鼻腔黏膜恶性黑色素瘤的临床病理特征分析

CLINICOPATHOLOGICAL FEATURES OF MUCOSAL MALIGNANT MELANOMA OF NASAL CAVITY

目的探讨鼻腔黏膜恶性黑色素瘤的临床病理特征,提高其诊断水平。方法收集6例鼻腔黏膜恶性黑色素瘤病人的临床病理资料,对其临床病理特点进行分析。结果 6例肿瘤细胞镜下形态多样,其中上皮细胞型3例,梭形细胞型2例,混合型1例。组织病理学特点:肿瘤由上皮样、梭形、卵圆形、多角形及未分化小细胞等多种类型的细胞构成;瘤细胞核仁大而清楚、嗜酸性,胞浆内或者细胞间可见或多或少的黑色素;肿瘤血窦丰富。6例恶性黑色素瘤肿瘤细胞LCA、CK、EMA、Myogenin、CD99、NSE和Syn皆呈阴性表达或者局灶弱阳性表达,Vimentin、S-100和HMB45均呈阳性表达;5例肿瘤细胞MelanA呈阳性表达;Ki67增殖指数平均约50%。结论鼻腔黏膜恶性黑色素瘤镜下形态多样,病理确诊需要综合组织病理学特征及多项免疫组织化学指标,并需与多种肿瘤进行鉴别诊断。

Objective To investigate the clinicopathological characteristics of mucosal malignant melanoma of nasal cavity and to improve its diagnosis. Methods A retrospective analysis was performed on the clinicopathological features of 6patients with mucosal malignant melanoma of nasal cavity. Results The histopathological structures and morphological characteristics of mucosal malignant melanoma of nasal cavity were complex.The tumors were composed of different types of cells,including epithelioid cell type,spindle cell type,oval cell type,polygonal cell type,undifferentiated small cell type,and so on.Of the 6melanomas,3were epithelioid cell type,2were spindle cell type,and 1was mixed cell type.The nuclei of tumor cells were large,clear,and eosinophilic.There was more or less melanin in the intracytoplasmic or intracellular area and abundant sinusoids were observed in the tumors.The immunohistochemistry results showed that all the 6malignant melanomas showed negative expression of leukocyte common antigen,creatine kinase,epithelial membrane antigen,Myogenin,CD99,neuron-specific enolase,and synaptophysin or weakly positive expression of them in local lesions and had positive expression of Vimentin,S-100,and HMB45.There were 5cases positive for MelanA and the mean Ki67 proliferation index was about 50%. Conclusion Mucosal malignant melanoma of nasal cavity has a variety of morphological features.Its pathological diagnosis needs to be supported by histopathological features and many immunohistochemical markers,and it needs to be differentiated from other tumors of nasal cavity.