Eyden B P, Banik S, Harris M
Department of Histopathology, Christie Hospital National Health Service Trust, Manchester, UK.
Ultrastruct Pathol. 1996 Jul-Aug;20(4):337-44. doi: 10.3109/01913129609016334.
A 71-year-old asbestos-exposed male with symptoms suggestive of asbestosis for the previous 8 years presented with abdominal distension and ascites. Clinically, a diagnosis of mesothelioma carcinoma was made. Light microscopy of an omental biopsy failed to advance the diagnosis: The tumor was a solid, papillary, and glandular neoplasm lacking mucin and hyaluronidase-sensitive Alcian blue staining material. Immunohistochemistry gave positive results for Ber-EP4, LeuM1, and CEA, markers, favoring carcinoma. Electron microscopy revealed processes in channels and lumina, which were long, slender, and uncoated with a length: diameter ratio of 19.7. A few possessed small rootlets. A glycocalyx and glycocalyceal bodies were not seen. Other features included tonofibrils, a basal lamina, and desmosomes. The patient died 3 months following the onset of abdominal symptoms. Autopsy findings included solid and papillary tumor throughout the peritoneum, but no intrinsic tumor of the gastrointestinal tract or elsewhere. Arriving at a final diagnosis was complicated by immunohistochemistry, which favored carcinoma, and ultrastructure, which suggested mesothelioma. Taking into account all lines of evidence, it was concluded that the tumor was probably a mesothelioma but one with some features developed to an extent more typical of carcinoma.
一名71岁有石棉接触史的男性，在过去8年里出现提示石棉肺的症状，此次因腹胀和腹水就诊。临床上诊断为间皮瘤癌。网膜活检的光镜检查未能明确诊断：肿瘤为实性、乳头状和腺性肿瘤，缺乏黏液且对透明质酸酶敏感的阿尔辛蓝染色物质。免疫组化结果显示Ber-EP4、LeuM1和癌胚抗原（CEA）标志物呈阳性，支持癌的诊断。电镜检查发现通道和管腔内有突起，这些突起长而细，无包膜，长宽比为19.7。少数有小根。未见糖萼和糖萼小体。其他特征包括张力原纤维、基膜和桥粒。患者在出现腹部症状3个月后死亡。尸检发现整个腹膜有实性和乳头状肿瘤，但胃肠道或其他部位无原发性肿瘤。免疫组化支持癌的诊断，超微结构提示间皮瘤，这使得最终诊断变得复杂。综合所有证据，得出结论：该肿瘤可能是间皮瘤，但具有一些更典型的癌的特征。
