原发性外阴、阴道恶性黑色素瘤14例临床分析

目的：探讨原发性外阴及阴道恶性黑色素瘤(恶黑)的临床诊治特点及影响预后的因素。方法：对我院1990年～2004年间收治的9例外阴恶性黑色素瘤及5例阴道恶性黑色素瘤的临床资料进行回顾性分析。结果：本组病例平均年龄55岁，发生于60岁以上者占42．9％(6／14)。14例中手术治疗12例，其他治疗2例。术后发现9例外阴恶性黑色素瘤患者腹股沟淋巴结转移6例，盆腔淋巴结转移2例；阴道恶性黑色素瘤患者盆腔淋巴结转移2例。随访4例中复发l例(Ⅲ期)，转移l例(Ⅲ期)，其病灶直径均大于2cm。1例Ⅳb期患者出现右下肢浮肿。另有l例I期患者术后7个月未见异常。结论：外阴及阴道恶性黑色素瘤预后不良。治疗原则应采用以手术为主的综合治疗，其预后与有无黑色素沉着，组织病理类型，生长方式，肿瘤厚度(Breslow)，侵入皮肤层次(Clark)，淋巴结转移情况及脉管内瘤栓等因素有关。     

胆管直肠恶性黑色素瘤(附五例报告)

肛管直肠恶性黑色素瘤是一种极为少见的恶性度很高的肿瘤，本大共收集5例肛管直肠恶性黑色素瘤资料，报告如下。临床资料一、一般资料：本组5例，男3例，女2例。年龄42~67岁，平均54．4岁。二、临床症状：肛管直肠恶性黑色素瘤临床主要症状与直肠癌相似，主要有粘液血便（4／5），大便时肿物脱出（3／5），大便困难（2／5）。本组5例中仅1例首次就诊时经病理证实为恶性黑色素瘤，余4例均有误诊史，误诊为痔3例，误诊为直肠息肉1例。三、病理资料：①肉眼所见：肿瘤位于肛管2例，位于直肠3例，其下缘距齿状线距离分别为0．9cm，2．1cm，2．9c…     

鼻腔原发性恶性黑色素瘤25例临床病理分析

目的观察鼻腔原发性恶性黑色素瘤的形态特点，以帮助临床诊断和治疗。方法对1975年-2006年间诊治的鼻腔原发性恶性黑色素瘤25例的临床资料进行回顾性分析。结果25例中，肿瘤多位于鼻腔外侧壁和鼻中隔，中鼻道10例，鼻中隔6例，中鼻甲4例，下鼻甲3例，鼻底1例，另1例病变范围广无法判断其来源。肿瘤呈黑色或紫褐色21例，呈结节状或菜花状；淡红色表面光滑如息肉状4例；肿瘤触之易出血。结论鼻腔原发性恶性黑色素瘤临床少见，易误诊，应与鼻腔癌、血管瘤、鼻息肉相鉴别；对鼻腔发现的黑色或紫褐色肿物，触之易出血者可作该病的临床诊断，活检应谨慎，以免促进肿瘤转移。     

22例肛管直肠恶性黑色素瘤的临床分析并文献复习

背景与目的：肛管直肠恶性黑色素瘤恶性度高,其治疗方法尚存在争议．本研究旨在总结肛管直肠恶性黑色素瘤的诊断及治疗经验。方法：回顾性分析1977年至2003年江苏省肿瘤医院收治的22例肛管直肠恶性黑色素瘤患者的临床及病理资料．包括临床表现、诊断、手术方式和预后,并复习相关文献。结果：本组22例．占同期收治的大肠恶性肿瘤的0．4％（22／5205）,男性6例,女性16例．中位年龄61岁。主要临床表现为：便血86％（19／22）、肛门疼痛或不适59％（13／22）、肛门口肿物27％（6／22）等。首次就诊误诊率86％（19／22）,术前病理诊断确诊率48％（10／21）。无远处转移16例,伴远处转移6例。行腹会阴联合切除术11例．局部广泛切除术5例（2例复发后补充腹会阴联合切除术）,Park’s术2例．Hartmann’s术1例,乙状结肠双腔造瘘术3例。术后1、3、5年生存率分别为45．4％、18．1％、9．1％,中位生存时间12个月（95％CI：6～18个月）。结论：肛管直肠恶性黑色素瘤少见,易误诊,预后差。腹会阴联合切除术可作为无远处转移的肛管直肠恶性黑色素瘤患者的首选术式。     

右足底恶性黑色素瘤术后十二指肠转移内镜像个案报道

目的探讨恶性黑色素瘤术后十二指肠转移内镜像变化。方法 对1例恶性黑色素瘤术后患者临床资料进行分析,通过内镜及病理检查明确诊断。结果 恶性黑色素瘤具有高转移性,内镜像与皮肤所见黑痣相似。结论 内镜检查结合镜下病理检查,在诊断上消化道恶性黑色素瘤中起着关键作用。     

头颈部黏膜恶性黑色素瘤诊断与治疗进展

头颈部黏膜恶性黑色素瘤常发生于眼内、口腔、下咽、鼻腔鼻旁窦、鼻咽等部位。睫状体或脉络膜黏膜恶性黑色素瘤诊断基础是临床检查，CT，MRI，细针穿刺抽吸活检利于确诊，治疗方法为观察和局部治疗方法，如放疗、光照疗法、冷冻疗法、超声高温疗法、局部切除以及眼球摘除术。鼻腔鼻旁窦黏膜恶性黑色素瘤组织学检查是首要的诊断依据，治疗可采取：手术、化疗、免疫治疗、局部复发后采用包括外科手术切除、补充放疗、化疗、免疫治疗。口腔、鼻咽及下咽黏膜恶性黑色素瘤主要依据内窥镜及病理活检诊断，CT扫描及MRI检查利于明确病变范围及分期，可采用手术、放疗和化疗综合治疗。     

食管原发性恶性黑色素瘤3例临床病理观察

目的：探讨食管原发性恶性黑色素瘤的临床病理特征、免疫表型、病程进展及诊断、治疗、预后。方法对3例食管原发性恶性黑色素瘤患者的临床表现、病理学形态、免疫组化及病程进展进行观察,并对3例患者进行了随访。结果3例患者中,男1例,女2例,年龄分别为68、57、65岁,均因吞咽不适入院,2例行食管切除,食管、胃吻合术,术后均辅以化疗,1例仅行化疗;患者术后平均生存期为19个月,从明确肿瘤转移到死亡的平均时间为9个月。结论食管原发性恶性黑色素瘤临床罕见,预后较差;食管原发性恶性黑色素瘤无特异临床症状;术前胃镜活检易误诊;手术切除可缓解症状,但无确切证据表明能延长患者生存时间。     

原发性食管恶性黑色素瘤1例报告及文献复习

目的探讨原发性食管恶性黑色素瘤的临床特点及其诊断和治疗。方法对本科收治的1例和计算机检索得到的29例原发性食管恶性黑色素瘤的临床资料结合文献复习,进行综合分析。结果最常见主诉为吞咽不适,进食后胸骨后疼痛,伴体重下降或消瘦。肿瘤多位于食管的胸中下段,肿瘤长径平均5.26cm,其中5.0cm以上者19例,占73.1%。食管钡餐检查病灶表现为轮廓较清晰,边缘光滑规则的充盈缺损。胃镜多见腔内息肉样肿物,表面多呈褐色、黑色、灰白色或其它深色改变。术前临床诊断明确率为19.2%。25例接受外科手术治疗。结论原发性食管恶性黑色素瘤预后极差,应提高对其临床特点的认识,以提高术前确诊率。手术是治疗原发性食管恶性黑色素瘤的首选方法,可有效改善临床症状。     

中枢神经系统黑色素瘤

本文报告恶性黑色素瘤11例,其中颅内10例,椎管内1例,占同期中枢神经系统肿瘤0.28％。男性9例,女性2例;20～40岁有9例(81.8％)。症状期大多数在4个月以内。本组5例为转移性黑色素瘤,均查到原发病灶;6例为原发性黑色素瘤。本组有4例腰穿脑脊液呈血性或变黄;8例脑血管造影有4例出现病理性循环。原发性黑色素瘤缺乏典型症状及体征,术前诊断困难;但如皮肤或眼底视网膜存在黑色素瘤,则有助于颅内转移的诊断。对可疑病例应行脑脊液的瘤细胞检查。中枢神经系统黑色素瘤预后不佳。目前以手术切除肿瘤为好,必要时作减压术,术后配合激素、放疗及化疗,可缓解症状和延长生命。     

原发性鼻腔鼻窦恶性黑色素瘤八例临床分析

目的：探讨原发性鼻腔、鼻窦恶性黑色素瘤的诊断和治疗方法。方法：对8例该类患者的临床资料进行回顾性分析。结果：病理形态以多种细胞类型和组织形态混合存在为主要特点，无色素型黑色素瘤S－100蛋白均阳性。所有患者均得到手术治疗且切缘阴性。术后加放疗6例，复发3例，复发灶与原发病灶同侧，复发时间在术后1年左右。1年和2年生存率分别为75％和62％。2例生存期超过5年，均系手术加放疗者。结论：S－100蛋白是无色素型黑色素瘤的重要标志物，术后放疗的患者生存期较长，手术切缘阴性并不提示良好的预后。     

A Primary Sacral Melanoma of Unknown Origin: A Case Report

Malignant melanoma caused by malignant transformation of melanocytes is associated with high mortality and is difficult to manage. Metastasis is not uncommon (up to 31% of all cases) and is closely associated with a poor prognosis. Although rare (4–5%), extracutaneous melanoma has been reported; however, primary malignant melanoma of the sacrum is extremely rare (only three case reports to date). Here, we present a 51-year-old patient who underwent surgical treatment for a lesion of the spinal canal and associated bony structures; extensive aggressive resection was required. She underwent partial sacrectomy and lumbo-iliac fixation (to maintain spinal stability). Pathology revealed malignant melanoma. We discuss the diagnosis, surgical intervention, and postoperative follow-up, which may assist clinicians. Although metastatic malignant melanoma is usually fatal, primary extracutaneous melanoma of the spine may respond well to surgery and adjuvant radiotherapy.     

Diagnosis of metastatic malignant melanoma by fine needle aspiration biopsy: a clinical and pathologic correlation of 298 cases

Fine needle aspiration biopsies (FNABs) from 298 lesions in patients with suspected metastatic melanoma were studied. The results were correlated either with histopathologic diagnoses on resected lesions or with prolonged clinical follow-up. Of 165 malignant aspirates, 160 were confirmed either by surgical resection (65 cases) or by an appropriate clinical course (95 cases). Of the 107 benign lesions with adequate follow-up, 73 were confirmed as benign. There were 25 false negatives: 19 were inadequate samples, and 6 were presumed failures of needle localization. No interpretative errors were identified. Although 3 cases of FNAB-diagnosed malignant melanoma could not be confirmed by surgical biopsy, the cytologic findings were typical of malignant melanoma. Clinical follow-up, however, suggested that the cytologic diagnosis was in error. One case of a second unrelated malignancy (an adenocarcinoma of the lung) was correctly diagnosed with the use of FNAB. Because of its high degree of accuracy, FNAB has proved useful in the differential diagnosis of subcutaneous nodules, enlarged lymph nodes, and lung nodules.     

38例无症状肺孤立性微小结节的电视辅助胸腔镜手术诊治

目的：探讨电视辅助胸腔镜手术（VATS）在无症状肺部孤立性微小结节的诊断、鉴别诊断以及治疗中的可行性和意义.方法：对38例无症状肺部孤立性微小结节患者进行了VATS诊治;结节直径均＜1.5cm,最小者0.3 cm;13例（34%）术前拟诊为肺癌,余25例（66%）拟诊为肺部良性病变;所有患者术前均未能获得明确病理学诊断.结果：所有患者均顺利完成手术,无严重术中、后并发症和围手术期死亡.全组患者均获得明确病理学诊断,确诊率100%.其中恶性病变11例（29%）,良性病变27例（71%）.5例（38%）术前拟诊为恶性病变的患者最终确诊为良性病变;3例（12%）术前拟诊为良性病变的患者最终确诊为恶性病变.本组中27例良性病例经VATS手术均获得临床治愈.11例肺癌患者中9例接受了根治性肺叶切除＋纵隔淋巴结清扫术;另2例患者仅接受姑息性结节楔形切除术.结论：VATS技术可应用于无症状肺孤立性微小结节的确诊,对良性或恶性病变均可获得满意的疗效,可行性良好,与传统诊疗方法相比具有明显的优势,有助于肺癌的早期诊断与治疗.     

颅内黑色素瘤的诊断与治疗--附五例临床分析及文献复习

为讨论颅内黑色素瘤的临床表现、影像学特征及治疗方法 ,对本科近 13年来治疗的 5例颅内黑色素瘤进行回顾性分析。结果示颅内黑色素瘤的临床表现不具有特征性。影像学上CT表现为高密度或混杂密度 ,增强扫描呈不同程度强化。核磁共振检查 (MRI)表现为短T1短T2 信号 ,也可以因顺磁性黑色素含量不同和瘤内有无出血 ,表现为高、低或混杂信号 ,注射二乙胺五乙酸钆 (GD DTPA)后出现不同程度的强化。 5例患者中 ,3例手术全切 ,1例大部分切除 ,1例未手术。初步研究结果提示 ,颅内黑色素瘤的预后差 ,主张在手术基础上进行包括放疗及化疗的综合治疗     

Second malignancies in hairy cell leukemia

Among 172 patients with hairy cell leukemia (HCL) seen at the University of Chicago over a 10-year period, 15 were found to have a second malignancy. Neoplasia of the skin was noted most frequently; there were three cases of basal cell carcinoma, one case of anaplastic squamous cell carcinoma, and one case of malignant melanoma. This was followed in frequency by three cases of carcinoma of the lung. The clinical characteristics of these 15 patients did not differ from those of the general population of patients with HCL. A variety of second hematologic malignant disorders and solid tumors were identified. In one case, the second neoplasm occurred before the diagnosis of HCL; six were diagnosed concurrently; and eight followed the diagnosis of HCL. Since HCL is a well-defined clinicopathologic entity, patients with HCL who exhibit unusual features of the disease should be investigated further for the presence of second malignancies.     

胸腔镜检查对少见疑难恶性胸腔积液的诊断价值

目的评价胸腔镜检查对少见疑难恶性胸腔积液的诊断价值.方法对5例经常规检查病因未明的可疑恶性胸腔积液者进行胸腔镜检查.结果发现胸膜多处结节或菜花样肿物,于胸膜病变处活检,病理确诊为胸膜转移性滑膜肉瘤、恶性纤维肉瘤、恶性组织细胞病各1例,恶性黑色素瘤2例.结论结果表明胸腔镜检查对少见疑难恶性胸腔积液是一种准确有效的诊断手段.     

A case of metastatic malignant melanoma of the stomach treated by a surgical operation

A metastatic malignant melanoma of the stomach is not a disease of rate occurrence, but reports of melanomas that were clinically diagnosed and were treated by a surgical operation are rare. The case presented is a 73-year-old woman, who underwent an excision of a malignant melanoma of the left sole in 1981. Subsequently, she had a subcutaneous metastasis of a melanoma three times and was treated by a resection and immunochemotherapy. In January, 1988, an X-ray examination of stomach revealed a giant elevated lesion, and an endoscopic examination of the stomach revealed a black pigmented tumor with ulceration. A biopsy taken from the tumor confirmed the diagnosis of a malignant melanoma. Thus, she was given a total gastrectomy. Reports in the Japanese literature of metastatic malignant melanomas of the stomach diagnosed while the patient was still living amount to 11 cases. Of this number, 3 patients were given a surgical operation. Further, these 3 patients lived longer than the non-surgically treated cases and had a better quality of remaining life.     

脊椎恶性淋巴瘤(18例报告)

目的 提高脊椎恶性淋巴瘤诊断与治疗的水平。方法 1974—2000年回顾性分析脊椎恶性淋巴瘤18例，男12例，女6例，平均年龄31．3岁。颈胸椎1例，胸椎10例，胸腰椎1例，腰椎6例，分析临床资料，x摄线片，CT和MRI的特点。结果 13例(72．2％)腰背部持续性疼痛、消瘦、盗汗、380C～39℃不规则发热，不同程度脊髓或马尾损害13例，8例(44．4％)酷似脊椎结核。脊椎x线摄片无特异性改变，难与脊椎结核鉴别；4例胸部摄片纵隔阴影扩大。MRI矢面T1W增强后，将脊椎淋巴瘤分为三型：硬膜外型，椎旁和椎体型。合并截瘫或马尾受累外科手术切除，随后放疗或／和化疗，可获得较好疗效。结论 对诊断不明确，特别并脊髓或马尾损害应行活检或手术探查，早期诊断，早期治疗。     

腹直肌肌皮瓣修复肿瘤相关腹股沟区软组织缺损临床价值的探讨

目的:探讨横行腹直肌肌皮瓣修复与肿瘤相关腹股沟区软组织缺损的临床价值。方法:2000-01-2009-01应用本法共修复腹股沟区软组织缺损12例,其中恶性纤维组织细胞瘤4例,滑膜肉瘤2例,鳞状细胞癌2例,恶性黑色素瘤转移2例,纤维瘤病1例,横纹肌肉瘤术后1例;原发3例,复发7例,放疗后切口溃烂2例(滑膜肉瘤、横纹肌肉瘤术后各1例);滑膜肉瘤术后放疗后复发1例。结果:围手术期腹直肌肌皮瓣移植,11例全部成活,1例部分坏死;11例平均随访15个月,1例失访;局部复发1例,肺、脑转移死亡3例,余8例均生存,供区无并发症出现。结论:腹直肌肌皮瓣修复腹股沟软组织缺损具有愈合快、抗感染力强、供区隐蔽以及手术操作方便等优点,可实行双组手术,宜于修复较大腹股沟区软组织缺损。