一例恶性腹膜间皮瘤误诊为结肠癌报道及文献复习

doi:10.3877/cma.j.issn.2095-3224.2019.04.015

恶性腹膜间皮瘤是一种起源于腹膜腔上皮或间皮组织的少见恶性肿瘤，起病隐匿，几乎无特异性临床表现、敏感性实验室指标及影像学明显特征，早期诊断困难，极易误诊，病理学及免疫组化诊断是其金标准。该病目前尚无标准治疗方案推荐，确诊时多为晚期，病死率高，预后极差。本文报道一例54岁男性，初始误诊为结肠癌合并腹腔积液，后在腹腔镜下探查及活检，方得以明确诊断，采用多种药物灌注而腹腔积液仍不能控制，胸腹腔积液引流总量达7万余毫升，如此大量腹腔积液在临床上较少见，其生存期15个月。本文加以报道与文献回顾，旨在提高对该病之认识。

关键词: 结肠肿瘤, 间皮瘤, 恶性腹膜间皮瘤, 腹腔积液, 误诊

Malignant peritoneal mesothelioma originates from the epithelial ormesenchymal tissue of the peritoneal cavity. It is a rare malignancy without specific clinical symptoms, sensitive laboratory examination and typical imaging features. The early diagnosis of malignant peritoneal mesothelioma is difficult and the mortality is high. The final diagnosis depends on pathology and immunohistological examination. For the time being there is not yet a definite treatment strategy. Most cases are diagnosed at late stage and its prognosis is poor. Here we reported one rare case to draw the attention of physicians through rough discussion and literature review: A 54-years old man, initially misdiagnosed as colon cancer combined ascites. The final diagnosis depended on laparotomy exploration and biopsy by laparoscope. Ascites was unable to control after local abdominal cavity chemotherapeutic instillation with many kinds of drugs and the total amount of ascites was more than 70 000 mL. The overall survival was 15 months.

Key words: Colon neoplasms, Mesothelioma, Malignant peritoneal mesothelioma, Ascites, Misdiagnose

图1 PET-CT。腹腔、盆腔以及肠袢间隙可见大量积液，腹膜、肠系膜及大网膜可见多发结节状、斑片状、长条状核素高代谢灶

图2 HE染色及免疫组化。2A：HE乳头状型间皮瘤（HE×10）；2B：WT-1：阳性（Envision×10）；2C：Calretinin：阳性（Envision×10）；2D：CEA：阴性（Envision×4）；2E：Villin：阴性（Envision×10）；2F：CK20：阴性（Envision×4）

[1]	James Miller, William H. A malignant tumour arising from the endothelium of the peritoneum, and producing a mucoid ascitic fluid [J]. J Pathol Bacteriol, 1908, 12(2): 267-278.
[2]	Boffetta P. Epidemiology of peritoneal mesothelioma: a review [J]. Ann Oncology, 2007, 18(6): 985-990.
[3]	Saraya T, Yokoyama T, Ishii H, et al. A case of malignant peritoneal mesothelioma revealed with limitation of PET-CT in the diagnosis of thoracic metastasis [J]. J Thorac Dis, 2013, 5(1): E11-E16.
[4]	梁建华，蒋祖福，杨余沙. 我国165例腹膜恶性间皮瘤临床特点[J]. 中国中西医结合外科杂志, 2011, 17(4): 355-356.
[5]	孙鑫义，郑国启，刘晨第, 等. 弥漫型恶性腹膜间皮瘤超声影像学分析[J].临床荟萃, 2017, 32(4): 323-326.
[6]	陆东燕，侯莎莎，丁恩慈, 等. 结核性与恶性腹膜弥漫性病变的18F-FDG-PET-CT影像特征分析[J].国际放射医学核医学杂志, 2014, 38(6): 398-402.
[7]	Wagner JC, Sleggs CA, Marchand P. Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province [J]. Br J Ind Med, 1960, 3 (sup1): 13-32.
[8]	魏思忱，郑国启，王志刚, 等. 沧州地区162例腹膜恶性间皮瘤临床资料回顾性分析[J].中华内科杂志, 2013, 52(7): 599-601.
[9]	宋慧，郑国启，魏思忱, 等. 以局部炎症为首发症状的恶性腹膜间皮瘤患者的临床特征[J].中华肿瘤杂志, 2014, 36(4): 312-313.
[10]	孙宁宁，郑国启，宋慧, 等. 干痛型恶性腹膜间皮瘤的临床分析 [J]. 临床荟萃, 2017, 32(5): 416-420.
[11]	Hemminki K, Li X. Time trends and occupational risk factors for peritoneal mesothelioma in Sweden [J]. Occup Environ Med, 2003, 45(4): 451-455．
[12]	魏思忱，郑国启，白文元. 恶性腹膜间皮瘤的研究进展[J]. 中华消化杂志, 2014, 34(3): 212-214．
[13]	Klemper P, Rabin CR. Primary neoplasms of the pleura [J]. Arch Pathol, 1931, 11(6): 385-412.
[14]	Ozguven S, Aras M, Dede F, et al. Scrotal peritoneal mesothelioma on PET/CT [J]. Clin Nucl Med, 2014, 39(12): 1045-1046.
[15]	王桢李，邵雪，张倩, 等. 恶性腹膜间皮瘤研究进展[J].临床荟萃, 2017, 32(9): 819-823, 828.
[16]	郑国启，魏思忱，杨雨鑫, 等. 父女三人共患腹膜恶性间皮瘤[J]. 中华消化杂志, 2013, 33(5): 351-352.
[17]	王香芹，刘春荣. 无腹水的腹膜恶性间皮瘤1例[J]. 实用乡村医生杂志, 1999, 6(6): 33-34.
[18]	陈海雄，胡秋根，王秋实, 等. 弥漫型恶性腹膜间皮瘤的MDCT征象分析及其鉴别诊断[J]. 临床放射学杂志, 2015, 34(1): 83-87.
[19]	蒙建文，梁礼平，常凯敏. 弥漫性恶性腹膜间皮瘤¹⁸F-FDG-PET-CT显像误诊1例分析[J].福建医科大学学报, 2016, 50(4): 275-276.
[20]	童瑞，曾艳，闫玉坤, 等. 21例腹膜恶性间皮瘤的临床分析[J]. 解放军医学院学报, 2016, 37(1): 16-19.
[21]	解学芳，徐日，徐风亮, 等. 腹水肿瘤标记物联合检测鉴别良恶性腹腔积液的临床应用价值[J]．中国临床实用医学, 2015, 6(3): 42-43.
[22]	Baratti D, Kusamura S, Deraco M. Circulating CA125 and diffuse malignant peritoneal mesothelioma [J]. Eur J Surg Oncol, 2009, 35(11): 1198-1199.
[23]	Li YC, khashab T, Terhune J, et al. Preoperative thrombocytosis predicts shortened survival in patients with malignant peritoneal mesothelioma undergoing operative cytoreduction and hyperthermic intraperitoneal chemotherapy [J]. Ann Surg Oncol, 2017, 24(8): 2259-2265.
[24]	李想，王东浩.恶性腹膜间皮瘤25例[J].中国中西医结合外科杂志, 2016, 22(4): 324-327.
[25]	Kinoshita Y, Takasu K, Yuri T, et al. Two cases of malignant peritoneal mesothelioma without bestos exposure:cytologic and immunohistochemical features [J]. Ann Diagn Pathol, 2013, 17(1): 99-103.
[26]	郝素红，岳伟丽，王新超. WT1在乳腺癌中的研究进展[J].现代肿瘤医学, 2015, 23(11): 1616-1619.
[27]	Cedrés S, Montero MA, Zamora E, et al. Expression of Wilms′tumor gene (WT1) is associated with survival in malignant pleural mesothelioma [J]. Clin Transl Oncol, 2014, 16(9): 776-782.
[28]	Gupta A, Rao HK, pande R, et al. A rare case of benign multicystic peritoneal mesothelioma: a clinical dilemma [J]. Indian J surgl, 2013, 75(suppl 1): 27-29.
[29]	Lambert LA. Looking up: Recent advances in understanding and treating peritoneal carcinomatosis [J]. Ca A Cancer Journal for Clinicians, 2015, 65(4): 283-298.
[30]	Baratti D, kusamura S, Deraco M. Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research [J]. J Surg Oncol, 2011, 103(8): 822-831.
[31]	Lainakis G, Zagouri F, Kastritis E, et al. Systemic chemotherapy with pemetrexed and cisplatin for malignant mesothelioma: a single institution experience [J]. Tumor, 2011, 97(1): 25-29.
[32]	Feldman AL, Libutti SK, Pingpank JF, et al. Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy [J]. J Clin Oncol, 2003, 21(24): 4560-4567.
[33]	梁育飞，郑国启，李春英, 等.COX-2、NF-κB、WT-1、PTEN在恶性腹膜间皮瘤中的表达及与预后的关系[J].肿瘤防治研究, 2016, 43(8): 704-708.
[34]	Scattone A, Serio G, Marzullo A, et al. High Wilms′ tumour gene (WT1) expression and low mitotic count are independent predictors of survival in diffuse peritoneal mesothelioma [J]. Histopathology, 2012, 60(3): 472-481.
[35]	Cunha P, Luz Z, Seves I, et al. Malignant peritoneal mesothelioma diagnostic and therapeutic difficulties [J]. Acta Med Port, 2002, 15(5): 383.

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A case of malignant peritoneal mesothelioma was misdiagnosed as colon cancer and the literature review

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A case of malignant peritoneal mesothelioma was misdiagnosed as colon cancer and the literature review