252 例胸膜恶性肿瘤的临床病理分析

目的：探讨胸膜恶性肿瘤的病理类型、肿瘤所占比例、临床病理特征及鉴别诊断。方法：结合病理形态学及免疫组化方法对252 例胸膜恶性肿瘤进行诊断及鉴别诊断。结果：252 例胸膜恶性肿瘤包括胸膜穿刺活检120 例，胸腔镜活检25 例，伴有胸膜转移的恶性胸水107 例；男性143 例，女性109 例，年龄19-87 岁，平均年龄59.9 岁。临床主要症状是胸闷、气短、咳嗽、胸痛等。CT表现为胸膜增厚、胸水(90%)、多发或单发胸膜结节和原发器官占位性病变。活检病例中，转移性癌86 例(34.1%)，包括肺腺癌64例(25.4%)，小细胞癌11 例(4.4%)，鳞癌11 例(4.4%)，恶性间皮瘤47 例(18.7%)，滑膜肉瘤9 例(3.6%)，非霍奇金淋巴瘤3 例(1.2%)；恶性胸水病例病例中转移性癌95 例(37.7%)，包括肺腺癌85 例(33.7%)，小细胞癌6 例(2.4%)，鳞癌2 例(0.8%)，乳腺腺癌2 例(0.8%)，恶性间皮瘤8 例(3.2%)，非霍奇金淋巴瘤4 例(1.6%)。结论：胸膜恶性肿瘤中以转移性腺癌多见，其次为恶性间皮瘤，结合形态学及免疫组织化学检测不同标志物的表达有助于诊断胸膜恶性肿瘤的种类。

Clinicopathological Analysis of 252 Patients with Malignant Tumors in the Pleura

Objective:To explore the pathologic types, proportion, clinicopathological characteristics and differential diagnosis ofmalignant tumors in the Pleura.Methods:252 cases of malignant tumors in the Pleura were diagnosed and distinguished throughpathomorphology and immunohistochemistry.Results:There were total 252 cases including 120 cases of pleura biopsy by puncture, 25video-assisted thoracoscopic pleural biopsy and 107 malignant pleural effusion with metastatic tumor in the pleura. The cases included143 males and 109 females. The age of patients ranged from 19 years to 87 years (median age=59.9 years). The main clinical symptomswere chest tightness, shortness of breath, cough, chest pain. The CT manifestations included: pleural thickening, pleural effusion (90%),solitary or multiple pleural nodules and primary organ lesions. In biopsy cases, there were 86 cases of metastatic cancer (34.1%),including 64 lung adenocarcinoma (25.4%), 11 small cell cancer (4.4%), 11 squamous cell carcinoma (4.4%), 47 malignant pleuralmesothelioma (18.7%), 9 synovial sarcoma (3.6%), 3 non-hodgkin''s lymphoma (1.2%); In malignant pleural effusion cases, there were 95cases of metastatic cancer(37.7%), including 85 lung adenocarcinoma (33.7%), 6 small cell cancer (2.4%), 2 squamous cell carcinoma(0.8%), 2 breast cancer (0.8%), 8 malignant pleural mesothelioma (3.2%), 4 non-hodgkin''s lymphoma (1.6%), diagnosed throughimmunohistochemistry with antibody combined.Conclusion:Metastatic adenocarcinoma is the most common malignant tumor in thepleura, followed by malignant pleural mesothelioma. Detection of various biomarkers expression through immunohistochemistry andpathologic morphology could contribute to the diagnosis of malignant tumor in the pleura.