恶性黑色素瘤的临床细胞病理学分析

Clinical analyses of malignant melanoma through cytopathology

目的:探讨恶性黑色素瘤的细针吸取细胞学(FNAC)特点,以提高诊断水平,避免误诊。方法:回顾性分析经病理组织学证实的38例恶性黑色素瘤的针吸细胞学改变及临床资料,部分病例行免疫组织化学染色。结果:38例经病理组织学证实的恶性黑色素瘤病例中,20例为原发灶,18例为转移灶;FNAC明确诊断者为32例,疑诊3例,误诊为淋巴结转移腺癌3例。FNAC表现以上皮样型多见,共29例,梭形细胞型8例,混合型1例;其中有色素性恶性黑色素瘤28例,无色素性黑色素瘤10例。结论:FNA易于诊断有色素性恶性黑色素瘤,而无色素性恶性黑色素瘤则容易误诊。详尽询问病史,掌握其镜下特征,结合免疫组织化学染色能提高诊断率,避免误诊。

Objective：To discuss the characteristics of malignant melanoma through the fine needle aspiration cytology （FNAC） ;to promote diagnostic accuracies and avoid misdiagnoses. Method： The methods include retro spectively analyzing the changes after FNAC and collecting cinical datum from 38 cases of malignant melanoma proved by pathologic histology,with part cases stained by immunocytochemistry. Result： In 38 cases of malignant melanoma proved by pathologic histology, 20 are primary focuses , 18 are metastases. 32 cases are accurately diagnosed by FNAC,3 are dubious,3 of lymph node metastasis of adenocareinoma. Most cases（29） are epithelium type by FNAC,8 of fusiform cell type, 1 of mixed type. Therein ,28 cases are malanotic melanoma, 10 are amelanotic melanoma. Conclusion： FNAC is useful to diagnose the melanotic malignant melanoma,however amelanotic malig nant melanoma still could be misdiagnosed. So detailed histories, morphological characteristics under microscope ang staining by immunocytochemistry are indispensable to promote diagnostic accuracies and avoid misdiagnoses.