原发性食管恶性黑色素瘤的临床病理特征及诊治研究(4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病理特征及其诊断和治疗。方法对我院收治的4例原发性食管恶性黑色素瘤进行临床表现、组织形态学和免疫组织化学的观察研究,结合文献对其诊断和治疗进行探讨。结果4例患者平均年龄62岁,临床症状均有进行性吞咽困难,肿瘤多位于食管中下段,组织化学染色显示瘤细胞异型性明显,内含嗜银性黑色素颗粒;免疫组化染色瘤细胞S-100和HMB45均为阳性。4例均接受手术治疗,有1例术后辅以放、化疗,随访生存期均未超过2年,均死于远处脏器转移。结论原发性食管恶性黑色素瘤是一种罕见的高度恶性肿瘤,侵袭性强,易转移,应及早诊断,及早手术治疗,放、化疗效果不明显,预后极差。新的化疗方案有望提高患者生存率。     

食管原发性恶性黑色素瘤临床病理观察

目的探讨食管原发性恶性黑色素瘤的诊断、鉴别诊断及生物学行为.方法报道1例食管原发性恶性黑色素瘤,对其进行临床及病理观察,并复习文献.结果食管原发性恶性黑色素瘤多见于中老年人,常发生于食管中、下段1/3处,大体呈息肉状;免疫组化染色HMB45和S-100（＋）.结论食管原发性恶性黑色素瘤是一种罕见肿瘤,对发生于中老年人的食管中、下段息肉样肿物应考虑原发性恶性黑色素瘤之可能.     

原发性食管恶性黑色素瘤一例并文献复习

目的:探讨原发性食管恶性黑色素瘤的临床、病理特征和鉴别诊断要点.方法:报告1例经伊红-苏木精染色及免疫组化染色诊断的原发性食管恶性黑色素瘤,同时回顾和总结国内外相关文献.结果:本例因进行性吞咽困难入院,术前诊断为原发性食管癌,于全麻下行食管中下段切除和胃代食管弓上吻合术.术后病理诊断为原发性食管恶性黑色素瘤,免疫组化表达HMB45、S-100,不表达CgA.结论:原发性食管恶性黑色素瘤临床罕见,诊断需结合临床症状、病理学特征以及免疫组化三个方面,以利准确分期,从而为制定合理治疗模式提供科学依据.     

5例食管原发性恶性黑色素瘤临床病理分析

目的:分析食管原发性恶性黑色素瘤(primary malignant melanoma of the esophagus,PMME)的病理诊断特点、鉴别诊断、生物学行为及预后。方法:收集安阳市肿瘤医院5例PMME,对其进行光镜观察、免疫组织化学染色、临床病理分析并进行随访。结果:PMME多见于中老年人,常发生于食管中段,大体呈蕈伞型。光镜下瘤细胞异型性明显,呈梭形、卵圆形或不规则形,以梭形细胞为主。肿瘤细胞胞核体积大,核仁清晰、染色质丰富。瘤细胞形态多样且无色素易误诊为分化差的鳞状细胞癌、肉瘤样癌、淋巴瘤等。免疫组织化学结果肿瘤细胞显示vimentin,S-100,HMB-45和Melan-A阳性;不表达神经特异性烯醇化酶(neuron-specific enolase,NSE)、白细胞共同抗原(leukocyte common antigen,LCA)、细胞角蛋白(cytokeratin,CK)、嗜铬素蛋白-A(chromogranin proteins A,Cg A)和突触素(syn)。随瘤细胞浸润不同组织层次可伴有淋巴结转移。结论:PMME是一种罕见肿瘤,恶性度高、预后差。由于其症状与食管其它肿瘤相似,在活检或手术前很难确诊,对发生于中老年人的食管中段蕈伞型肿物应考虑原发性恶性黑色素瘤的可能。临床病理分析肿瘤大小、浸润层次、淋巴结转移及治疗方式可能影响预后。     

食管原发性恶性黑色素瘤1例并文献复习

目的 探讨食管原发性恶性黑色素瘤的临床病理学特征及诊断要点.方法 对1例食管原发性恶性黑色素瘤进行组织学观察和免疫组化标记并相关文献复习.结果 食管原发性恶性黑色素瘤与其他部位的恶性黑色素瘤组织学类型相似,免疫组化:瘤细胞HMB-45、S-100、Vimenlin阳性;Cytokeratin(AE8),Cytokeratin(AE1/AE3),EMA,CgA阴性.结论 食管原发性恶性黑色素瘤是一种罕见肿瘤,恶性度极差,应与一些食管原发肿瘤如低分化鳞状细胞癌、神经内分泌癌、间质肉瘤等相鉴别.     

妊娠黄体瘤10例临床病理研究

目的:探讨卵巢妊娠黄体瘤(pregnancy luteoma,PL)的临床病理学特点、免疫表型、组织学发生、诊断及鉴别诊断。方法:对10例妊娠黄体瘤的临床特点、组织形态学和免疫组织化学及网状纤维染色的结果进行分析,并复习相关文献。结果:10例PL均为初产妇,无妊娠史;肿瘤3~10 cm,棕黄色或红褐色,质地嫩。镜下可见瘤细胞胞质嗜酸性,弥漫性增生。免疫组织化学结果示:α-inhibin,AE1/AE3,CD99及波形蛋白阳性,上皮膜抗原,S-100,HMB45及MelanA阴性。网状纤维染色结果示嗜银网状纤维呈黑色包绕在瘤细胞巢周围。结论:PL是一种罕见瘤样病变,多在妊娠末期出现,大体观、免疫组织化学染色及网状纤维染色结果有助于本病的诊断,需与类固醇细胞瘤、妊娠黄体、转移性恶性黑色素瘤等鉴别。     

鼻腔无色素性恶性黑色素瘤的病理特征及鉴别诊断

目的：探讨鼻腔原发性无色素性恶性黑的病理特点及其鉴别诊断。方法：对9例鼻腔无色素恶性黑色素瘤进行光镜观察，并对全部病例作免疫组化染色。结果：光镜形态以细胞形态的多形性和组织结构的多样性为主要特点，免疫组化染色S^-100蛋白、HHB^45及波形蛋白的阳性率分别为100％、88．9％和77．8％。结论：鼻腔无色素性恶性黑色素瘤组织学结构的变化特点有重要意义，免疫组织化学对其诊断及与鼻腔发生的其他肿瘤的鉴别诊断有重要价值。     

卵巢原发性非霍奇金恶性淋巴瘤的诊断与鉴别诊断

目的探讨卵巢原发性恶性淋巴瘤的诊断及卵巢原发性恶性肿瘤（颗粒细胞瘤、克鲁根伯瘤、未分化癌、无性细胞瘤及原始外胚叶肿瘤）鉴别诊断。方法应用组织病理学及免疫组织化学观察。结果免疫组织化学明确了卵巢原发性恶性淋巴瘤的诊断。结论原发性恶性淋巴瘤非常罕见，临床及病理诊断较困难，单凭形态学很难与其他小细胞肿瘤相鉴别，免疫组织化学标记有一定价值。     

原发性食管恶性黑色素瘤的X线及CT诊断

目的提高对于原发性食管恶性黑色素瘤影像的认识。方法回顾性分析4例经手术病理证实的原发性食管恶性黑色素瘤患者的X线及CT影像资料,并复习相关国内外文献。结果 4例患者术前均行上部胃肠道口服钡餐造影及多层螺旋CT检查。肿瘤均为单发,2例肿瘤位于食管下段,2例位于食管中下段。病变均突向腔内,2例呈结节样,2例为不规则肿块。4例中1例螺旋CT证实有食管旁淋巴结增大。4例中1例术前考虑为原发性食管恶性黑色素瘤,3例考虑为食管癌。结论原发性食管恶性黑色素影像表现缺乏特异性,当食管中下段发现肿瘤且梗阻不明显时,应考虑原发性食管恶性黑色素可能。     

鼻腔恶性黑色素瘤临床病理分析

目的 探讨鼻腔恶性黑色素瘤的临床病理特征,对其诊断和鉴别诊断进行讨论,以提高对该病的认识.方法 收集我院1995年至2007年4例鼻腔恶性黑色素瘤病例,观察其临床病理特点并进行免疫组化分析.结果 4例鼻腔恶性黑色素瘤中男性2例,女性2例,年龄37～77岁,70岁以上3例,37岁1例,病变主要发生于鼻腔,其中左鼻腔1例,右鼻腔3例,肿瘤由上皮样、梭形及未分化小细胞等多种类型的细胞构成,通常血管周围细胞呈瘤样结构.免疫组化标记瘤组织HMB45、S-100和Vim均( ).结论 鼻腔恶性黑色素瘤是鼻腔的罕见疾病,通常诊断较困难,根据其组织学改变和免疫组织化学染色可有助于与鼻腔其他原发肿瘤相鉴别.     

Malignant melanoma of the esophagus

We have presented a case of malignant melanoma of the esophagus, which appeared to be a primary neoplasm. Characteristic clinical, histologic, and ultrastructural features are described. This lesion should be suspected clinically when a polypoid mass is found in the esophagus, even in the absence of pigmentation.     

Multifocal malignant melanoma of the esophagus.

We have described a case of primary melanoma of the esophagus in an asymptomatic patient. The tumor presented as a multinodular filling defect on a routine barium swallow. The distal esophagus and a proximal portion of the stomach were resected. The patient died ten days postoperatively of Klebsiella sepsis. Grossly, the surgical specimen showed multiple polypoid tumors which arose from separate pigmented areas shown microscopically to be melanoma in situ. By electron microscopy, the tumor cells contained numerous melanosomes in various stages of melanization. Primitive hemidesmosomes were found where a basal lamina was present. Better developed desmosomes interconnected the melanocytes.     

The screening test of various chemotherapeutic drugs in primary malignant melanoma cells and human malignant melanoma cell line (TM-1).

The sensitivities to various chemotherapeutic drugs of the primary malignant melanoma cell of the esophagus and the malignant melanoma cells established from human skin were studied by determining the incoporation of 3H-thymidine into tumor cells using the tissue culture method. The incorporation of 3H-thymidine was depressed by a low concentration of Actinomycin D in malignant melanoma cells of the esophagus and by a low concentration of Adriamycin or Actinomycin D in the established malignant melanoma cells. When Actinomycin D was clinically used according to the experimental results, the subcutaneously metastasized tumor was remarkably reduced.     

Primary malignant melanoma of the esophagus

We report the case of a 74-year-old woman who was admitted to hospital with progressive dysphagia. Further examinations revealed a tumor in the esophagus in which the macroscopic aspect and the histological work-up showed a primary malignant melanoma. The histogenesis of primary malignant melanoma in the esophagus is discussed, and a short review of the literature presented.     

Metastatic tumors to the stomach: analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases.

BACKGROUND AND STUDY AIMS: There have been several published reports on metastatic lesions in the stomach, but the numbers of cases have been limited due to the low frequency of the condition. The present study examined the clinicopathological features of metastatic tumors in the stomach from distant sites in a large series of cases. PATIENTS AND METHODS: A total of 389 patients with gastric metastases from solid malignant tumors were examined between 1968 and 1998 at our institution. Of these, 347 were identified from a series of 6380 autopsy cases; 54 patients were diagnosed endoscopically while alive, 12 of whom had confirmation of the condition at autopsy. RESULTS: In the endoscopically diagnosed cases, the metastases presented as solitary (65%) or multiple lesions (35 %), and were more frequently located in the middle or upper third of the stomach. Although the endoscopic appearance often resembled that of submucosal tumor (51%) or primary gastric cancer (39%), the final diagnosis was easily obtained in over 90% of cases from endoscopic biopsies. In two cases of lung cancer and breast cancer, gastric metastases were found before the primary tumors. In the autopsy cases with solid malignancies, metastatic lesions to the stomach were found in 5.4%, and the lung, breast, and esophagus were common primary sites. Malignant melanoma was the most frequent tumor to metastasize to the stomach (29.6%). CONCLUSIONS: Since metastatic lesions to the stomach are rare, the above characteristics of the lesions should be borne in mind, and biopsies should be taken for precise diagnosis during endoscopic examinations.     

原发性鼻腔鼻窦黏膜恶性黑色素瘤4例临床病理分析

目的 探讨原发性鼻腔鼻窦黏膜恶性黑色素瘤(SMMM)的临床病理特点、鉴别诊断、治疗与预后.方法 回顾性分析4例SMMM的临床病理资料,观察其组织形态特征及免疫组化特点,并复习相关文献.结果 患者男性1例,女性3例,平均年龄75.5岁(65～90岁),临床主要表现为鼻塞、出血及鼻腔新生物,镜下瘤细胞形态多样,异型性较明显,以上皮样细胞和小圆细胞为主,伴有局部少量梭形细胞样细胞,仅部分显示黑色素.其中1例可见黏液样变,1例色素性黏膜恶性黑色素瘤局部复发后细胞体积明显增大,色素减少,多数细胞胞质透明,呈气球样变.免疫组化示HMB45、vimentin、S-100均不同程度(+),NSE、LCA、sMA、CD99和desmin(-),局部CK、CD68弱(+)各1例,Ki-67程度不一.结论 鼻腔原发性黑色素瘤少见,恶性程度较高,形态多样,免疫组化对诊断及鉴别较为重要.     

卵巢原发性恶性黑色素瘤1例及文献复习

目的 探讨卵巢原发性恶性黑色素的临床病理特征,及其与卵巢转移性肿瘤的鉴别诊断。方法 对１例原发于卵巢囊性畸胎瘤的恶性黑色素瘤标本,通过光镜及免疫组化等方法进行病理组织学观察。结果 组织学特征为：肿瘤细胞大小不等,形态多样,界限不清,呈透明细胞和／或印戒细胞样;瘤细胞内外可见一些粗大的黑色素颗粒,瘤组织内血管较多,核分裂现象多见,〉１０个／１０ＨＰＦ。免疫组化ＨＭＢ４５、Ｖｉｍｅｎｔｉｎ及Ｓ－１００