中枢神经系统黑色素瘤的诊治

Diagnosis and treatment of central nervous system melanoma

目的总结中枢神经系统黑色素瘤的临床特征及诊治经验。方法回顾性分析6例中枢神经系统黑色素瘤病人的临床资料,肿瘤位于颈椎椎管内1例,颅后窝1例,大脑半球4例。临床表现依据肿瘤所在位置而不同,临床症状、体征无特异性。术前影像学误诊率达67%。结果手术治疗5例,其中显微镜下全切除4例,次全切除1例;放射治疗1例。5例行病理检查显示:恶性黑色素瘤3例,良性2例。随访5例,3例恶性黑色素瘤病人死亡,2例良性黑色素瘤病人存活。结论原发于中枢神经系统的恶性黑色素瘤及转移性黑色素瘤预后差,应在手术基础上采取综合治疗;而良性黑色素瘤应尽可能全切,术后预后良好。

Objective To summarize the clinical features and diagnostic and therapeutic approaches of melanoma in the central nervous system.Methods Clinical data of 6 patients with melanoma in the central nervous system were analyzed retrospectively.The tumor located in the spinal canal of the cervical vertebra in 1 case,posterior cranial fossa in 1 and cerebral hemisphere in 4.There were no specific symptoms and signs in patients with melanoma,and the clinical situation changed according to the location of the tumors.The preoperative misdiagnosis rate reached 67% by imaging examinations.Results The tumor was treated by surgery in 5 cases,including total resection in 4 and subtotal resection in 1,and radiotherapy was performed in 1 case.Five tumors were confirmed as malignant melanoma in 3 and carcinoid melanoma in 2 according to pathological examination.Five patients were followed up,and 3 with malignant melanoma died,and 2 with carcinoid melanoma were alive.Conclusions The prognosis of primary malignant melanoma in the central nervous system and metastatic melanoma is poor,and the tumor should be removed firstly,then be treated with comprehensive therapy.However,the carcinoid melanoma should be resected completely as far as possible because its prognosis is good after the complete resection.