Olig2阳性的脑转移性恶性黑色素瘤临床病理观察  

Clinicopathological observation of Olig2 positive brain metastatic malignant melanoma

作　　者：饶洁[1] 陈芳芳 刘雯[1] 袁静萍[1] 何惠华[1] Rao Jie;Chen Fangfang;Liu Wen;Yuan Jingping;He Huihua(Department of Pathology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院病理科,武汉430060

出　　处：《中国组织化学与细胞化学杂志》2022年第3期279-283,共5页Chinese Journal of Histochemistry and Cytochemistry

基　　金：湖北省卫生健康科研基金资助(WJ2021M151)。

摘　　要：目的探讨Olig2弥漫强阳的脑转移性恶性黑色素瘤的临床病理学特征、免疫表型、诊断及鉴别诊断。方法应用光学显微镜及免疫组织化学方法分析1例Olig2弥漫强阳的脑转移性恶性黑色素瘤的临床病理特点及免疫表型,并总结相关文献。结果患者入院后行右额叶病损显微切除术并送病理活检,镜下见弥漫增生的异型细胞呈片状,围绕血管生长,形态相对一致,呈上皮样,肿瘤细胞圆形、卵圆形,胞质嗜酸性,核异型性明显,核仁清楚,部分区域肿瘤细胞核偏位呈横纹肌样形态,核分裂像多见,可见大片出血坏死。免疫表型:Olig-2(+)、GFAP(-)、Melan A(+)、SOX10(+)、HMB45(灶+)、S100(+)、ATRX(+,未见缺失)、IDH1(-)、p53(+,约8%)、BRAF-V600E(+)、CD34(-)、EMA(-)、SSTR2(-)、PR(-)、Ki-67(+,约30%)。入院1周后患者自觉右侧大腿外侧渐起包块,增大明显;取少许组织送病理活检,病理诊断均为:恶性黑色素瘤,考虑转移。患者确诊后行免疫治疗,电话随访6个月,症状有明显好转。结论恶性黑色素瘤形态表现多种多样,当转移至脑且Olig2弥漫强阳性表达时,与颅内其他肿瘤形态和免疫表型鉴别困难,极易漏诊,详细的临床病史及免疫组化有助于诊断。Objective To investigate the clinicopathological features,immunophenotype,diagnosis and differential diagnosis of Olig2 positive brain metastatic melanoma.Methods The clinicopathological features and immunophenotypes of a case of metastatic malignant melanoma with Olig2 diffuse positive in brain were analyzed by light microscope and immunohistochemistry,and the relevant literature was summarized.Results After admission,right frontal lobe lesions were resected with microsurgery and sent for pathological biopsy.Biopsy:under the microscope,diffusely proliferated heterotypic cells could be observed and are in flakes,growing around blood vessels,with relatively consistent morphology and epithelioid shape.The tumor cells are round and oval,the cytoplasm is eosinophilic,the nuclear atypia is obvious,the nucleolus is clear,the nuclear deviation in some areas is rhabdomyoid,mitotic figures are common,and large areas of bleeding and necrosis can be seen.Immunophenotype:Olig-2(+),GFAP(-),Melan A(+),SOX10(+),HMB45(focal+),S100(+),ATRX(+,no deletion),IDH1(-),p53(+,about 8%),BRAF-V600E(+),CD34(-),EMA(-),SSTR2(-),PR(-),Ki-67(+,about 30%).One week after admission,the patient consciously had a mass on the outside of the right thigh,which increased significantly.A few tissues were taken for pathological biopsy.Pathological diagnosis:malignant melanoma,metastasis is considered.Follow up:the patient received immunotherapy after diagnosis,and the symptoms were significantly improved after telephone follow-up for 6 months.Conclusion Malignant melanoma has a variety of morphological manifestations.When it metastasizes to the brain,its Olig2 diffuse strong positive expression makes it difficult to distinguish from other intracranial tumors in morphology and immunophenotype,and it is very easy to miss diagnosis.Detailed clinical history and immunohistochemistry are helpful for diagnosis.

关 键 词：OLIG2 黑色素瘤 上皮样胶质母细胞瘤 鉴别诊断 

分 类 号：R365[医药卫生—病理学]