原发性食管恶性黑色素瘤的CT表现及临床病理分析

Clinicopathological characteristics and CT findings of primary malignant melanoma of the esophagus

目的:探讨原发性食管恶性黑色素瘤(primary malignant melanoma of the esophagus,PMME)的计算机断层扫描(computer tomography,CT)表现及临床病理特点。方法:回顾分析经手术病理证实的5例PMME患者CT表现和临床病理特征,并复习文献。结果:5例患者的PMME均位于食管中下段,CT显示病变呈不规则结节或肿块状突向管腔内,其上下径大于横径,病变区食管壁不均匀增厚,而病变对侧食管壁正常,肿块有中至重度不均匀或均匀强化。病理检查结果显示,5例均为蕈伞型,表面粗糙,3例呈暗褐色,4例表面可见糜烂;光镜下见瘤细胞形态多样,以梭形或圆形多见,细胞质丰富,核仁较大,核分裂象多见,4例见黑色素颗粒;免疫组织化学染色结果显示,肿瘤细胞S-100、HMB-45和Melan-A阳性表达。结论:PMME罕见,临床表现无特异性,CT表现虽有一些特征,但确诊需依靠病理检查。

Objective:To study the clinicopathological characteristics and computer tomography(CT) features of primary malignant melanoma of the esophagus(PMME). Methods:Clinicopathological characteristics and CT findings of 5 cases of PMME confirmed by surgical pathology were retrospectively analyzed,and available literatures were reviewed. Results:The PMME of the 5 patients were all located in the middle and lower esophagus. CT scanning showed that the lesions were irregular nodules or masses protruding into the lumen,and the upper and lower diameters were greater than the transverse diameters. The esophageal wall was not uniformly thickened in the lesion area,while the esophageal wall on the opposite side of the lesion was normal. The masses were inhomogeneous or uniformly enhanced in moderate to severe. Pathological examination showed that 5 cases were fungating type with rough surface,3 cases were dark brown,and 4 cases showed surface erosion. Under light microscope,the tumor cells were in various forms,mostly spindle or round,with voluminous cytoplasm,large nucleolus and common mitosis. Melanin granules were observed in 4 cases. Immunohistochemistry of tumor cells showed positive in S-100,HMB-45 and Melan-A. Conclusion:PMME is rare and has no specific clinical manifestations. Although CT findings have some features,the diagnosis still depends on pathological examination.