手指恶性黑色素瘤的临床特征与疗效分析

目的 探讨手指恶性黑色素瘤的临床特征及治疗效果.方法 回顾性分析1995年2月-2007年10月收治并经病理检查证实的22例手指恶性黑色素瘤的临床资料,其中拇指12例,示、中指各3例,环、小指各2例.手指黑斑及疼痛为共同的首发症状,15例有甲下病变,12例有外伤史,2例X线片显示指骨有溶骨性改变.主要采用手术、全身化疗及免疫治疗.所有患者均采用截指术,其中13例行同侧腋窝淋巴结清扫术.结果 22例患者获得随访,其中3例2年后失访.随访时间为1～10年,平均4.5年.1年生存率为86.4%(19/22),3年生存率为63.2%(12/19),5年生存率为31.6%(6/19).结论 手指恶性黑色素瘤临床少见,治疗应以手术、化疗、免疫治疗等综合方法为主.其预后与肿瘤大小、浸润深度及临床分期有关.     

手指恶性黑色素瘤的诊治

1998年 9月至 2 0 0 0年 11月 ,我院共收治 3例手指恶性黑色素瘤。 3例在发现手指出现黑斑后 ,均未引起重视延误了治疗 ,影响了治疗效果。一、资料与方法1.一般资料 :本组共 3例 ,男 2例 ,女 1例 ;年龄 30～ 70岁。肿瘤部位 :拇指甲下及示指甲下各 1例 ,小指中节掌侧 1例。 3例手指出现棕黑色和黑褐色斑点距就诊时间为 8年、1年和 3个月。黑色斑块出现后快速增长、扩大 ,并有刺痛、灼痛感。 2例甲下的黑色斑块高出甲床 ,指甲被掀起、变形 ,1例的指甲已脱落。 3例均在黑色斑增长扩大及出现疼痛后去外院治疗。2 .病例介绍 :例 1　示指甲下黑色…     

足部恶性黑色素瘤21例临床分析

目的 探讨足部恶性黑色素瘤的临床表现、诊断与治疗.方法 回顾性分析我科1994年至2006年收治的21例足部恶性黑色素瘤患者.其中男性19例,女性2例,平均年龄63.8岁(42～86岁).结果 所有患者均经病理证实为足部恶性黑色素瘤.21例患者确诊后均接受了外科手术治疗,术后5例接受化疗,2例接受生物学治疗.19例随访3～41个月.2例患者分别于术后6个月及31个月死亡,其余患者目前均存活.结论 目前恶性黑色素瘤仍是不能根治的疾病.足底为负重功能区,应根据手术切除后缺损的部位和范围,选择合适的皮瓣修复对足部功能恢复起着十分重要的作用.     

原发女性生殖道恶性黑色素瘤21例临床分析

目的探讨原发性女性生殖道恶性黑色素瘤的临床特点、治疗及预后。方法回顾分析本院1986年1月至2006年3月收治的原发性女性生殖道恶性黑色素瘤患者21例。其中外阴8例、阴道10例、阴道及宫颈1例、外阴及阴道1例、盆腔1例。结果患者中位年龄50(21~71)岁。临床表现主要为阴道流血、流液及发现外阴或阴道肿物。本资料阴道恶性黑色素瘤发病率高于外阴恶性黑色素瘤。按照国际妇产科联盟(FIGO)分期,期别和预后呈负相关。治疗以手术为主,手术方式由根治性切除逐渐衍变为扩大局部切除。随访:21例患者中随访率为67%(14/21),随访时间6~96个月,死亡7例,随访期间的死亡率为50%。结论女性生殖道恶性黑色素瘤发病率低,预后差。肿瘤厚度和淋巴结转移是其主要的危险因素。应采用手术基础上的综合治疗,治疗方案个体化。     

肛管直肠恶性黑色素瘤1例报告

患者女性,7l岁。因下腹部坠胀感伴大便次数增多2个月,便血1个月于2 0 0 3年5月2 6日入院。查体:腹股沟淋巴结未触及肿大。肛门视诊:肛缘有一黑痣,呈斑片状,略高出皮肤。直肠指诊:于肛管前壁距肛缘约2 5cm处有一球形肿块,大小约3 0cm×2 0cm×2 0cm ,质硬,无触痛,基底与顶部之间有蒂相连,基底固定,且与阴道壁粘连。辅助检查:CAl9 9、CEA均为阴性。阴道超声提示:该实性肿块内呈低回声伴有小透声区,局部层次消失,与阴道壁分界不清晰,范围1 2cm ,彩色多普勒显示肿块血管丰富。纤维电子结肠镜提示:于肛管前壁见一3 0cm×2 0cm×2 0cm大小…     

肛管直肠恶性黑色素瘤

目的　总结肛管直肠恶性黑色素瘤的诊断与治疗经验。　方法　回顾性分析 10例肛管直肠恶性黑色素瘤的临床病例资料。　结果　出现症状至确诊时间平均 8( 2～ 12 )个月 ,首诊确诊 4例 ,误诊 6例。手术 9例 ,8例肿瘤直径 >3cm。其中 8例行腹会阴联合根治术 ,1例以直肠息肉、肛乳头肥大行局部切除 ,1例放弃手术仅行化疗 ,3月后死于肝、肺腹股沟等广泛转移。术后 8例行化疗 ,2例辅助放疗 ,化放疗联合应用 1例。术后 2年内死亡 5例 ,余 4例存活 ,存活最长者已超过 6年。　结论　肛管直肠恶性黑色素瘤恶性程度高 ,早期行腹会阴联合根治术是最优选择。长期生存有赖于早期治疗以及治疗方法的改进     

直肠恶性黑色素瘤1例

患者女，70岁，因大便带脓血1月余，于2003年8月16日入院。患者于1月前无明显诱因地出现大便带脓血，为暗红色血液，伴大便次数增多，每天达5次左右，大便能成形，伴肛门下坠感，无腹痛、腹胀，无发热，无明显消瘦。体格检查：全身浅表淋巴结不肿大，心肺正常，腹部无肿块，直肠指诊：     

原发性膀胱恶性黑色素瘤1例

<正>原发于膀胱恶性黑色素瘤十分罕见。我院于2007年底收治1例,现报告如下。患者,女,74岁。因尿频、尿急、间断无痛性肉眼血尿2个月入院。全身皮肤无斑疹,浅表淋巴结不大。彩超检查膀胱腔左侧壁可见3.5 cm×4.5cm不规则实性低回声影,突向膀胱腔,表面不光滑。膀胱剩余尿量135 ml。CT示膀胱左侧壁团块软组织影突入膀胱腔内,局部膀胱壁增厚,其下     

肾恶性黑色素瘤一例报告

肾恶性黑色素瘤（ｍａｌｉｇｎａｎｔｍｅｌａｎｏｍａ　ｏｆ　ｔｈｅ　ｋｉｄｎｅｙ）临床罕见,文献报道１０例左右,且以继发为主。我科近期收治１例,结合文献复习,报告如下。 临床及病理资料 患者,女,２７岁。因右腰腹部包块胀痛１周于１９９９年３月１６日入院。病程中无尿频、尿急、尿痛、血尿及排尿困难史,亦无外伤史。胀痛位于右侧腰部、右上腹部,不向它处放散。发育良好,全身皮肤未见明显突出的黑色素痣。右上腹部稍隆起,包块可触及,下极平脐,上极不清,内侧达中线,表面光滑,质中、固定。Ｂ超示右肾区肿块约１１．２ｃ…     

肛管直肠恶性黑色素瘤的诊治进展

肛管直肠恶性黑色素瘤（anorectalmalignantmelanoma,ARMM）是一种非常罕见且预后极差的恶性肿瘤。ARMM发病率低,缺乏特异性临床表现,容易误诊。单纯常规病理学检查不易诊断ARMM,免疫组化联合S-100蛋白、HMtM5、Vimentin的检测有助于诊断。目前,胃肠道肿瘤的治疗多采用外科手术、放疗、化疗及靶向治疗等综合治疗方式,而ARMM对放化疗敏感性较差,因此外科手术切除仍为本病的主要治疗手段。作者通过查阅近年来有关ARMM的国内外文献报道,对该病的生物学特性、诊断和治疗进展进行综述,以期对其进一步研究及临床诊治有所助益。     

Transperitoneal laparoscopical iliac lymphadenectomy for treatment of malignant melanoma

Background: Current treatment for melanoma of the lower limb includes excision of the primary tumor with ilioinguinal lymphadenectomy in the case of lymph node metastases. The standard surgical approach includes sectioning of the inguinal ligament to gain access to the iliac nodes. More recently, some authors have reported that extraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for the treatment of malignant melanoma is feasible and less aggressive than standard open surgery. So far, no publications have described transperitoneal laparoscopic iliac lymphadenectomy (TPLND). Methods: From November 2001 to June 2002, 13 patients with ilioinguinal node melanoma metastases underwent TPLND (stage IIIA in 1 case, IIIB in 5 cases, IIIC in 4 cases, and IV in 3 cases). Results: In all 13 cases, the TPLND and groin dissection was performed correctly. Operative time, intra- and postoperative complications, number of lymph nodes retrieved, immediate morbidity, hospital stay, and feasibility of TPLND were evaluated. Conclusions: This study was conducted to evaluate the feasibility and the preliminary results of TPLND used to manage malignant melanoma of the lower limb. This approach has many advantages over the traditional procedure: less surgical trauma, no incision of the abdominal muscles or the inguinal ligament, and less postoperative pain. Moreover, as compared with extraperitoneal laparoscopically assisted ilioinguinal lymphoadenectomy, it provides an improved view of the operative area, dissection zone, and surrounding structures. Further research is needed to confirm these preliminary results regarding the potential applications of this method for treating malignant metastasis to the lower limb.     

原发性食管恶性黑色素瘤的诊断和治疗

目的 总结原发性食管恶性黑色素瘤(PMME)的临床病理特征及其诊断和治疗经验.方法 回顾性分析2008年1月至2009年6月首都医科大学附属北京友谊医院收治的3例PMME患者的临床资料.采用多种检查诊断,行手术治疗,术后给予辅助性化疗及免疫治疗.结果 3例患者术前食管钡餐造影检查显示食管下段不规则充盈缺损.食管内镜检查示食管腔内黑紫色包块,直径为3 ～8 cm.EUS检查示病变起源于黏膜层,呈偏低回声.胸部CT检查显示食管下段呈向心性不均匀增厚,管腔明显狭窄,增强后不均匀强化.患者均行左侧开胸食管部分切除+食管胃吻合术,手术顺利.术后行病理检查确诊,免疫组织化学染色显示瘤细胞抗黑色素瘤特异性单抗(HMB-45)、黑色素-A和S-100蛋白阳性.2例患者生存时间超过3年,1例患者术后6个月因肿瘤广泛转移而死亡.结论 PMME是一种罕见的食管恶性肿瘤,预后较差,外科手术治疗是首选治疗方法,辅助性化疗和免疫治疗可能延长患者生存时间.     

直肠肛管恶性黑色素瘤的诊治

目的 探讨直肠肛管恶性黑色素瘤的临床表现、诊断、治疗及预后。方法 回顾性分析了1981－1996年我科诊治的直肠肛管恶性黑色素瘤6例,并进行随访。结果 6例患者肿块位于齿状线附近,肉眼观为紫黑色或褐色,均行手术治疗,其中2例行Mile′s术,2例行后盆腔清扫术,1例行经肛门肿块局部扩大切除术,1例行剖腹探查术,所有患者手术时均已有淋巴结或肝脏转移。6例患者于确诊后5－23个月死亡,平均存活14．7个月。结论 直肠肛管恶性黑色素瘤恶性度极高,死亡率高,较早发生淋巴和血行转移,宜采用根治手术辅以化疗及生物治疗的综合性治疗。     

Platelet count and malignant melanoma

Summary Thrombocytosis in malignancy is a recognised phenomenon. It can occur before the neoplasm becomes clinically obvious and can imply metastatic disease. This study of 83 patients with over 10 years follow-up from their first presentation with proven malignant melanoma appears to show that there is no association between high platelet counts and the malignancy.     

Extensive primary malignant melanoma of the oesophagus

Primary malignant melanoma of the oesophagus (PMME) is a rare tumour. It has characteristic pathological and immunohistochemical features and diagnosis and management is difficult. This paper reports a patient with PMME, with a review of literature. The literature search was made with the Index Medicus/MEDLINE database using ‘melanoma’ and ‘oesophagus’ as key words, and cross‐referencing of other articles on the subject. Three‐phase oesophagectomy was performed and the patient died 2 months afterwards with respiratory failure and bone metastasis. Primary malignant melanoma of the oesophagus is a highly lethal tumour. Radical surgery is the treatment of choice.      

Primary malignant melanoma of the adrenal gland

Primary malignant melanoma of the adrenal gland is an established entity. Fewer than 20 cases have been reported in the published literature. Because of the high frequency of adrenal gland metastases from malignant melanoma and pigmented pheochromocytoma, several rigid diagnostic criteria have been established for accepting an adrenal melanoma as primary. A new case is reported in this article. This observation is an opportunity update the literature on the diagnostic difficulties in this rare pathology.     

Primary malignant melanoma of the male urethra

BACKGROUND: We describe a rare case of malignant melanoma originating from the male urethra. METHODS/RESULTS: This case, which presented a tan-colored lesion at the distal urethra on urethroscopy, was considered as transitional cell carcinoma by transurethral biopsy. Pathologic examination of widely resected urethra revealed scattering cells, which included melanin granules in cytoplasm, and then immunohistochemical stains established the diagnosis as amelanotic melanoma. Although partial penectomy and inguinal lymph node dissection were subsequently performed, 7 months later, total cystourethrectomy was required because of multifocal recurrence at the residual urethra. CONCLUSIONS: In cases of amelanotic melanoma, it should be noted that a lack of melanin granules in tumor cells may lead pathologists and urologists to a misdiagnosis due to the histologic non-specific appearance. With respect to surgical management, of significance is the fact that malignant melanoma may progress multifocally along the total urethra; therefore, total urethrectomy should be considered as radical surgery for the primary site, even if the tumor is confined to the distal urethra.     

Direct bony invasion of malignant melanoma

Malignant melanoma is known to spread by local extention, by the lymphatics by the blood stream. Direct invasion of the bone from a cutaneous melanoma is unknown. Hence, this case is presented in view of its rarity. A 75-year-old Caucasian lady presented with a small papillary lesion in the region of a recurrent chronic cellulitis on the lower third of the lateral aspect of the right leg. Histopathology diagnosed the lesion as locally advanced malignant melanoma. Radiological investigations by X-ray and magnetic resonance imaging revealed malignant infiltration of the tibia in its mid and lower third with two soft tissue metastatic masses adjacent. Histology following amputation confirmed malignant melanoma with cranial resection margin involvement. She underwent a further above-knee amputation followed by chemotherapy. The patient recovered from the amputation but subsequently died 6 months later due to bronchopneumonia from lung metastasis.     

Rare primary malignant melanoma of the lung

Primary malignant melanoma of the lung is a very rare but very aggressive tumour. We report two patients who had primary malignant melanoma of the lung and underwent surgical resection in our hospital. Both of them had lymph node metastases and received postoperative adjuvant therapy. They died of tumour recurrence in 12 and 37 months. Management of this uncommon tumour is difficult and has not been standardized, but surgical resection is the only treatment option.