直肠亲神经性-促纤维增生性恶性黑色素瘤临床病理分析  

作　　者：徐永辉[1] 马爱玲[1] 翟学峰[1] 

机构地区：[1]宁夏医科大学附属医院病理科,750004

出　　处：《当代医学》2013年第7期21-23,共3页Contemporary Medicine

摘　　要：目的探讨直肠的亲神经性-促纤维增生性恶性黑色素瘤的临床病理特征、免疫表型及其鉴别诊断。方法对1例直肠的亲神经性-促纤维增生性恶性黑色素瘤进行光镜和免疫组化检测。结果组织学上,肿瘤主要有排列致密的梭形细胞和上皮样细胞构成,梭形细胞呈栅栏状,细胞异型性明显,部分区域梭形细胞间可见胶原纤维增生,上皮样细胞体积较大,呈卵圆形、多角形,胞浆丰富,核分裂像多见。免疫组化Vimentin、NSE梭形细胞阳性,HMB45、Melan-A上皮样细胞局灶阳性,S-100梭形细胞及上皮样细胞均强阳性,CD68局灶阳性,CD117、AE1/AE3、34βE12均阴性,Ki-67指数40%～50%。结论直肠的亲神经性-促纤维增生性恶性黑色素瘤是恶性黑色素瘤的一种少见的特殊类型,形态学非常类似于胃肠间质瘤和恶性外周神经鞘瘤等病,极易误诊,免疫组化可有助于正确诊断。Objective To explore the clinicopathological features, diagnosis and differential diagnosis of rectal desmoplastic neurotropic melanoma. Methods 1 cases of rectal desmopIastic neurotropic melanoma were observed and analyzed by means of hematoxylin-eosin and immunohistochemical staining. Results Histologically, the tumor is composed of spindle cells and epithelioid cells. Spindle cells a large, palisaded, abviously cytological atypia, some tumor show a desmoplastic stroma surrounding the spindle cells. Epithelioid ceils is big, oval vesicular polygonal, abundant cytoplasm, numerous mitotic figures. Immunohistochemically, the spindle cells were positive for Vimentin and NSE; the epithelioid cells were locally positive for HMB45 and Melan-A; S-100 were strongly positive in both spindle cells and epithelioid cells; CD68 were locally positive, CD 117, AE 1/AE3, 34 13E 12 were negative the proliferative index with MIB was 40%-50%. Conclusion Rectum desmoplastic neurotropic melanoma is a rare type of maligant melanoma. It is easily confused with lesions of Gastrointestinal Stromal tunours and malignant peripheral nerve sheath tumor, the differential diagnosis can helped by immunohistochemical staining.

关 键 词：直肠 亲神经性-促纤维增生性恶性黑色素瘤 病理诊断 免疫组化 鉴别诊断 

分 类 号：R735.3[医药卫生—肿瘤]