原位恶性黑素瘤临床病理分析及鉴别诊断  

Clinical and histopathological features of malignant melanoma in situ: report of 3 cases and literature review

作　　者：吴运瑾[1] 张澜静 梁军[1] 朱旭友[1] 曾郁[1] 易祥华[1] 

机构地区：[1]同济大学附属同济医院病理科,上海200065 [2]普林斯顿医疗系统病理系,美国新泽西07450

出　　处：《同济大学学报（医学版）》2014年第2期111-115,共5页Journal of Tongji University(Medical Science)

摘　　要：目的探讨原位恶性黑素瘤（malignant melanoma in situ,MMS）的临床和病理组织学特点以及鉴别诊断。方法对3例原位黑素瘤进行临床表现、病理形态学及免疫组化检查分析,随访并复习相关文献。3例MMS均为女性,平均年龄56.7岁（53~61岁）,病程0.5~2年。甲下2例,外阴1例。结果临床检查病灶表现为大于7 mm形状不规则的色素斑,边界不清,深浅不一。病理组织学观察,见单个异型黑素细胞在表皮内的不均匀增生,部分细胞分布于表皮的中上层,可见不规则的巢状细胞团。瘤细胞核大、深染,可见核分裂,胞浆树突状,含有较粗大的色素颗粒;免疫组化S-100,HMB-45,Melan-A阳性。随访32~35个月,2例稳定,外阴MMS 2年后原位复发。结论 MMS需与交界痣、非典型性黑色素细胞痣及皮肤Paget病等鉴别,早期诊断需结合临床和病理形态特点以及免疫组织化学染色法。Objective To investigate the clinicalpathologic characteristics of malignant melanoma in situ（ MMS） and its differential diagnosis. Methods Three cases of malignant melanoma in situ（ MMS） were reported and related literatures were reviewed. All 3 patients of MMS were females with an average age of 56. 7 years（ 53 - 61 years）. The duration of symptoms or signs ranged from 0. 5 to 2 years. Tw o cases w ere subungual melanoma in situ and another one w as vulvar melanoma. Results The lesions were ＆gt; 0. 7 cm in diameter and presented as ill-defined,variably dark pigmented. Microscopically,single-melanocytic proliferation w as identified along the dermo-epidermal junction and some w as located in the middle and upper layer of the epidermis. Some tumor cells formed noncohesive nests w ith different sizes and shapes. The cells had enlarged hyperchromatic nucleui,long dendritic cytoplasm and dusty cytoplasmic melanin and w ere positive for HMB45,Melan-A and S-100 by immunohistochemistry. Occasional mitotic figures w ere present. During the follow-up of 32 ~ 35 months,tw o cases of subungual MMS w ere stable,and one case w ith vulval MMS recurred tw o years later. Conclusion MMS should be distinguished from junctional nevus,dysplastic melanocytic naevi and cutaneous Paget’s disease. The early diagnosis of MMS is based on the clinicopathologic features in combination w ith immunohistochemical staining.

关 键 词：恶性黑素瘤 原位 诊断 免疫组化 预后 

分 类 号：R730.23[医药卫生—肿瘤]