肛管直肠恶性黑色素瘤：42例诊断与治疗

目的：肛管直肠恶性黑色素瘤（AMM的）是一种罕见的和积极的恶性肿瘤,其治疗仍controversial.This调查研究和总结我们的经验诊断,治疗和AMM.Methods误诊：从1980年8月至十二月2009,42与AMM的患者在我们hospital.The这些患者治疗的临床资料进行回顾性分析,包括主要症状,治疗和prognosis.Further免疫抗体分析使用的S - 100蛋白,液压集成块- 45抗原和波形蛋白活性进行了22 specimens.Results：在42例的投诉主要是便血（四十二分之二十三,55.0％）,（42分之12,28.6％）,肛门群众,改变大便性状（4 / 42,9.5％）,和或肛门里急后重疼痛（3 / 42,7.1％）。误诊率是62％（42分之26）,最常见的误诊痔（9 / 26,34.6％）组成,息肉（11/26,42.3％）和直肠癌（6 / 26,23.1％）.28例腹会阴切除术,10例行局部广泛切除,3例行姑息性手术,手术和没有operation.After 1,15例患者进行放疗,化疗和21日进行了8个与这两个治疗。 22例1年内死亡,11在2年,5起3年内,并在四余年的平均存活时间为11个月,1 45 months.The的免疫组化结果最长,显示的S - 100蛋白存在于所有22例（100％）,液压集成块- 45是在22染色（95.5％）21 22（86.4％）和波形蛋白19。结论：AMM的是一个贫穷的预后和资质的罕见疾病被误诊。便血是最常见的symptom.Immunohistochemical染色利于AMM.Operation诊断是主要治疗,操作类型应该是个性化。

Anorectal malignant melanoma: Diagnosis and treatment of 42 cases

Objective

Anorectal malignant melanoma (AMM) is a rare and aggressive malignant tumor, and its treatment still controversial. This study was to investigate and summarize our experience on diagnosis, treatment and misdiagnosis of AMM.

Methods

From August 1980 to December 2009, 42 patients with AMM were treated in our hospital. The clinical data of those patients were retrospectively analyzed, including the major symptoms, treatment and prognosis. Further immunophenotyping analyses using antibodies to S-100 protein, HMB-45 reactive antigen and vimentin were performed in 22 specimens.

Results

The major complaints among the 42 cases were hematochezia (23/42, 55.0%), anal masses (12/42, 28.6%), changes in stool character (4/42, 9.5%), and anal tenesmus or pain (3/42, 7.1%). The misdiagnosis rate was 62% (26/42), the most common misdiagnosis consisted of hemorrhoid (9/26, 34.6%), polyps (11/26, 42.3%) and rectal cancer (6/26, 23.1%). 28 cases underwent abdominoperineal resection, 10 underwent local wide excision, 3 underwent palliative operation, and 1 with no operation. After surgery, 15 patients underwent radiotherapy, 21 underwent chemotherapy and 8 were treated with both. 22 cases deceased within 1 year, 11 within 2 years, 5 within 3 years and 1 within 4 years. The median survival time was 11 months, with the longest of 45 months. The immunohistochemical findings revealed that the S-100 protein was present in all 22 cases (100%), HMB-45 was stained in 19 of 22 (86.4%) and vimentin in 21 of 22 (95.5%).

Conclusion

AMM is a rare disease with a poor prognosis and with an aptitude of being misdiagnosed. Hematochezia is the most common symptom. Immunohistochemical staining is conducive to the diagnosis of AMM. Operation is the major treatment, the operation type should be individualized.