肢端雀斑样黑色素瘤10例临床病理分析

Pathological analysis of 10 cases with acrallentiginous melanoma

目的探讨肢端雀斑样黑色素瘤的病理形态学特征、组织发生、诊断及鉴别诊断、治疗及预后等。方法采用HE及免疫组化SP法对10例ALM进行染色,并复习相关文献。结果在水平生长期异形的黑色素细胞位于表皮基底层,进展期则浸润真皮深部。通常肿瘤细胞核大、可见核仁,染色质较粗,胞质嗜酸性,其内可见黑色素颗粒。免疫表型:HMB45、Melan-A、S-100、CK、Ki67均呈强阳性。结论 ALM主要见于无毛发被覆的肢端部位,如手掌、足底和甲下区,是黄种人与黑种人较常见的黑色素瘤类型。ALM确诊依靠病理检查。

Objective To explore the pathomorphological features,histogenesis,diagnosis,differential diagnosis,therapy and prognosis of acrallentiginous melanoma （ALM）.Methods Specimens were obtained from all ALM patients and made into paraffin section.Specimens were stained with HE using the immunohistochemical SP method and the relevant literature was reviewed.Results Among the 10 patients,7were males and 3 were females,ranging in age from 40 to 82 years,with an average age of 65 years.Eight of the lesions occurred in the foot and two in the hand.The diameter of the tumors was from 0.7 cm to 5.0 cm.The heteromorphic melanocyte located in the basal layer of the epidermis in the horizontal growth phase and infiltrated the deep dermis in the vertical growth phase.Generally,the nucleus of the tumor cells was large,nucleolus was visible,chromatin was coarse,the cytoplasm was eosinophilic and filled with melanin granules.The immunophenotype HMB-45,Melan-A,S-100,CK and Ki67 appeared strongly positive.Conclusion ALM mainly occurred in the non-hair-covered extremities,such as palms,soles and the subungual region.It is the most common type of melanoma in the black and Asian populations.Definitived iagnosis of ALM relied on pathological examination.