36例粘膜原发恶性黑色素瘤临床病理分析及鉴别诊断

Clinicopathological Analysis and Differential Diagnosis of 36 Cases of Primary Malignant Melanoma of Mucous Membranes

目的探讨粘膜原发恶性黑色素瘤的临床病理特点及其鉴别诊断。方法回顾性分析36例粘膜原发恶性黑色素瘤的临床病理资料,对肿瘤进行光镜观察,并做免疫组化染色。结果根据肿瘤细胞形态特点及有无黑色素,36例粘膜恶性黑色素瘤被分为上皮样细胞为主型17例,梭形细胞为主型8例,小痣样细胞型2例,混合型9例;黑色素明显者16例,无或黑色素少者20例。免疫组化染色HMB45、S-100、Vimentin阳性率分别为80%、100%和80%。结论粘膜恶性黑色素瘤的组织结构和病理形态复杂,有不同病理类型,部分病例诊断比较困难,需借助免疫组织化学方法诊断和鉴别诊断。

Objective To investigate the clinicopathological characteristics and differential diagnosis of primary malignant melanoma of mucous membranes. Methods The clinical pathological data of 36 patients were analyzed retrospectively and 15 cases were stained with HMB45, S-100 and Vimentin by SP immunohistochemical method. All cases were observed under microscope. Results According to the morphological characters of tumor cells,36 cases of mucosal malignant melanoma were classified into epithelioid cell type including 17 cases, spindle cell type including 8 cases,lentigo cell type including 2 cases and mixed cell type including 9 cases. Pigment granules were rare or absence in 20 cases. Immunohistochemically, the positive rates of the expression of HMB45,S-100 protein, Vimentin in 15 cases were 800%, 100% and 80%0, respectively. Conclusion The histopathological structures and morphological characters of primary malignant melanoma of mucous membranes are very complex. There have different histopathologic types and some cases are difficult to diagnose. The application of immunohistochemistry may be helpful for diagnosis and differentiation.