.l均呈阳性染色，尽管后者的免疫反应性更强。发现procol.l免疫染色是区分间皮瘤与腺癌的有用工具之一。使用石棉纤维提取方法，除肺实质外，在包括淋巴结、肝脏、小肠、脾脏、肾脏、睾丸和胸膜在内的许多组织中均发现了石棉小体。尽管不能排除来自未确定原发部位的多灶性肿瘤转移，但从石棉纤维的广泛沉积怀疑为“多灶性肿瘤发生”。
