肛管直肠原发性恶性黑色素瘤临床病理分析  

Clinical and pathologic features of primary malignant melanoma in anorectum

作　　者：唐涛[1] 关剑[1] 王刚[1] 肖兰[1] 王莉[1] 

机构地区：[1]天津市人民医院病理科,天津300121

出　　处：《临床与实验病理学杂志》2008年第2期225-229,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨肛管直肠原发性恶性黑色素瘤的临床表现、手术方式、病理特征、免疫组化特点及误诊原因。方法分析13例肛管直肠原发性恶性黑色素瘤的临床及病理资料,所有标本均行HE及免疫组织化学染色,免疫组织化学采用SP法。结果本组男4例,女9例,平均年龄56.5岁。主要临床症状为排便习惯改变、便血、肛门口脱出肿物、肛门坠胀和肛周疼痛。临床误诊率为100%。肿物距肛缘1-4cm,肉眼呈结节状、息肉状、菜花状、溃疡型及平坦型,镜下形态多样,以上皮细胞及梭形细胞为主,11例检见黑色素颗粒。结论肛管直肠原发性恶性黑色素瘤是一种相对少见、恶性度极高的肿瘤,临床误诊率高,病理活检难以准确分型,S-100、HMB-45免疫组织化学染色有助于诊断,且特异性高,特别是对于无色素者。Purpose To investigate the clinical manifestations, surgical methods, pathological and features, and misdiagnosis reasons of anorectal primary malignant melanoma. Methods The clinicopathological data were analyzed in 13 cases of anorectal primary malignant melanoma. HE and immunohistoehemical stain （SP method） were used in all cases. Results In this group, 4 were males and 9 were females. Their average age was 56. 5 years. The main presenting symptoms were changed defecation habit, bloody stool and visible or palpable mass in the anus, straining and pain around the anus. The rate of clinical misdiagnosis was 100%. There was 1 -4 cm distance from tumor to anus region. Grossly, the tumors appeared nodular, polypoid, cauliflower-like, ulcerated or flat in shape. Histological studies revealed that the tumors were pleomorphic but mainly epithelial or spindle cells. However, melanin granules were observed within the tumor cells in 11 cases. Conclusion Anorectal malignant melanoma is a rare and highly malignant tumor. It is easily misdiagnosed in clinical practice and it is difficult to classify the tumor based mainly on biopsy. The neoplastic cells are positive for S-100 protein and HMB-45, which is significant for pathological diagnosis, especially in the cases without melanin granules.

关 键 词：肛管直肠肿瘤 恶性黑色素瘤 误诊 临床病理 免疫组织化学 

分 类 号：R735.3[医药卫生—肿瘤]