颅内恶性黑色素瘤的诊断和治疗:15例报告

Diagnosis and treatment of intracranial malignant melanoma: a report of 15 cases

目的颅内黑色素瘤发病率较低,手术是治疗的主要方法,本文探讨颅内黑色素瘤的诊断与治疗与预后。方法回顾性分析15例临床病理诊断为颅内黑色素瘤的病例,所有患者均进行手术治疗,根据其影像学、病理与预后进行分析。结果颅内黑色素瘤的临床表现以占位效应、癫痫与局灶神经症状为主,CT与MRI表现多样,MRI典型表现只有5例,上皮样细胞是病理的主要类型共13例,溶解蛋白(S-100)的敏感性与人黑色素相关抗原(HMB-45)的特异性结合可以对诊断有所帮助。原发性颅内黑色素瘤患者平均生存期为12个月,继发性颅内黑色素瘤平均生存期为5个月。结论颅内黑色素瘤的临床表现缺乏特异性,手术大体所见与病理是确诊的主要手段,但患者总体预后较差,继发性颅内黑色素瘤较原发性颅内黑色素瘤更差。

Objective The diagnosis,treatment and prognosis of intracranial malignant melanoma are discussed.Methods A total of 15 cases of intracranial malignant melanoma were diagnosed by pathologcial examination underwent operation and all the cases were analyzed retrospectively based on the radiology,pathology and prognosis.Results Major manifestations of intracranial malignant melanoma were mass effect,epilepsy and local symptoms.Various signal profiles were found in CT and MRI scan,only 5 cases were typical in MRI scan.Epithelioid cells which found in 13 cases were common in pathologic diagnosis.Sensitivity of soluble protein-100 （S-100） and specifically bind to human melanoma-associated antigen （HMB-45） were helpful for diagnosis.Mean survival time of primary intracranial malignant melanoma was 12 months,while that of secondary intracranial malignant was 5 months.Conclusion The clinical manifestations of intracranial malignant melanoma lack of specificity,and most diagnosis depends on surgical findings and tissue pathology.The prognosis of intracranial malignant melanomas is poor,even worse in secondary cases.