恶性腹膜间皮瘤(malignant peritoneal mesothelioma, MPM)与累及腹膜浆液性癌的鉴别仍然是诊断中的一个挑战，特别是对于小活检标本和细胞学标本。在两者鉴别中，PAX8表达被认为是浆液性癌的特异性标志物。此外，有文献报道，区别于良性间皮病变和卵巢浆液性肿瘤(ovarian serous tumors, OST),恶性腹膜间皮瘤具有特异的BAP1表达缺失。我们通过免疫组织化学方法检测了27例恶性腹膜间皮瘤、25例良性间皮细胞病变和45例OST中PAX8和BAP1表达。5例MPM表达PAX8⁺(5/27，18%），8例良性间皮细胞病变表达PAX8 (8/25, 32%)。女性患者中间皮表达PAX8较男性患者更为常见（P=0.01)。16例MPM的BAP1表达缺失（16/25，64%），而在所有良性间皮细胞及所有OST中BAP1表达无缺失。所有PAX8⁺病例中，间皮细胞雌激素受体均为阴性。这些数据表明，PAX8在良性和恶性间皮细胞中均可表达，相较于良性间皮细胞病变和OST，BAP1表达缺失对于MPM高度特异。这些结果对于OST的初步诊断及病理分期也具有重要意义。通过检测PAX8表达来鉴别间皮源性与浆液性病变时一定要慎重，对于倾向间皮瘤的病例可通过检测BAP1表达缺失来证实。

Am.J Surg Pathol 2017;41:1675-1682

美国外科病理学杂志中文版2018年第二期摘要No.7

李杜鹃 翻译 邱雪杉 审校

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