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[目的]观察消化道黏膜恶性黑色素瘤的临床表现和病理学变化特点,探讨早期诊断及鉴别诊断依据,寻找最佳治疗方案。[方法]对已经手术切除、病理确诊的消化道恶性黑色素瘤15例进行临床回顾性分析、病理组织学复查及免疫组织化学检查。[结果]15例中发生在食管1例,肛管直肠14例。男10例,女5例;年龄57~79岁。以下腹部不适、肛门刺激症状、便血或脓血便为主。内镜可见黏膜隆起、息肉样、明显的肿块、或肿块伴溃疡。影像学检查可发现有明显肿块。病理表现为肿瘤细胞以梭型和上皮型为主,或两者混合存在,出现变异为多种多样。肿瘤组织结构表现:弥漫性、片巢状、梁索状、乳头状或腺泡样。部分细胞内有黑色素颗粒。免疫组织化学检查12例肿瘤组织HMB-45呈阳性表达,全部病例Malen-A,S-100呈阳性表达。[结论]消化道恶性黑色素瘤的临床表现无特异性。术前以内镜检查的特异性较高,病理检查是必须的,由于组织学上具有细胞和结构的多样性和变异性表现,会给诊断带来一定困难,免疫组织化学HMB-45,Malen-A,S-100肿瘤标记有助于诊断和鉴别诊断。治疗以根治性手术为主,术后辅以化疗或放疗。
[Objective] To observe the clinical manifestations and pathological changes of gastrointestinal mucosal malignant melanoma and to explore the basis of early diagnosis and differential diagnosis to find out the best treatment plan. [Method] Fifteen cases of digestive malignant melanoma, which had been excised and pathologically confirmed, were retrospectively analyzed, histopathologically and immunohistochemically. [Results] In 15 cases, one case occurred in the esophagus and 14 cases in the anorectal tube. 10 males and 5 females; aged 57 to 79 years. The following abdominal discomfort, anal irritation, blood in the stool or pus and blood-based. Endoscopic mucosal swelling seen, polypoid, obvious mass, or mass with ulcers. Imaging examination can be found with significant lumps. Pathological manifestations of tumor cells to shuttle-based and epithelial-based, or a combination of both, there are many variations. Tumor tissue structure: diffuse, nests, cords, papillary or acinar-like. Some cells have melanin particles. HMB-45 expression was detected in 12 cases of tumor by immunohistochemistry, and Malen-A and S-100 were all positive in all cases. [Conclusion] The clinical manifestations of gastrointestinal malignant melanoma are nonspecific. The high specificity of preoperative endoscopic examination, pathological examination is necessary, due to the histology of cells and structures of diversity and variability in performance, will bring some difficulties in the diagnosis of immunohistochemistry HMB-45, Malen- A, S-100 tumor markers contribute to the diagnosis and differential diagnosis. The main treatment of radical surgery, postoperative adjuvant chemotherapy or radiotherapy.