鼻腔恶性黑色素瘤的光镜、电镜及免疫组化研究

Light and electron microscopy and immunohistochemical studies of Malignant Melanoma of the Nasal Cavity

目的探讨鼻腔恶性黑色素瘤的临床病理、免疫组化和超微结构特点。方法对32例鼻腔黑色素瘤进行临床和病理（HE染色、免疫组织化学染色和电镜）资料观察。结果临床症状为进行性鼻塞和或鼻衄，6例伴有轻重不等的头痛。12例临床诊断为鼻息肉、鼻窦炎，16例诊断为鼻肿瘤。4例诊断为恶性黑色素瘤。治疗为手术加放、化疗综合手段。生存时间为3-65个月。组织学特征为：黑色素瘤组织结构既有象癌的组织像，又有似肉瘤的组织像，肿瘤细胞大小不一，形态多样，部分病例瘤细胞内外可见粗大的黑色素颗粒。4例电镜检查各种瘤细胞胞浆内均可见数量不等的圆形或椭圆形黑色素小体。免疫组化阳性率分别为HMB4590．6％、S-100100％、Vim71．9％、CK21．1、％、EMA8.3％。LCA反Acfin不表达。结论鼻腔性黑色素瘤是一种少见的肿瘤，其生存期短。恶性度高。根据其组织学特点。结合免疫组化染色及电镜下特征，可以作出明确的病理诊断。

Objective To investigate the clinicopathologic, ultrastrutural features of malignant melanoma of the nasal cavity Thirty two cases of tumor were studied with clinicopathological analysis, HE staining,immunohistechemical staining, electron microscopy. Results Progressive nasal obstruction or/and epistaxis were the common clinical symptoms, and 6 cases had light to heavy unequal headache. 12 patients were clinical diagnosticated as rhinopolypus, nasosinusitis and 16 patients as nasal oncosis, for patients as malignant melanoma. Rhinorrhagia necrotic polyps associated with nasosinusitis. The live time were 3 months to 65 months through operation and radiochemotherapy. Histological features as follows： melanoma, both the organizational structure of the organization such as cancer, like, another might like the organization of sarcoma, the tumor cells of different sizes, shape varied, some patients can be seen inside and outside the tumor cells thick melanin granules.4 cases electron microscopy the cytoplasm of a variety of tumor cells were seen, ranging from the number of round or oval-shaped body melanoma. Immunohistochemical positive rates were HMB4590.6%,S-100100%,Vim71.9%,CK21.1%,EMA8.3%,LCA and Actin did not express. Conclusion It was a rare tumor with poor live span and high grade of the nasal cavity melanoma. According to their histological features, combined with immunohistochemical staining and electron microscopy features, you can make a definitive pathological diagnosis.