胆囊原发性恶性黑色素瘤1例及文献复习

目的探讨胆囊原发性恶性黑色素瘤的I临床病理特征、组织发生及鉴别诊断。方法对1例原发于胆囊的恶性黑色素瘤进行光镜观察,并行组织化学及免疫组化染色标记。结果组织学特征为：在上皮和固有层交界处黑色素肿瘤细胞呈巢状或片状分布,肿瘤细胞大小不等,形态多样。瘤细胞内外可见粗大的黑色素颗粒,Masson—Fontana染色阳性,免疫表型HMB45、vimentin及S-100蛋白肿瘤细胞呈阳性表达。结论胆囊原发性恶性黑色素瘤罕见,诊断必须结合病史、全身检查及随访资料,以排除转移性恶性黑色素瘤。     

原发性胃绒毛膜癌临床病理分析

研究胃原发性绒毛膜癌的组织学特点，探讨其组织学的发生。方法：对１例残胃原发性绒毛膜癌进行尸检、组织学观察，应用免疫组织化学研究其组织学的发生。结果：肿瘤表现单一的绒毛膜癌形态伴有坏死和出血，肿瘤转移至肝脏，双肺及胃周围淋巴结。免疫组化肿瘤表达ＨＣＧ阳性，部分肿瘤细胞表达ＣＫ阳性。在目前英文文献报道的４８例胃原发性绒毛膜癌中，２８．３％病例以单一的绒毛膜癌形态，１３％的病例胃为腺癌而转移灶为绒毛膜癌     

鼻腔恶性黑色素瘤10例临床病理分析

目的 探讨鼻腔恶性黑色素瘤的临床病理特征,并对其诊断和鉴别诊断进行讨论.方法 结合组织形态学结构和免疫组化,对10例鼻腔恶性黑色素瘤进行临床病理分析.结果 10例鼻腔恶性黑色素瘤中男性3例,女性7例,年龄52～83岁,平均年龄59.8岁.肿瘤由上皮样,梭形及未分化小细胞等多种类型的细胞组成.免疫组化标记瘤细胞均表达HMB-45、S-100蛋白、vimentin.结论 鼻腔黏膜恶性黑色素瘤易误诊为其它鼻腔原发性肿瘤,导致临床处理不当,延误治疗,与皮肤恶性黑色素瘤相比,鼻腔黏膜恶性黑色素瘤更具有侵袭性、预后差等特点.     

《临床与实验病理学杂志》2004年第20卷关键词索引

AA10 3　肾上腺肿瘤中A10 3、Inhibinα和c erbB 2的表达 (3) :316AgNOR技术　 AgNOR技术的“一法多用”(1) :110API2 MALT1　胃MALT淋巴瘤中API2 MALT1的检测及其临床病理意义 (4 ) :397癌肉瘤　胆囊癌肉瘤 1例 (6 ) :75 8BBRCA1　散发性乳腺癌中BRCA1和cyclinB1的表达 (3) :2 73白血病　毛细胞白血病细胞表面糖蛋白三聚体的免疫电镜检测 (6 ) :72 0贲门肿瘤　原发性食管胃交界处恶性黑色素瘤 1例及文献复习 (4 ) :4 4 7鼻咽肿瘤　鼻咽癌组织中巨噬细胞移动抑制因子和MMP 2、MMP 9表达的关系 (2 ) :16 9鼻咽癌中hTER…     

恶性黑色素瘤生物免疫治疗的研究进展

恶性黑色素瘤是一种恶性程度极高的皮肤肿瘤,病人发生转移后应用传统治疗方法很难达到有效治疗.自从恶性黑色素瘤的肿瘤抗原表位被发现后,恶性黑色素瘤的免疫治疗就开始成为研究热点.过继性细胞治疗临床应用研究在近几年内得到快速发展,其中疗效最好的当属肿瘤浸润淋巴细胞(TIL)回输治疗,其治疗有效率可以达到70%以上.同时,各种用...     

黑色素瘤优先表达抗原免疫组织化学染色在良恶性皮肤黑色素细胞肿瘤鉴别中的应用

目的探讨黑色素瘤优先表达抗原(PRAME)免疫组织化学染色在良恶性皮肤黑色素细胞肿瘤鉴别中的应用价值。方法收集北京大学第三医院病理科2018年10月至2020年12月间常规及会诊确诊的黑色素瘤病例59例(皮肤原发性黑色素瘤50例, 转移性黑色素瘤9例), 黑色素细胞痣48例(普通型痣40例, 非典型性痣8例), 进行PRAME免疫组织化学染色, 比较黑色素瘤和黑色素细胞痣中PRAME免疫组织化学表达的差异。结果皮肤原发性黑色素瘤患者50例, 男性23例, 女性27例;年龄33～87岁(平均年龄62.4岁, 中位年龄64.5岁)。转移性黑色素瘤9例, 男性7例, 女性2例;年龄40～82岁(平均年龄64岁, 中位年龄65岁)。26例(26/50, 52.0%)皮肤原发性黑色素瘤和4例(4/9)转移性黑色素瘤均表现为PRAME弥漫阳性;40例(40/40, 100%)普通型痣和8例(8/8)非典型性痣均表现为PRAME阴性。黑色素瘤组中PRAME弥漫阳性病例数所占比例显著高于黑色素细胞痣组(P<0.05)。本组病例中, PRAME鉴别良恶性皮肤原发性黑色素细胞肿瘤的灵敏度和特异度分别...     

胃肠道间质瘤的TNM分期系统简介

2009年底国际抗癌联盟(UICC)和美国癌症联合会(AJCC)合作制定了第7版肿瘤TNM分期,规定从2010年1月开始生效[1-2].其中增加了9种肿瘤的TNM分类,这9种肿瘤分别是上消化呼吸道黑色素瘤、食管-胃交界处癌、胃肠道间质瘤(GIST)、阑尾癌、神经内分泌肿瘤(胃、肠、阑尾、胰腺、肺)、肝内胆管癌、Merkel细胞癌、子宫肉瘤和肾上腺皮质肿瘤.     

无色素性恶性黑色素瘤伴全身转移一例

恶性黑色素瘤来源于成黑色素细胞、好发于皮肤。口腔内的恶性黑色素瘤多见于牙龈和腭部,来自粘膜黑斑和色素痣;约有30％的粘膜黑斑可发生恶变。临床特点是肿瘤呈蓝黑色,为扁平结节状或乳突状的肿块,生长迅速,向四周扩散,并浸润至粘膜及骨组织内引起牙槽突及颌骨破坏,使牙齿发生松动,故典型的恶性黑色素瘤不难诊断。但无色素性恶性黑色素瘤甚少     

原发宫颈恶性黑色素瘤术后复发并广泛腹腔转移1例

恶性黑色素细胞瘤是一种高度恶性肿瘤,主要发生于四肢皮肤,其次肛管、鼻窦、眼眶、内耳等脏器。女性生殖道恶性黑色素瘤的发生率约占女性全身恶性黑色素瘤的3%,极少发生在宫颈;但宫颈恶性黑色素瘤同其他部位的恶性黑色素瘤生物学特点     

原发性肝脏恶性黑色素瘤1例并文献复习

目的 探讨原发性肝脏恶性黑色素瘤患者的临床病理学特征、诊断、鉴别诊断、治疗方法和预后.方法 报道1例原发性肝脏恶性黑色素瘤,对其进行光镜观察、免疫组织化学染色,并复习相关文献,探讨该病的临床病理学特点.结果 肿瘤位于肝脏右叶,浸润性生长.组织学上可见肿瘤细胞呈结节状或巢状分布,并见少量黑色素沉积,细胞呈圆形、卵圆形、多角形或梭形,细胞界清,胞质丰富,核大深染,可见1～2个大的核仁.免疫表型:肿瘤细胞HMB45、S-100、vimentin、Melan-A呈强阳性表达,Ki-67增殖指数35%,肿瘤细胞不表达CKpan、EMA、CEA、低分子量CK、高分子量CK、CK7、CK8、CK19、CD34、AFP、CD45、ALK、CD117、Dog-1、actin、α-SMA、h-caldesmon、CD68、CD163、Syn、CgA.病理诊断:原发性肝脏恶性黑色素瘤.结论 原发性肝脏恶性黑色素瘤是一种罕见的高度恶性肿瘤,临床与病理均要与转移性肝脏恶性黑色素瘤、肝脏低分化癌、转移癌、淋巴瘤等相鉴别,预后不良.     

Melanocytes and melanosis of the oesophagus in Japanese subjects — analysis of factors effecting their increase

Summary Normal oesophagus specimens taken from 65 autopsy cases and surgical specimens from 127 oesophageal carcinoma cases were examined histopathologically to determine melanocyte incidence and distribution. Melanocytes were found in the epithelio-stromal junction in 7.7% of normal oesophagus specimens examined at autopsy, and in 29.9% of surgical cases with oesophageal carcinoma. Positive specimens in the latter groups, especially from pre-operatively irradiated individuals, showed a more remarkable increase of melanocytes than was evident in any of the normal oesophageal samples. There were no significant differences in incidence between males and females, or between age groups. In cases where the cancer invaded into deeper stroma, the melanocytes were mainly observed in the normal epithelium around the carcinomas. Epithelial and stromal elements of the melanotic mucosa commonly showed hyperplastic changes such as acanthosis or basal cell hyperplasia, and chronic oesophagitis. Melanocytes were observed most commonly in the lower part of the oesophagus, the site where malignant melanoma of the oesophagus, most often originates. These results strongly suggest that the melanocyte increase observed in areas of hyperplastic epithelium and chronic oesophagitis may play an important role as a precursor lesion for malignant melanoma in the oesophagus.     

Primary malignant melanoma of the ovary: case report and review of the literature

Ovarian malignant melanomas are extremely rare tumors. Most of them are secondary tumors and disseminated metastases are recognized at the time of diagnosis. Primary tumors are even more rare and usually associated with a teratoma. A 67-year-old female had a pelvic mass that was recognized on ultrasonography (USG) and physical examination. Intraoperative pathological consultation was reported as "pigmented solid ovarian tumor, probably compatible with malignant melanoma". Paraffin sections, and histochemical (Masson Fontana and Prussia blue) and immunohistochemical examination (S-100 and HMB-45) were also consistent with "malignant melanoma". This case was accepted as "Probably primary ovarian malignant melanoma" in lack of any other tumor focus on detailed clinical and radiological investigation, skin biopsies or pigmented lesions in medical history. It is reported for being an extremely rare tumor and its distinctive characteristics for differential diagnosis are emphasized.     

Vascular architecture of melanocytic skin tumors. A quantitative immunohistochemical study using automated image analysis

The present study examines the distribution of blood vessels in melanocytic skin tumors. Fresh frozen sections of 11 cases each of benign nevocellular nevus, primary malignant melanoma and metastatic malignant melanoma were stained with the endothelium-specific monoclonal antibody BMA 120 and evaluated by an automated image analysis system. Additionally, the proliferative activity was assessed in parallel sections using Ki 67 monoclonal antibody. There were only slight differences between the diagnostic groups as to the vascular distribution in the tumor center, but there were remarkable differences in the connective tissue at the base of the lesions: The area occupied by small vessels (minimum diameter less than 20 microns) was 0.3 +/- 0.05% in benign nevi, 0.6 +/- 0.05% in primary malignant melanoma, and 1.2 +/- 0.10% in metastatic malignant melanoma (U-test: p less than or equal to 0.05). The proliferative activity within each lesion showed a strong positive correlation with the number of small vessels at the base of the tumor (linear regression analysis: r = 0.86; p less than or equal to 0.0001). The findings demonstrate that neovascularization in malignant melanocytic tumors takes place predominantly in the surrounding host tissue and is closely related to the proliferative activity.     

Rhabdomyoblastic differentiation in malignant melanoma in adults: report of 2 cases

Two cases of malignant melanoma are reported in adults exhibiting rhabdomyoblastic differentiation to alert pathologists to this rare variant of malignant melanoma. One of the cases presented as a metastasis in a submandibular lymph node, and the other was a primary skin melanoma. There are only a few published reports on melanocytic tumors with rhabdomyoblastic differentiation, mainly occurring in giant congenital nevi. Both cases reported here were confirmed by immunohistochemistry. Both cases were also studied by electron microscopy, and one showed distinctive ultrastructural features of striated muscle.     

Scalp junctional nevus with malignant transformation (melanoma) metastatic to parotid lymph node region,cervical lymph nodes and the back: a case report and review of literature

Parotid malignancy may occur as a primary neoplasm of the salivary tissue or as metastatic involvement of the parotid lymph nodes. Primary tumors of squamous cell carcinoma and malignant melanoma involving the skin of the head and neck have the potential to spread to lymph nodes of the parotid gland. Metastatic malignant melanoma to the back was exceptionally rare and no such reports have been noted in the literature. We reported an exceptional case of intraparotid lymph nodes metastasis of the right scalp junctional nevus with malignant transformation to malignant melanoma in a 48-year-old man. The patient presented with a mass in the parotid gland area, which was misdiagnosed as a primary parotid tumor and surgical removal was performed. Unfortunately, recurrence with newly developed metastatic lesions in the back and cervical lymph nodes occurred 1 year after initial surgical management. This case is presented highlighting the unusual features of metastatic junctional nevus with malignant transformation to malignant melanoma of intraparotid lymph nodes, cervical lymph nodes and the back, which should help us to reduce misdiagnosis and obtain the best results.     

Immunohistochemical and ultrastructural investigation on cutaneous neuroendocrine carcinoma: report of a case and review of the literature

We report a tumor in an 80-year-old man that was difficult to distinguish from other tumors, i.e., small cell carcinoma of the lung, PNET/Ewing tumor, malignant lymphoma, or malignant melanoma (amelanotic), and which was finally identified as cutaneous neuroendocrine carcinoma using immunohistochemical and ultrastructural methods. Autopsy did not show any tumors in the lungs, excluding the possibility of small cell carcinoma of the lung. Immunohistochemistry tests gave negative results for LCA, UCHL-1, CD3, and CD20, thereby excluding malignant lymphoma, and the negative results for S-100 protein and HMB-45 ruled out malignant melanoma. The possibility of PNET/Ewing sarcoma was also excluded because of negativity for CD99. In addition, the ultramicrostructure showed intercellular junctional complexes and neuroendocrine granules, indicating that the tumor had characteristics of both epithelial and neuroendocrine tissues. We therefore diagnosed the primary carcinoma of the skin as cutaneous neuroendocrine carcinoma.     

Fine-needle aspiration cytologic diagnosis of metastatic melanotic schwannoma: familial case of a mother and daughter with Carney's complex and literature review

Carney's complex is an autosomal dominant, multisystem tumorous disorder that includes myxomas, spotty skin pigmentation, endocrine tumors, and peripheral nerve tumors. Psammomatous melanotic schwannomas have recently been included as a part of this complex. Here, we describe the first known familial case of a mother and daughter, both presenting with malignant, already metastatic, pigmented schwannomas initially diagnosed as metastatic melanoma by CT guided fine-needle aspiration.Patients with highly pigmented, extra-cutaneous lesions that are clinically and pathologically suspicious for metastatic malignant melanoma, without known primary tumor, should be evaluated for possible Carney's complex. Additional screening of family members should be recommended to exclude the presence of potentially malignant neoplasms, such as psammomatous melanotic schwannomas.     

Bilateral oncocytic malignant melanoma in axillary lymph nodes without evidence of an extranodal primary

A malignant melanoma was diagnosed in an axillary lymph node of a 49-year-old man. The tumor was examined by electron microscopy and was found to be composed of large oncocytic cells, filled with abundant mitochondria. No primary tumor could be identified on the skin or within internal organs. Approximately 2 years after the initial diagnosis, the patient presented with malignant melanoma in an axillary lymph node on the contralateral side. The second tumor also expressed the same oncocytic phenotype, favoring the common origin of both tumors. These data illustrate that oncocytic melanomas may retain their oncocytic phenotype during metastatic dissemination.     

Development of a tridimensional microvascularized human skin substitute to study melanoma biology

Cutaneous malignant melanomas represent an important clinical problem because they are highly invasive, they can metastasize to distant sites and are typically resistant to available therapy. The precise molecular determinants responsible for melanoma progression and chemo-resistance are not yet known, in part due to lack of pertinent experimental models that mimic human melanoma progression. Accordingly, we developed a complex human microvascularized reconstructed skin substitute in which the organized three-dimensional (3D) architecture of the native skin is reproduced. Human melanoma cell lines derived from primary and metastatic sites were added to this 3D model. Our results demonstrate that histological features and behavior of melanoma cells applied in our skin substitute model are specific to their site of origin. In particular, the ability of melanoma cells to cross the dermal–epidermal junction correlates with their metastatic potential. In addition, a potent angiogenic effect was detected for an aggressive metastatic cell line that produces VEGF. The presence of a microvascular network within this model will allow studying a crucial step of the metastatic process. We conclude that such an in vitro human tumor microvascularized reconstructed skin substitute promises to be a versatile and efficient model to investigate skin cancer progression and to screen new anticancer drugs to improve currents clinical treatments.     

Proliferative activity of primary cutaneous melanocytic tumours

The expression of proliferating cell nuclear antigen (PCNA) was examined in formalin-fixed paraffin-embedded tissue sections from 41 lesions (27 melanocytic nevi, 3 atypical nevi and 11 malignant melanomas) to determine the proliferative activity of primary cutaneous melanocytic tumours. Most of the malignant melanomas had more than 7% PCNA-positive cells (9.2±0.5%), while the melanocytic nevi manifested less than 1% PCNA-positive cells (0.4±0.1%). Atypical nevi exhibited an intermediate, but still significantly lower, labelling ratio when compared with malignant melanomas (0.8±0.2%). The proliferative activity of the lesions was compared between portions at different depths in the skin (epidermal, upper dermal and lower dermal location). In cases of malignant melanoma, the proliferative activity was higher in the deeper portion of dermis whereas PCNA-positive cells in melanocytic nevi were located in the upper dermis predominantly. Thus the PCNA labelling ratio of malignant melanoma and/or melanocytic nevus cells located in the epidermodermal junction was not necessarily higher than that of malignant melanoma and/or melanocytic nevus cells in the dermis. These results indicate that staining with PCNA would be very useful in the differentiation of malignant melanoma from melanocytic nevi manifesting cellular and/or structural atypia by virtue of a significant difference in the proportion of PCNA-positive cells. Although malignant melanomas have higher proliferative activity than melanocytic nevi in the deeper dermis, junctional activity in melanocytic tumours does not indicate cell proliferation.