老年患者原发鼻腔或鼻咽黑色素瘤临床病理分析  

Clinicopathological analysis of primary nasopharyngeal melanomas in elderly patients

作　　者：李艳青 沈珊珊 娄晓莉 夏维[2] 曹志飞 张永胜[2] 陈光强[3] 戴晓晓 Li Yanqing;Shen Shanshan;Lou Xiaoli;Xia Wei;Cao Zhifei;Zhang Yongsheng;Chen Guangqiang;Dai Xiaoxiao(Department of Pathology,Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,China;Department of Pathology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Radiology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]江苏省南京中医药大学附属苏州市中医医院病理科,苏州215009 [2]江苏省苏州大学附属第二医院病理科,苏州215004 [3]江苏省苏州大学附属第二医院影像科,苏州215004

出　　处：《中华老年医学杂志》2023年第3期328-333,共6页Chinese Journal of Geriatrics

基　　金：江苏省卫生健康委医学科研项目(H2019071);苏州市科技发展计划应用基础研究项目(SYS2020146)。

摘　　要：目的 探讨老年患者鼻腔、鼻咽黑色素瘤(STMMMs)的临床病理特征及分子遗传学特征。方法 回顾性分析10例老年患者STMMM临床病理特征、免疫组化特点及BRAF、C-KIT、NRAS基因突变情况。结果 10例老年患者STMMM中女性5例,男性5例,年龄65~81岁,平均(72.5±8.5)岁;7例发生于鼻腔及鼻窦,3例发生于鼻咽;光镜下瘤细胞形态复杂多样,呈浆细胞样、横纹肌母细胞样、小细胞样、上皮样细胞、梭形细胞样形态。10例免疫组化标记HMB-45、S-100均为阳性,MelanA阳性率70.0%。基因检测结果显示,10例STMMMs中BRAF、NRAS基因均为野生型;有1例发生C-KIT第11号外显子c.1666_1667insA移码突变,余9例为野生型。10例均具有随访资料,随访时间4~50个月,至今3例存活。结论 老年患者STMMM临床罕见,容易漏诊误诊,免疫组化及基因检测可为准确诊断及靶向治疗提供指导作用。Objective To investigate the clinicopathologic features and molecular genetics characteristics of sinonasal tract mucosal malignant melanomas(STMMMs)in elderly patients.Methods The clinicopathological features,immunohistochemical features and BRAF,C-KIT,NRAS mutations of STMMM in ten elderly patients were retrospectively analyzed.Results Among the 10 patients,5 were female and 5 were male.The patients were aged 65-81 years,with an average age of(72.5±8.5)years.The lesions in 7 cases were located in the nasal cavity and paranasal sinuses,and in the other 3 cases were located in the nasopharynx.The morphologies of tumor cells under microscope was complex and diverse,showing plasma cell-like,rhabdomyoblast-like,small cell-like,epithelial-like,and spindle cell-like morphologies.Immunohistochemically,HMB-45 and S-100 were generally positive in 10 cases,and the positive rate of Melan A was 70.0%.The genes detection data showed no mutations in BRAF or NRAS genes in all the 10 cases,while C-KIT exon 11 c.1666_1667insA mutation was found in one case,and the remaining 9 cases were wild-type for C-KIT.All the 10 cases were followed up for 4~50 months.Three cases survived so far.Conclusions STMMM in elderly patients are rare and easy to be misdiagnosed.Immunohistochemistry and genetic testing provide guidance for accurate diagnosis and targeted therapy.

关 键 词：鼻咽 黑色素瘤 病理 C-KIT 预后 

分 类 号：R739.62[医药卫生—肿瘤] R739.63[医药卫生—临床医学]