女性原发性生殖道恶性黑色素瘤的临床病理特征及预后分析

Clinicopathologic features and prognosis of primary malignant melanoma of female genital tract

目的:探讨女性原发性生殖道恶性黑色素瘤的临床病理特点及鉴别诊断,分析影响预后的因素。方法:收集女性原发性生殖道恶性黑色素瘤21例,观察其临床病理特点,进行免疫组织化学染色,并用寿命表分析法和Kaplan-Meier法分析影响预后的因素。结果:免疫组化结果显示,S-100、HMB45、Melan-A和Vim均呈阳性表达。预后分析显示,中位生存时间为42个月,5年生存率为24%。外阴、阴道和宫颈恶性黑色素瘤患者的中位生存时间分别为43、60和34个月。外阴恶性黑色素瘤患者单纯手术治疗的生存时间长于手术加其他辅助治疗或单纯辅助治疗,差异有统计学意义,χ2=11.592,P=0.003;阴道恶性黑色素瘤患者手术加其他辅助治疗的生存时间长于单纯手术治疗或单纯辅助治疗,差异有统计学意义,χ2=10.368,P=0.006。Ⅰ、Ⅱ和Ⅲ期患者平均生存时间分别为88、53和27个月,Ⅰ期患者的生存时间长于Ⅲ期患者,差异有统计学意义,χ2=4.947,P=0.026。原发肿瘤部位、肿瘤大小、复发及转移与生存时间无相关性,P>0.05。结论:女性原发性生殖道恶性黑色素瘤恶性程度高,预后差。S-100、HMB45、Me-lan-A和Vim联合标记可提高诊断恶性黑色素瘤的准确率。

OBJECTIVE：To investigate the clinicopathologic features,differential diagnosis and prognosis of primary malignant melanoma of female genital tract.METHODS：The clinicopathologic features and immunophenotype were observed in 21 cases of primary malignant melanoma of female genital tract,all the cases were performed by survival analysis and Kaplan-Meier.RESULTS：The expression of S-100,HMB45,Melan-A and Vim were all positive.The medians survival time was 42 months and the 5-year survival rate was 24%.The median survival time of patients with malignant melanoma in vulva,vagina and cervix was 43,60 and 34 months,respectively.The vulvar malignant melanoma patients treated with surgery alone had a longer survival time than the patients treated with other adjuvant therapy alone or surgery plus adjuvant therapy （χ^2=11.592,P=0.003）.Vaginal malignant melanoma patients treated with surgery plus adjuvant therapy had a longer survival time than the patients treated with surgical treatment alone or adjuvant therapy alone （χ^2=10.368,P=0.006）.The median survival time of the patients with pathologic grade Ⅰ,Ⅱ and Ⅲ was 88,53 months and 27 months,respectively,and the patients with pathologic grade Ⅰ had a longer survival time than the patients with pathologic grade Ⅲ （χ^2=4.947,P=0.026）.The tumor site,tumor size,recurrence and metastasis were not correlated with the survival status （P〈0.05）.CONCLUSIONS：The primary malignant melanoma of female genital tract is a high malignancy tumor and its prognosis is poor.It is helpful to diagnose malignant melanoma by immunostaining of S-100,HMB45,Melan-A and Vim together.