肢端雀斑样黑色素瘤27例临床病理分析  

Acral-lentiginous melanoma: a clinicopathological analysis of 27 cases

作　　者：徐新运[1] 王益华[1] 

机构地区：[1]南京大学医学院附属鼓楼医院病理科,南京210008

出　　处：《临床与实验病理学杂志》2013年第10期1105-1108,共4页Chinese Journal of Clinical and Experimental Pathology

基　　金：南京市医学科技发展项目(YKK09120)

摘　　要：目的探讨肢端雀斑样黑色素瘤(acral-lentiginous melanoma,ALM)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EnVision两步法对27例ALM进行染色,并复习相关文献。结果 27例患者中男性17例,女性10例,年龄40～82岁,平均年龄65岁,男女比为1.7∶1。病变位于足端23例,手端4例,肿块直径0.2～8 cm。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:肿瘤细胞S-100、HMB-45、Melan-A、BCL-2、Nodal和cyclin D1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,是黄种人与黑种人最常见的黑色素瘤类型,高峰发病年龄70～80岁。ALM确诊依靠病理检查。Purpose To review the literature and to explore the morphological features, histogenesis, diagnosis and differential diagno- sis, therapy and prognosis of the acral-lentiginous melanoma （ALM）. Methods 27 cases of ALM were studied by using paraffin sec- tion, HE staining, and immunohischemistrical method （EnVision method）. Results The age distribution of those 17 male and 10 fe- male, patients was from 40 to 82 years, with mean of 65 years. The male to female ratio was 1.7 ： 1. The lesions of 23 cases were lo- cated in the foot and 4 cases in the hand. The diameter of lesions was 0. 2 em to 8 cm. In the radial growth phase, the lesions were characterized by marked lentiginous proliferation of atypical melanocytes along the basal epidermis. In the vertical growth phase, atypi- cal melanocytes extended into the deep dermis. Usually the tumour cells were characterized by large, often bizarre nuclei and nucleoli, and cytoplasm filled with melanin granules. By immunohistochemical stain, the turnout cells were positive for S-100, HMB-45, Melan- A, BCL-2, Nodal and cyclin D1, but negative for CK, SMA, CD45, and desmin. Conclusion ALM is defined as a melanoma loca- ted on the non-hair bearing skin of the palms and soles or under the nails, which is the most common type of melanoma in darkskinned peoples and Asians. Overall, the peak age of ALM is 70 ~ 80 years. The clinical and histopathologieal features of this group patients are consistent with literatures. Definate diagnosis of ALM can be made with patholologic examination.

关 键 词：黑色素瘤 肢端 临床病理 免疫组织化学 

分 类 号：R739.5[医药卫生—肿瘤]