腋窝转移性恶性黑色素瘤七例临床病理及误诊分析

Clinical and Pathological Misdiagnosis Analysis of 7 Cases of Axillary Metastatic Malignant Melanoma

目的探讨腋窝转移性恶性黑色素瘤(malignant melanoma,MM)的临床病理学特点,以减少误诊误治。方法回顾性分析7例腋窝转移性MM的临床及病理资料。结果 7例平均年龄为60.1岁,均因腋下肿物就诊,仅两例术前确诊,5例误诊为恶性淋巴瘤、梭形细胞肉瘤、恶性外周神经鞘膜瘤、肺癌、神经纤维肉瘤,均经追问病史和单纯根治性手术后病理免疫组化确诊,S-100均阳性,两例HMB-45阳性。术后3例失访,1例死亡。结论腋窝转移性MM临床表现无特异性,肿瘤细胞形态复杂多样,极易误诊,病理和临床医师在诊断时应想到该病的可能,需仔细询问病史和细致行体格检查,病理诊断应结合免疫组化、特殊染色或电镜检查。

Objective To investigate the clinical and pathological characteristics of axillary metastatic malignant melanoma,and improve correct diagnosis rate of the disease. Methods Clinical and pathological data of 7 cases of axillary malignant melanoma were analysed retrospectively. Results The average age of the 7 cases was 60. 1 years old. Only two cases were diagnosed correctly,and the other five cases were misdiagnosed as lymphoma,spindle cell sarcoma,malignant peripheral nerve sheath tumor,lung carcinoma,and Malignant neurofibrosarcoma. The 7 patients underwent radical surgery,and then were diagnosed by pathology and immunohistochemistry. S-100 protein was positive in all the cases,HMB-45 was positive in 2cases. After surgical operation,3 patients lost follow-up,and 1 died. Conclusion There are no special and typical clinical features of axillary malignant melanomas. The tumor cells are very complex and diverse. So they may be easily misdiagnosed.Pathological and clinical physicians should be aware of the possibility of the disease in the diagnosis,and should carefully asked about the history of the case and perform physical examinations. Pathological diagnosis should be made with the help of immunohistochemistry,special staining or electron microscopy.