头颈部恶性黑色素瘤的临床及病理研究

Clinical and pathological characteristics of head and neck malignant melanoma

目的 研究头颈部恶性黑色素瘤的临床 ,病理及免疫组织化学特征 ,以提高临床和病理诊断率。方法 收集头颈部恶性黑色素瘤 (除脉络膜外 ) 6 8例 ,其中原发于鼻腔和口腔黏膜 33例 ,头颈部皮肤 35例。发病高峰年龄为 41～ 6 0岁。 5 2例为手术切除标本 ,16例为活检 (咬取、切除 )标本。复习所有患者的临床及病理资料 ,并对 42例进行S 10 0、HMB45和NSE免疫组织化学观察。结果 在6 8例中 ,手术切除者 5 2例 ,其中有 13例行补充放疗 ,2 1例进行了化疗 ;单纯放疗 10例 ;拒绝治疗 6例。在获得随诊的 5 6例中 ,存活 5年以上者 12例 ,其中头颈部皮肤恶性黑色素瘤 9例 ,占 75 0 % ;鼻腔及口腔黏膜者 3例 ,占 2 5 0 %。结论 恶性黑色素瘤在组织学结构上的改变具有重要意义 ;免疫组织化学对恶性黑色素瘤诊断和鉴别诊断有重要价值 ;发生于鼻腔和口腔黏膜的恶性黑色素瘤的预后明显比发生在头颈部皮肤的差。

Objective To investigate the clinical and pathogical characteristics of head and neck malignant melanoma. Methods Sixty eight cases of head and neck malignant melanoma were reviewed. There were 33 patients with melanoma in the nasal cavity and oral cavity, 35 patients with melanoma in the skin. The age fastigium of the patients was from 41 to 60 years. Surgical specimens in 52 cases and biopsy specimens in 16 cases were studied pathologically. S 100, HMB45 and NSE were examined immunohistochemically.Results Histopathology studies showed that the cell mosphology was pleomophic as well as polymorphic both in shape and size of the cells. Immunohistochemical studies helped diagnosis as all of the 42 melonoma specimens were positure for S 100 and 90.5% positive for HMB45. In 52 of the 68 cases, the tumor was excised surgically, with additional radiotherapy in 13 cases or chemotherapy in 21 cases. Ten cases were treated with radiotherapy alone. In 56 patients followed up, 12 survived for 5 years, including 9 cases of skin melanoma and 3 cases of nasal and oral melanoma.Conclusion The histo pathological features of malignant melanoma vary significally. Immunohistochemical staining helps diagnosis and differential diagnosis.The prognosis of malignant melanoma in nasal cavity and oral cavity is poor as compared to that in the skin of head and neck region.