鼻腔原发性恶性黑色素瘤的临床病理观察

目的:探讨鼻腔原发性恶性黑色素瘤的临床、病理特点,以期掌握其诊断及相关鉴别诊断要领,提高其诊断准确率。方法:收集经特染及免疫组化确诊的鼻腔原发性恶性黑色瘤,并对其临床专科特征、生存随访情况、病理形态学特征及特染与免疫组化表型进行综合分析。结果:临床症状为进行性鼻塞或(和)鼻衄,9例伴轻重不等的头痛。专科检查均见广基性息肉样新生物填塞鼻腔,表面有暗灰褐黑色样坏死物覆附,触之为血痂或坏死物、质脆。8例临床诊断为鼻息肉、鼻窦炎,5例诊断为鼻肿瘤、鼻出血坏死性息肉伴鼻窦炎。治疗为手术加放、化疗综合手段,生存时间为2个月~53个月。病理形态学12例均见胞质深红染的大多边形上皮样细胞及横纹肌样细胞为主,色素少。结论:鼻腔原发性恶性黑色素瘤是一种少见肿瘤,其生存期短、恶性度高。临床专科检查以息肉样外观伴表面灰褐色坏死为特点。病理学以胞质深红染仅有少量黑色素颗粒的大多边形上皮杆细胞及横纹肌样细胞为主要成分,黑色素特染及免疫组化可明确诊断。

The Clinicopathological Observation on 13 Cases of Primary Malignant Melanoma of the Nasal Cavity

Objective To explore the clinicopathological features of the primary nasal cavity malignant melanoma,so as to master the diagnostic and differential diagnostic points and to improve the diagnostic correct rate.Methods The cases of primary malignant melanoma of nasal cavity were collected which were diagnosed by histochemical and immunohistochemical staining,and all the otorhinolaryngological clinical features,living state,pathomorphism and the staining type of immunohistochemistry and histochemistry were aggregate analysed.Results Progressive nasal obstruction or/and epistaxis were the common clinical symptoms,and 9 cases had light to heavy unequal headache.The nasal cavity were obturated by broad stem polypoid neoplasm through otorhinolaryngological examination,and surface were covered with spodo-fusco-piceous necrosisont,which were haemascab or necrosisont and pregirrhexis by palpate.8 patients were clinical diagnosticated as rhinopolypus,nasosinusitis and 5 patients as nasal oncosis?Rhinorrhagia necrotic polyps associated with nasosinusitis?The live time were 2 months to 53 months through operation and radiochemotherapy.The major polygon epithelioid cells and rhabdomyoid cells with cytoplasm crimson staining were the main component and hypopigment in 12 cases from pathomorphism.Conclusion It was a rare tumor with poor live span and high grade of the primary nasal cavity melanoma.The polypoid neoplasm associated with surface spodo-fusco-piceous necrosis were their clinical features through otorhinolaryngological examination.The major polygon epithelioid cells and rhabdomyoid cells with plasm crimson staining and only little melanin grain were the pathological feature,and it could be identify diagnosed by melanin staining and immunohistochemistry.