原发性鼻黏膜恶性黑色素瘤17例临床病理分析  

Primary mucosal melanoma of the nasal cavity: a linicopathological analysis of 17 cases

作　　者：刘雯[1] 曾智[1] 周亨[1] 吴昊[1] 袁静萍[1] 

机构地区：[1]武汉大学人民医院病理科,武汉430060

出　　处：《临床与实验病理学杂志》2017年第2期169-173,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金(81602535)

摘　　要：目的探讨原发性鼻黏膜恶性黑色素瘤(primary mucosal melanoma of the nasal cavity,PMMNC)的临床病理学特征及鉴别诊断。方法回顾性分析17例PMMNC的临床病理学及免疫表型特征,并复习相关文献。结果 73%PMMNC患者表现为单侧鼻塞和间歇性鼻出血,61%发生于鼻中隔和鼻侧壁。镜检:组织结构及病理形态复杂多样,其中6例(35.3%)主要为上皮样细胞型,3例(17.6%)主要为梭形细胞型,5例(29.4%)主要为小细胞型,其他3例(17.6%)为三种细胞混合存在。肿瘤细胞内可见较多坏死和核分裂象,纤维间质少,血管丰富,可有色素沉着。免疫表型:16例行免疫组化标记,S-100和HMB-45阳性率为93.8%,Melan-A和vimentin阳性率为87.5%,CK和EMA均阴性。结论 PMMNC临床罕见,免疫组化标记MelanA、S-100、HMB-45、vimentin可辅助诊断。Purpose To study the clinicopathologic features and differential diagnosis of primary mucosal melanoma of the nasal cavity （PMMNC）. Methods 17 cases of PMMNC diagnosed from January 2003 to September 2016 were studied by clinical pathological analysis and immunohistochemical staining, and relevant literatures were reviewed. Results 73% of the PMMNC was characterized by unilateral nasal congestion and intermittent epistaxis and 61% of the PMMNC occurred in the nasal septum and nasal side wall. Microscopically, the organizational structure and morphology were complex and diverse, which had several cell types including epithelioid cell type （6 cases, 35.3%） , spindle cell type （3 cases, 17.6%） and small cell type （5 cases, 29.4% ） , the other 3 cases （ 17. 6% ） were mixed cell type. Mitotic activity and tumor necrosis were more likely to be seen in PMMNC, among other clinicopathological features with a small amount of fibrous stroma and melanoma and rich blood vessels. The immunohistochemical study showed that the positive rate of S-100 and HMB-45 were both 93.8% （15 cases） and those of Melan-A and vimentin were both 87.5% （ 14 cases） , while CK and EMA were both negative （ 16 cases）. Conclusion PMMNC is a rare disease and the phenotype of S-100, HMB-45, Melan-A and vimentin are useful for diagnosis of PMMNC.

关 键 词：鼻肿瘤 原发性鼻黏膜恶性黑色素瘤 临床病理 鉴别诊断 

分 类 号：R739.62[医药卫生—肿瘤]