鼻腔恶性黑色素瘤18例临床病理分析

Primary mucosal melanomas in nasal cavity: a clinicopathological analysis of 18 cases

目的 探讨鼻腔恶性黑色素瘤的临床病理特征，对其诊断和鉴别诊断进行讨论。方法 收集18例鼻腔恶性黑色素瘤，观察其临床病理特点并进行免疫组化分析。结果 18例鼻腔恶性黑色素瘤中男性7例，女性11例；年龄34—75岁，平均55．9岁。病变主要发生于鼻腔，或鼻腔和鼻窦同时受累。肿瘤由上皮样、梭形及未分化小细胞等多种类型的细胞构成，通常血管周围细胞呈瘤样结构。免疫组化标记瘤组织HMB45、S-100和Vim均（＋）。结论 鼻腔恶性黑色素瘤与皮肤黑色素瘤相比具有不同的组织形态学特征，通常诊断较困难，根据其组织学改变和免疫组化染色结果可有助于与鼻腔其他原发肿瘤相鉴别。

Objective To study the clinicopathological features of the primary mucosal melanomas in the nasal cavity and to discuss its diagnosis and differential diagnosis. Methods The clinical data were reviewed retrospectively and immunohistochmical stains were performed in 18 case of the primary mucosal melanomas in the nasal cavity. Results The patients were 7 males and 9 females, aged from 34 to 75 years （mean 55.9 years）. The lesions were mainly located in the nasal cavity, or a combination of the nasal cavity and sinuses. Histologically, the tremors were composed of a variety of cell types （epithelioid, spindle, undifferentiated）, frequently arranged in a peritheliomatons pattern. Immunolaistochemical stain showed the tumors were positive for HMB45, S-100 and vimentin. Conclusion To compare with melanoma in the skin, primary nasal cavity melanoma has different histological features. The diagnosis is often difficult. Based on the histopathologic features and immunohistochemical finding, it can be differentiated from other tuners derived from nasal cavity.