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1.乳头状间皮增生和间皮瘤的诊断标准？
2.乳头状间皮瘤发病的原因？
3.从增生，到瘤，到恶性，我们如何把握这一过程，如何掌握其诊断原则问题？
4.和部位，性别的关系？
Well-Differentiated Papillary Mesothelioma of the Female Peritoneum: A Clinicopathologic Study of 26 Cases(Am J Surg Pathol 2012;36:117–127)
实际病例：http://www.pathology.cn/bbs/foru ... mp;page=1#pid923623Abstract: Well-differentiated papillary mesothelioma (WDPM)
is an uncommon mesothelial tumor that occurs in the
peritoneum of women over a wide age range. Although
considered a tumor of uncertain malignant potential, information
about its biological behavior is still limited. In this study, we
present the clinicopathologic features of 26 cases of WDPM of
the female peritoneum seen in our institution over a 20-year
period (1990 to 2010). Clinical information and pathology
material were reviewed in all cases. Patients ranged in age from
23 to 75 years (median, 47 y; mean, 48.6 y). There was no history
of asbestos exposure in any of our cases. Ten patients had
undergone surgery previously, and 6 had a history of
endometriosis. In 24 patients, the WDPM was an incidental
finding during surgery for a benign or malignant lesion. Only 2
patients presented with symptoms: 1 with an acute abdomen and
the other with chronic pelvic pain. The former had developed a
small hemoperitoneum because of bleeding of 1 of the lesions of
WDPM, whereas the latter had a 2-cm WDPM involving the
distal fallopian tube. The lesions were single or multiple (13
cases each) and ranged in size from 0.1 cm to 2 cm. The
following sites were involved: abdominal or pelvic peritoneum
not otherwise specified (10 cases), omentum (7 cases), cul-de-sac
(6 cases), colonic serosa (4 cases), small bowel mesentery (2
cases), uterine serosa (2 cases), stomach serosa (1 case), large
bowel mesentery (1 case), fallopian tube (1 case), ovary (1 case),
and inguinal hernia (1 case). In all cases the lesions were excised.
Microscopically, all of our cases had the typical features
described for WDPM (ie, a papillary architecture that may be
accompanied by glandular/tubular patterns, nests of cells and
individual cells, bland mesothelial cells, absent or rare mitotic
figures). The initial diagnosis in our cases was variable, including
WDPM, mesothelial hyperplasia, malignant mesothelioma,
serous tumor of low malignant potential of the peritoneum,
papillary endosalpingiosis, and chronic xanthogranulomatous
salpingiosis. Follow-up was obtained for 25 patients, and it
ranged from 4 to 192 months (mean, 47.5 mo; median, 32 mo);
22 patients are alive with no evidence of WDPM after a followup
that ranged from 5 to 144 months. One of these patients
experienced recurrence of WDPM 46.5 months after initial
diagnosis. In this patient, WDPM was an incidental finding
during a total abdominal hysterectomy and bilateral salpingooophorectomy
for serous cystadenofibroma. The recurrence was
also an incidental finding during a colectomy for colonic
adenocarcinoma. This patient is alive with no other recurrences
73 months after initial diagnosis and 36 months after diagnosis
of the recurrence. Three patients died of other causes: pancreatic
cancer at 4 months and 12 months and leukemia at 192 months.
Recognition of the histologic features of WDPM and proper
clinical correlation allow for the correct diagnosis of this entity.
If necessary, immunohistochemical studies such as calretinin
and keratin 5/6 facilitate the recognition of the mesothelial
nature of this neoplasm. Although no patient died of disease in
this series, follow-up of patients with this diagnosis is warranted
on the basis of possible recurrences or misdiagnosis of an
undersampled malignant mesothelioma.