气管原发恶性黑色素瘤1例临床病理分析及文献复习  

Clinicopathological analysis of 1 case of primary malignant melanoma of trachea and literature review

作　　者：何蕾蕾[1] 米会敏 HE Leilei;MI Huimin(Pathology Department,Baoji Central Hospital,Baoji 721008,China)

机构地区：[1]宝鸡市中心医院病理科,陕西宝鸡721008

出　　处：《临床医学研究与实践》2023年第25期1-4,共4页Clinical Research and Practice

摘　　要：分析1例气管原发恶性黑色素瘤的病理学特征、影像学特征、免疫表型、特殊染色及鉴别诊断,并复习文献。本例患者增强计算机断层扫描(CT)示气管胸段距离气管隆突约4.6 cm处见一乳头状结节突入腔内,大小约1.5 cm×1.4 cm,病变与气管右后壁宽基底相连,病变下方见局限性透亮影突出气管腔。镜下结果示组织表面被覆复层鳞状上皮,黏膜下可见其瘤细胞呈梭形,弥漫片状、交错、编织状排列,核呈圆形或椭圆形,部分可见大核仁,局部瘤细胞排列密集,呈束状、交错排列,局部见色素沉积,核分裂像易见。免疫组化及特殊染色结果示细胞角蛋白(CK)(-),波形蛋白(部分+),蛋白63(P63)(-),蛋白40(P40)(-),突触素(Syn)(++),嗜铬颗粒素A(CgA)(部分+),Ki-67(+,30%),甲状腺转录因子-1(TTF-1)(-),细胞角蛋白7(CK7)(-),细胞表面分化抗原117(CD117)(-),S-100(++),HMB45(+++),SOX-10(++),Melan-A(部分+),上皮细胞膜抗原(EMA)(-),平滑肌肌动蛋白(SMA)(-),细胞表面分化抗原34(CD34)(-),胃肠道间质瘤内发现的蛋白1(Dog-1)(-),脱色素(+)。气管原发恶性黑色素瘤非常罕见,临床应仔细观察形态学特征,寻找证据,借助免疫组化及特殊染色等辅助手段,减少误诊及漏诊。The pathological features,imaging features,immunophenotype,special staining and differential diagnosis of 1 case of primary malignant melanoma of trachea were analyzed and the literature was reviewed.In this case,enhanced computed tomography(CT)showed a papillary nodule protruding into the trachea cavity at a distance of about 4.6 cm from the tracheal bulge in the thoracic segment of the trachea,with a size of about 1.5 cm×1.4 cm.The lesion was connected to the broad base of the right posterior wall of the trachea,and a localized bright shadow protruding from the tracheal cavity was observed below the lesion.Microscopic results showed that the surface of the tissue was covered by stratified squamous epithelium,and the tumor cells were spindle-shaped,diffuse,staggered,and braid arranged under the mucosa.The nucleus was circular or elliptical,with some visible large nucleoli.The focal tumor cells were densely arranged,presenting bundle and staggered arrangement,and local pigmentation and mitotic images were easily seen.Immunohistochemistry and special staining results showed cytokeratin(CK)(-),Vimentin(partial+),protein 63(P63)(-),protein 40(P40)(-),synaptophysin(Syn)(++),chromogranin A(CgA)(partial+),Ki-67(+,30%),thyroid transcription factor-1(TTF-1)(-),cytokeratin 7(CK7)(-),cluster of differentiation 117(CD117)(-),S-100(++),HMB45(+++),SOX-10(++),Melan-A(partial+),epithellal membrane antigen(EMA)(-),alpha-smooth muscle actin(SMA)(-),cluster of differentiation 34(CD34)(-),discovered on gastrointestinal stromal tumors protein 1(Dog-1)(-),and depigmentation(+).Primary malignant melanoma of trachea is very rare.In clinical practice,morphological characteristics should be carefully observed to find evidences,and auxiliary means such as immunohistochemistry and special staining should be used to reduce misdiagnosis and missed diagnosis.

关 键 词：气管原发恶性黑素色瘤 病理特征 免疫组化 

分 类 号：R739.5[医药卫生—肿瘤]