背景:恶性间皮瘤(MM)是一种起源于胸膜的肿瘤,腹膜,或心包腔。它分为弥漫性和局限性恶性间皮瘤,弥漫性MM有四种亚型:上皮样,肉瘤样,去可塑性,和双相的,双相不太常见。这个肿瘤的发病是阴险的,在某些情况下预后极差,中位生存期为6-18个月,过去没有标准治疗方案。目的:我们报告了一例腹膜恶性间皮瘤,并通过转化疗法成功治疗。并对相关文献进行综述,以期为此类患者的治疗和病理诊断提供参考。方法:对腹膜恶性间皮瘤的病例进行处理,并对不同阶段的活检标本进行常规报道。结果与结论:我们报告一例起源于肝肾隐窝的恶性肿瘤,通过活检被诊断为双相恶性间皮瘤。免疫组织化学检测显示PD-L1表达。经过多学科的讨论,病人接受了转化性治疗,包括联合免疫疗法的试验。肿瘤明显缩小,患者获得了根治性手术切除的机会。显微镜检查显示病变区域有明显的胶原化,几乎没有残留肿瘤.经过19个月的综合治疗,患者在双肺胸膜下出现多个蓬松的混浊。CT引导下经胸芯针活检,病理显示机化性肺炎,根据既往治疗史,将其视为由免疫治疗引起的迟发性间质性肺炎。此例腹膜恶性间皮瘤成功综合治疗,病人已经活了33个月没有疾病的证据,长期随访。在这个过程中,病理学家有三次病理诊断的机会,这需要了解病人的病史,注意标本的临床目的,并对不同阶段的形态变化提供准确的反应,以及相应的描述和诊断,为临床治疗提供有效的信息。
Background: Malignant mesothelioma (MM) is a tumor originating from the pleura, peritoneum, or pericardial cavity. It is divided into diffuse and localized malignant mesothelioma, with four subtypes in diffuse MM: epithelioid, sarcomatoid, desmoplastic, and biphasic, with biphasic being less common. The onset of this tumor is insidious, and the prognosis is extremely poor in some cases, with a median survival of 6-18 months and no standard treatment options in the past. Aims: We report a
case of peritoneal malignant mesothelioma that was successfully treated with transformative therapy. We also review the literature in the hope of providing reference for the treatment and pathological diagnosis of such patients. Methods: The
case of the peritoneal malignant mesothelioma was processed and reported in the routine manner for biopsy specimens at different stages. Results and conclusion: We report a
case of a malignant tumor originating in the hepatorenal recess, which was diagnosed as biphasic malignant mesothelioma through a biopsy. Immunohistochemical testing showed PD-L1 expression. After multidisciplinary discussion, the patient received transformative treatment, including a trial of combined immunotherapy. The tumor significantly shrank, and the patient obtained a chance for curative surgical resection. Microscopic examination showed significant collagenization in the lesion area, with almost no residual tumor. After 19 months of comprehensive treatment, the patient developed multiple fluffy opacities under the pleura of both lungs. Transthoracic core needle biopsy under CT guidance, the pathology showed organizing pneumonia, considering it as delayed interstitial pneumonitis due to immunotherapy based on previous treatment history. Successful comprehensive treatment was achieved for this
case of peritoneal malignant mesothelioma, and the patient has been alive without evidence of disease for 33 months, with long-term follow-up. In this process, the pathologist had three opportunities for pathological diagnosis, which required understanding the patient\'s medical history, being attentive to the clinical purpose of the specimen, and providing accurate responses to morphological changes at different stages, along with corresponding descriptions and diagnoses to provide effective information for clinical treatment.