目的 探讨睾丸鞘膜恶性间皮瘤(malignant mesothelioma)的临床病理学特征及诊断、鉴别诊断要点.方法 对3例睾丸鞘膜恶性间皮瘤进行临床病理学分析、免疫组化EnVision两步法染色及超微结构观察,并结合文献对该病的临床表现、组织形态学特点、免疫表型、超微结构特点和预后进行探讨.结果 3例患者临床症状均为阴囊肿块伴或不伴鞘膜积液,大体观察肿瘤呈结节状,直径0.4～5.0 cm,切面实性或囊实性,灰白,质韧.光镜下见肿瘤细胞形态多样,呈巢状、束状、编织状、实性片状或腺管状排列,瘤细胞胞质空淡或淡红染,核圆形、卵圆形或不规则形,核仁明显,核分裂象可见.免疫表型:瘤细胞均表达CKpan、Calretinin、EMA、vimentin、calponin、CK7、Villin;部分表达CK5/6、WT-1、CEA、SMA、S-100蛋白、CD34、CEA;D2-40、HBME-1、CD30、desmin、CD117和CK20均阴性;Ki-67增殖指数10%～30%.电镜观察细胞表面可见多量细长的微绒毛,细胞间可见细胞间连接,包括桥粒和连接复合体,胞质内见多量细胞丝,包括张力原纤维及一定数量的糖原.结论 睾丸鞘膜恶性间皮瘤较罕见,临床诊断较困难.确诊需根据其光镜病理形态特征,辅以免疫组化标记和(或)电镜检查.病理学上应与间皮增生、腺瘤样瘤、睾丸网腺癌、浆液性乳头状肿瘤等鉴别.该肿瘤完全切除后预后较好,以随访为主,可行放、化疗等辅助治疗.%Purpose To study the clinicopathological features of malignant mesothelioma ( MM ) of the tunica vaginalis testis and provide useful imformation for the diagnosis and differential diagnosis of the tumor. Methods The morphology features of 3 malignant mesotheliomas of the tunica vaginalis testis were observed by gross observation, HE staining and electron microscopy. Immunohisto-chemisty was used to identify the immunophenotype. We also reviewed the literatures to further analyze the clinical manifestations, his-topathological features, immunohistochemisty, treatment and prognosis of MM. Results The three cases presented with scrotal masses with or without hydrocele. Macroscopically, the tumors are nodular, 0. 4 ~ 5. 0 cm in diameter. On the cut surface, the tumors are solid or cystic-solid, gray-white and texture tough. Microscopically, tumor cells arranged in varied patterns: nested, fascicular, storiform, solid sheets and glandular. Cytoplasm is pale or light. Nucleus is round, oval or irregular in shape, with prominent nucleoli, and mi-totic figures can be seen. Immunohistochemically, the tumor cells expressed CKpan, Calretinin, EMA, vimentin, calponin, CK7 and ViUin. Some of the tumor ceUs expressed CK5/6, WT-1, CEA, SMA, S-100, CD34 and CEA. While D2-40, HBME-1, CD30, desmin, CD117 and CK20 were negative. Proliferation index was 10% ~30%. By electron microscope, there were a lot of elongated microvilli on tumor cells surface. Intercellular junctions were also observed between tumor cells, including desmosome and junctional complex. There were a lot of cytofilaments in the cytoplasma, including tonofilaments and a certain amount of glycogen. Conclusions Malignant mesothelioma of the tunica vaginalis testis is rare, and it can be difficult to diagnosis clinically. The definite diagnosis requires light microscopy plus immunohistology and ( or ) electron microscopy. The differential diagnosis including mesothelial hyperplasi-a, adenomatoid tumor, adenocarcinoma of the rete testis, and papillary serous tumor. The patients after complete resection will have a better prognosis. The patient needs follow-up after surgery. Additional treatment with radiation and chemotherapy may also be used.
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