恶性黑色素瘤57例临床病理分析

Clinical pathologic analysis of 57 cases of malignant melanoma

目的探讨恶性黑色素瘤的临床病理特征。方法对57例恶性黑色素瘤的临床病理资料进行回顾性分析。结果(1)组织学类型检测:上皮细胞为主型33例,占57.89%;梭形细胞为主型16例,占28.07%;混合细胞型8例,占14.04%。(2)免疫组织化学检测:人黑色素瘤标记物45(human melanoma marker 45,HMB45)阳性53例,占92.98%;S-100蛋白阳性55例,占96.49%;波形蛋白(vimentin)阳性52例,占91.23%;Ki-67阳性57例,占100%;上皮膜抗原(epithelial membrane antigen,EMA)阳性3例,占5.26%;细胞角蛋白(cytokeratin,CK)阳性5例,占8.77%;白细胞共同抗原(leukocyte common antigen,LCA)、平滑肌肌动蛋白(smooth muscle actin,SMA)以及结蛋白(desmin)均阴性表达。(3)发生部位:下肢24例(其中足部19例),躯干7例,头颈部9例,上肢7例,黏膜部位10例。(4)术前诊断:色素痣25例,恶性黑色素瘤13例,待查19例。结论恶性黑色素瘤恶性度高,好发于四肢,细胞形态及组织学结构多样,免疫组织化学对恶性黑色素瘤的诊断和鉴别诊断具有重要价值。

Objective To investigate the clinical pathological features of malignant melanoma. Methods A retrospective a-nalysis was made of the medical data of the 57 cases of malignant melanoma. Results （ 1） Concerning histological types, there were 33 cases with epithelial cells as the main the type, accounting for 57. 89% ; there were 16 cases with spindle cells as the main the type, accounting for 28. 07% , and there were 8 cases with hybrid cells as the main the type, accounting for 14.04%. （2） Concerning immu- nohistochemistry tests, there were 53 positive cases of Human melanoma marker 45（ HMB45） , accounting for 92. 98% ; there were 55 positive cases of S-100, accounting for 96.49% ; there were 52 positive cases of Vimentin, accounting for 91.23% ; there were 57 posi-tive cases of Ki-67, accounting for 100% ; there were 3 positive cases of epithelial membrane antigen（EMA） , accounting for 5.26% ; and there were 5 positive cases of Cytokeratin（ CK） , accounting for 8. 11%. However, no expressions of leukocyte common antigen （LCA） , smooth muscle actin（SMA） and desmin could be detected. （3） As for the site of affection, there were 24 cases of malignant melanoma at lower limbs, of which 19 cases were at the foot; there were 7 cases at trunk; 9 cases at neck and another 7 cases at the up-per limbs; and 10 cases at mucosa. （4） With regard to pre-surgical diagnosis, there were 25 cases of pigmented nevus, 13 cases of ma-lignant melanoma and 19 cases to be further confirmed. Conclusion Malignant melanoma was highly heterogenous and commonly oc-curred at limbs, and its cellular morphology and histological structure were complex. Immunohistochemistry was of important value in the diagnosis and identification of malignant melanoma.