肝脏恶性黑色素瘤1例并文献复习

Malignant melanoma of the liver:a case report and review of literature

目的:探讨肝脏恶性黑色素瘤的诊断、鉴别诊断及生物学行为。方法:报道1例肝脏恶性黑色素瘤,对其进行光镜观察、免疫组织化学及特殊染色检测,并回顾文献。结果:肉眼观察见椭圆形肿物,有明显包膜,局部与肝组织黏连,但二者分界清楚;光镜下瘤细胞呈弥漫性分布,与肝组织分界处有纤维组织分割,但局部瘤细胞突破包膜侵及肝组织;肿瘤细胞异型性明显,呈圆形、多角形或梭形,胞界清,胞质丰富。部分区域瘤细胞胞浆中可见灰黑色颗粒;核圆形或卵圆形,核仁明显,嗜酸或弱嗜碱性,核分裂像易见;免疫组化结果肿瘤细胞显示Vimentin、Melanoma-pan、HMB45和S-100阳性;不表达AFP、CK高、CK18、CEA、CK19、CD34、CD117、NSE、LCA、CK、CHA、HCG、EMA、SCLC、Desmin、SM-actin、SC-actin、myoglobin和Syn等。结论:肝脏恶性黑色素瘤是一种极其罕见的肿瘤,且组织学形态又复杂多样,如遇到诊断有困难的肝脏肿瘤时,应考虑到恶性黑色素瘤之可能。

Objective：To investigate the diagnosis, differential diagnosis and biologic behaviors of primary malignant melanoma of the liver. Methods： A case of primary malignant melanoma of the liver was reported with clinicopathological analysis, immunohistochemistry and review of literature. Results： Grossly, there was a clear circumsciption between mass and liver tissues,with a intact capsule. Microscopically, the tumer cells were diffuse, and there was fibrous tissue between lesions and liver tissues, but a few tumor cells broke through the capsule and infiltrated into the liver tissues. The tumor cells were multi - pleomorphic, and they were round, spindle shaped and irregular. The tumor cell nucleus were round or oval, and the nucleoli were prominent with eosinophilic or basophilla. Some tumor cells were with melanin deposition of melanin pigment. Immunohistochemistry assay showed that the tumor cells were positive for HMB - 45, Melanoma - pan, S - 100 protein and Vimentin, and negative for AFP, High - MW - CK, CK18, CEA, CK19, CD34, CD117, NSE, LCA, CK, CHA, HCG, EMA, SCLC, Desmin, SM - actin, SC - actin, myoglobin and Syn. Conclusion： Primary malignant melanoma of the liver is a very rare neoplasm with many kinds of histological appearance. It should be considered as malignant melanoma when it is difficult to dignose for liver neoplasm.