巨大的脑实质内局限性间皮瘤：一例罕见病例报告

摘要(中文译文)

弥漫性间皮瘤（DM）是一种高度侵袭性的肿瘤，通常以弥漫性生长和一致的不良预后为特征。相比之下，局限性间皮瘤（LM）是一种罕见的变异型，占所有间皮肿瘤的不到1%，表现为孤立的、界限清楚的肿块，无弥漫性浆膜播散。由于LM常模仿更常见的胸部病变，如支气管源性癌或纵隔恶性肿瘤，因此常导致诊断显著延迟。尽管早期LM通过手术切除可能治愈，但由于其具有侵袭性恶性转化的潜力，干预窗口可能迅速关闭。一名71岁男性，表现为两个月的呼吸困难和胸膜性疼痛病史。一个最初不明显的1厘米结节在18个月内侵袭性增大为17厘米的坏死性肿块。PET成像显示高代谢环状边缘伴中心坏死，模仿巨大肺脓肿或癌。纵隔镜检查阴性后，VATS活检证实为上皮样局限性间皮瘤。据我们所知，此病例代表了已报道的最大的肺实质内局限性间皮瘤，在短短18个月内从1厘米扩大到17厘米。鉴于其与弥漫性间皮瘤的形态学相似性，免疫组织化学仍是诊断的金标准。这种侵袭性进展强调了机会窗口风险，即监测不足使可治愈的早期病变进展至无法切除。即使无石棉暴露，在孤立性胸部肿块的鉴别诊断中也应考虑局限性间皮瘤。与弥漫性间皮瘤不同，早期LM通过手术切除可能治愈。这需要高度的临床怀疑和对不确定结节及时进行手术探查，以确保及时诊断。

Abstract

Diffuse mesothelioma (DM) is a highly aggressive neoplasm typically characterized by diffuse growth and a uniformly poor prognosis. In contrast, localized mesothelioma (LM) is a rare variant representing less than 1% of all mesothelial tumors, presenting as a solitary, circumscribed mass without diffuse serosal spread. Because LM frequently mimics more common thoracic pathologies, such as bronchogenic carcinoma or mediastinal malignancies, it often leads to significant diagnostic delays. Although early-stage LM is potentially curable through surgical resection, the window for intervention can close rapidly due to its potential for aggressive malignant transformation. A 71-year-old male presented with a two-month history of dyspnea and pleuritic pain. An initially subtle 1-cm nodule had aggressively expanded over 18 months into a 17-cm necrotic mass. PET imaging revealed a hypermetabolic rind with central necrosis, mimicking a giant lung abscess or carcinoma. Following negative mediastinoscopy, a VATS biopsy confirmed epithelioid localized mesothelioma. To the best of our knowledge, this case represents the largest reported intraparenchymal localized mesothelioma, expanding from 1 cm to 17 cm in just 18 months. Given its morphological similarity to diffuse mesothelioma, immunohistochemistry remains the diagnostic gold standard. This aggressive progression underscores the window of opportunity risk, where inadequate surveillance allows curable, early-stage lesions to advance beyond resectability. Localized mesothelioma should be considered in the differential diagnosis of solitary thoracic masses, even without asbestos exposure. Unlike diffuse mesothelioma, early-stage LM is potentially curable through surgical resection. This requires high clinical suspicion and prompt surgical exploration of indeterminate nodules to ensure a timely diagnosis.

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