原发性子宫颈恶性黑色素瘤四例临床分析

Primary malignant melanoma of the cervix: report of four cases and review of the literature

目的 探讨原发性宫颈恶性黑色素瘤(恶黑)患者的临床病理特征、治疗及预后。方法对北京协和医院和江西省妇幼保健院 1996年 9月至 2002年 8月收治的 4例原发性宫颈恶黑患者的临床病理资料进行回顾性分析,全部病例进行随访。所有病理标本进行免疫组化S 100及抗黑色素瘤特异性抗体(HMB-45)测定。结果 免疫组化检测: 4例患者HMB-45及S 100均呈阳性。治疗: 4例患者均接受了手术治疗;其中 3例接受了联合化疗, 3例中 1例同时接受了干扰素和抗雌激素受体治疗。预后: 1例仅接受手术治疗的患者于术后 6个月死亡;其他 3例均存活 3年以上,其中 1例于术后 41个月死亡,另 2例目前仍无瘤生存,分别存活 3、6年以上。1例存活 6年以上的患者在化疗的同时接受了免疫治疗。结论 S 100及HMB-45检测对于确诊恶黑具有重要意义。对于早期患者,手术应作为首选治疗手段,而辅助性化疗及免疫治疗有可能改善其预后。

Objective To investigate the clinical and pathological characteristics of primary cervical malignant melanoma, the treatment, and prognosis. Methods The clinical and pathological data of four patients with primary malignant melanoma of the cervix admitted to our hospital from Sept. 1996 to Aug 2002 were analyzed retrospectively. Their follow-up records were also reviewed. Nerve tissue protein S-100 and monoclonal antibody to melanoma (HMB-45) were examined in all cases by immunohistochemical method. Results All the patients received radical hysterectomy. In addition, three of them received chemotherapy, and one received immunotherapy simultaneously. One patient died six months and another 41 months after the operation respectively. One patient survived for 3 years, and another over 6 years free of tumor. S-100 protein and HMB-45 were positive in all patients. Conclusions The prognosis of primary malignant melanoma of cervix is relatively poor. S-100 protein and HMB-45 play important roles in the diagnosis of primary malignant melanoma of cervix. Radical hysterectomy, chemotherapy combined with dimethyl triazemo imidazole carboxamide(DTIC) and immunotherapy can improve the prognosis if the disease could be diagnosed in early stage.