鼻腔鼻窦恶性黑色素瘤临床病理分析  

Clinopahological analysis of sinonasal mucosal malignant melanoma

作　　者：古庆家[1] 何刚[1] 李静娴[1] 樊建刚[1] 李德炳[1] 赵李冰[1] 宋林红[2] 

机构地区：[1]四川省人民医院耳鼻咽喉科,成都610072 [2]四川省人民医院病理科,成都610072

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第19期1508-1510,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨鼻腔鼻窦恶性黑色素瘤（SMMM）的临床病理特点、鉴别诊断、治疗与预后。方法：回顾性分析有完整随访资料的18例SMMM的临床病理资料。全部患者均行手术治疗,其中单纯手术5例,手术联合术后放疗4例,手术联合术后化疗4例,手术联合术后化、放疗5例。术后均进行1-7年随访。结果：12例死于肿瘤复发或远处转移,6例存活。6例术后复发;5例术后出现颈淋巴结转移,其中3例行颈淋巴结清扫术,2例因无手术指征而行放、化疗。3例出现远处转移,肝、肺、脑转移各1例。结论：SMMM临床少见,恶性度高,尚需结合免疫组织化学与多种肿瘤进行鉴别。CT及MRI影像学检查有助于了解病变范围及性质。鼻内镜下或鼻内镜辅助下手术切除SMMM,疗效确切,但必须严格选择适应证。Objective：To investigate the clinopathological characteristics,differential diagnosis,therapy and prognosis of sinonasal mucosal malignant melanoma.Method：Clinopathological data of 18 cases which were diagnosed by pathology and immmunohistochemistry were analyzed retrospectively.All cases were proved by pathology and immmunohistochemistry.All cases were performed operations.5underwent single surgery.4underwent surgery plus adjuvant radiotherapy.4underwent surgery plus adjuvant radiotherapy chemotherapy.5underwent surgery plus adjuvant chemoradiation.Result：All cases were followed up for a period of 1to 7years after operation.Twelve patients died of tumor until the last follow-up,meanwhile 6patients stayed alive.In Six casesrecurrence occurred.In five casescervical lymph node metastasis occurred,of which 3cases received neck dissection and2 cases received chemotherapy and radiotherapy due to no surgical indications.In three cases distant metastasis occurred.Conclusion：Sinonasal mucosal malignant melanoma is rare and highly heterogenous.Current diagnosis depends on clinical characteristics and immunohistochemical examination.It still should be differentially diagnosed from other tumors.CT and MRI image examination can provide some helpful information to understand the extent and nature of lesions.The treatment of nasal endoscopic or the surgery under endoscopy has become to be a safe,viable and reasonable alternative to open resection.Appropriate indication must be carefully selected for these lesions.

关 键 词：鼻窦肿瘤 恶性黑色素瘤 免疫组织化学 鼻内镜手术 

分 类 号：R739.5[医药卫生—肿瘤]