胃转移性恶性黑色素瘤1例

Metastatic malignant melanoma of the stomach:a case report and literature review

目的:探讨胃转移性恶性黑色素瘤的临床病理特征、鉴别诊断及治疗与预后.方法:报道1例胃转移性恶性黑色素瘤,取胃活检经HE染色及免疫组织化学染色诊断.并复习国内外相关文献.结果:活检组织切片光镜下见胃黏膜固有层弥漫浸润的小细胞,部分呈巢状排列,细胞胞质较丰富,核偏位,核仁大而明显,仅少部分细胞的胞质内可见黑色素颗粒.免疫组织化学染色显示vimentin(+),S-100(+),HMB45(+),AE1/AE3(-).病理诊断为胃(底、体交界)恶性黑色素瘤,结合病史考虑为转移性.结论:恶性黑色素瘤转移到胃时没有典型临床表现,若出现与原发肿瘤不相关的症状,要高度怀疑转移.主要与胃原发性肿瘤鉴别.预后差.对远处转移的最初部位为胃的患者,进行根治性手术能有效缓解症状,并可能对延长生存期有帮助.

AIM：To investigate the clinicopathologic characteristics, differential diagnosis, treatment and prognosis of metastatic malignant melanoma of the stomach.METHODS：We reported a case of metastatic malignant melanoma of the stomach that was diagnosed by HE and immunohistochemistry staining.A literature review was also performed to summarize the clinicopathologic characteris tics, diagnosis, treatment and prognosis of the disease.RESULTS：Microscopic examination of the biopsy specimen revealed that a number of small cells, some of which were organized in nests, were scattered in gastric lamina propria.These neoplastic cells had relatively rich cytoplasm, eccentric nucleus and large and clear nucleolus.Few of these cells had melanin granules in the cytoplasm.Immunohistochemistry analysis showed that these neoplastic cells were positive for vimentin, S-100 and HMB45, but negative for AE1/AE3.The patient was finally diagnosed with metastatic malignant melanoma of the stomach at the borderline between the fundus and body.CONCLUSION：Metastatic malignant mela-noma of the stomach has no typical symptoms.A high index of suspicion for metastasis must be maintained when patients with a history of melanoma present with seemingly unrelated symptoms.The metastatic malignant melanoma of the stomach should mainly be distinguished from primary neoplasms of the stomach.The prognosis of metastatic malignant melanoma of the stomach is poor.A complete resection can be effective for palliation and may result in long-term survival in patients whose stomach is the initial site of distant metastases.