足跟部皮肤恶性黑素瘤的治疗分析

皮肤恶性黑素瘤（ＭＭ）是恶性肿瘤中恶性程度较高的一种，而ＭＭ的发病率有逐年上升的趋势。在我国的ＭＭ病人中发生于肢端的ＭＭ患者并不少见，对这部分病人如何进行有效的治疗是大家关心的问题。我们对５例足跟部ＭＭ采取了病灶切除、游离植皮方法进行治疗，取得了较好的疗效。现报告如下。材料与方法临床资料　５例中，男３例，女２例，年龄４５～８０岁，平均５９．２岁。病程２月～１６年，平均４．２年，均为无意中发现足跟部出现黑（褐）斑，其中２例（例１、２）曾有剜除病灶史。体检：右足跟病灶３例、左足跟２例，病灶最小为１．…     

面部恶性雀斑样黑素瘤二例

例1女,37岁.右侧口角黑色斑片4年,多次手术切除仍复发就诊.患者于4年前无明显诱因右侧口角出现米粒大小黑色斑片,渐增大,当地医院行激光治疗,治疗后不久原皮损处又出现黑色斑片.此后1年中,黑色斑片进行性增大,无任何不适.3年前分3次手术切除该黑色斑,病理诊断为复合痣,皮脂腺痣.术后不久患处义出现褐色皮疹,渐增大至1 cm×1 cm大小.2年前再次切除,术后病理报告“交界痣”.     

头皮上皮样血管瘤一例

患者,女,36岁.头皮丘疹、结节3年余.皮损组织病理示:真皮内和皮下组织见大量血管腔隙组成的小叶状团块,境界不清,增生的血管内皮细胞肥大而圆,突向管腔,间质间见淋巴组织和大量嗜酸粒细胞浸润.诊断:上皮样血管瘤.     

皮肤上皮样血管瘤样结节一例

50岁女性患者,右前臂结节3年.右前臂可见一约花生米大黑色结节,无压痛.皮损组织病理示:表皮变薄,两端皮突下延呈衣领状包绕肿瘤团块,瘤体由分化成熟的小血管和上皮样细胞组成,细胞大,泡状核,胞质丰富、嗜伊红.部分细胞胞质内可见空腔,腔内可见红细胞.免疫组化染色示:CD31(+).诊断:皮肤上皮样血管瘤样结节.手术完整切除...     

上皮样血管瘤1例

报告1例发生于头部的上皮样血管瘤。患者男，40岁。左侧头皮多发性丘疹、结节7年组织病理检查示：病变由许多增生的大小不等的血管组成，血管内皮细胞较肥大，呈立方形或上皮样突向腔内形成鞋钉状，血管间散在灶性炎性细胞浸润，以淋巴细胞为主，可见少量嗜酸粒细胞，病理诊断为上皮样血管瘤。     

息肉样黑素瘤一例

患者女,49岁。因右腰部起小结节半年余就诊。患者于半年前无意间发现右腰部有一绿豆大的红色小结节,逐渐增大,为明确诊断于2007年7月27日来我院就诊……     

肾小球样血管瘤

报告1例肾小球样血管瘤.患儿男,9岁.颈部红色丘疹3年,逐渐增大,无任何不适.体格检查示颈部一0.5cm×0.8cm红色结节;系统检查无异常.皮损组织病理检查示真皮内较多扩张的血管腔,内含增生的毛细血管袢,似肾小球结构.免疫组化检查示扩张的血管腔和毛细血管袢内皮细胞CD31和CD34阳性.诊断为肾小球样血管瘤.     

汗腺血管瘤样错构瘤1例

患者男,35岁。因左臀部大片褐红色斑块伴局部多汗35年,于2000年5月10日至我院就诊。患者自出生时左臀部即有一核桃大褐红色斑,逐渐增大,隆起,伴局部多汗;当剧烈活动时局部出汗明显增多。皮损处有轻度触痛。既往体健。体格检查:系统检查无异常。皮肤科检查:左臀部见-20 cm×19 cm褐红色斑块,境界清楚,形状不规则,表面有密集分布的粟粒大丘疹,丘疹顶部多呈细小颗粒状,并见许多黄豆至小枣大、不规     

小汗腺血管瘤样错构瘤1例

患儿男,3岁2个月。左大腿出现皮疹伴疼痛1年。皮肤科情况:左股伸侧多个丘疹、结节,融合成境界清楚斑块,可见散在毛发分布,按压疼痛明显,无明显多汗。皮损组织病理示:表皮角化过度伴灶性角化不全,棘层呈轻度乳头瘤样增生,真皮浅中层血管成簇、密集增生,深层大量小汗腺腺体和腺管增生。诊断:小汗腺血管瘤样错构瘤。     

无色素性恶性黑素瘤一例

患者男,56岁,农民。右足底皮肤结节1年多,增大伴出血半年。患者于1年前发现右足跟内侧绿豆大小淡红色结节,不痛不痒,自行用缝衣针挑破。近半年来结节逐渐增大至核桃大小,易出血,外用红霉素等抗生素软膏无明显效果,故来皮肤科求诊,怀疑鳞状细胞癌或汗腺肿瘤而手术治疗。起病前局     

血管瘤样纤维组织细胞瘤

报告1例血管瘤样纤维组织细胞瘤.患者女,24岁.因左胫前出现无痛性紫红色皮下结节4年就诊.皮损组织病理检查:真皮下层可见肿瘤细胞团块,肿瘤主要由成纤维细胞样细胞和组织细胞样细胞组成,在肿瘤团块中可见数处不规则出血性裂隙和囊腔,但管周无内皮细胞.免疫组化染色示肿瘤细胞波形蛋白(vimentin)、平滑肌肌动蛋白(SMA)、上皮膜蛋白(EMA)和CD68阳性,而结蛋白(desmin)、S-100蛋白、CD31、CD34和Ⅷ因子相关抗原均阴性.结合临床表现、组织病理改变和免疫组化染色,诊断为血管瘤样纤维组织细胞瘤.     

A case of Werner syndrome with three primary lesions of malignant melanoma

Three primary lesions of malignant melanoma developed in a 44-year-old Japanese woman with Werner syndrome. One lesion was on the right large pudental lip and the others in distinct locations on her left sole. After the wide local excision of these tumors, the wound of the large pudental lip was sutured, and the defects on the sole were covered with skin grafts. After one course of chemotherapy consisting of dacarbazine, nimustine, vincristine sulfate and local injection of Interferon beta were performed, severe myelosupression occurred and continued for two months. Defective production of WRN protein was confirmed by Western blotting, although the three representative mutations in Japanese patients, mutations 1, 4 and 6, which include over 90% of the Japanese patients, were not detected. We also reviewed 26 cases of malignant melanoma associated with Werner syndrome (WS), including ours.     

A case of pedunculated malignant melanoma of the vaginal mucosa.

We report an 84-year-old Japanese woman who presented with a pedunculated malignant melanoma of the vaginal mucosa. Mucosal melanoma is believed to be more common in Japan than other countries, but such tumors of the vulvovaginal region are quite unusual. In our patient, three tumors were connected by a narrow pedicle. Three black tumors measuring 5-10 mm in diameter with a common pedicle were seen on the vaginal mucosa at five o'clock from the cervix. The tumors were hanging from the narrow pedicle. On histologic examination, they were diagnosed as malignant melanoma. Resection was done with a distal margin of 3 cm from the tumors and a margin of 1 cm from the cervix. The patient has had no evidence of local recurrence or distant metastasis. In our patient, the three main tumors had a common pedicle, which seems to be a unique finding. Since pedunculated malignant melanomas are rare, making a clinical diagnosis is difficult. Although pedunculated melanomas are recognized as having a high malignant potential because these lesions are generally thick, a relatively good outcome is sometimes reported. In our patient, there was no tumor infiltration into the dermis of the pedicle, and this may be one reason for the good outcome at present. There has been no previous report of a mucosal melanoma consisting of three tumors like those in the present patient.     

无黑素性黑素瘤伴全身转移1例

报道无黑素性黑素瘤全身转移1例。患者男 ,52岁 ,农民。左下肢有一米粒大小皮色肿物10年 ,增长缓慢。5个月前在基层医院行手术切除后很快发生局部淋巴结转移和全身转移。组织病理见真皮内瘤细胞呈团块状或巢状 ,小血管内可见肿瘤细胞浸润 ,HE染色未见黑色素。免疫病理S100( ) ,HMB45( )。     

转移性血管瘤样黑素瘤一例

恶性黑素瘤（MM）是黑素细胞起源的高度恶性肿瘤,具有侵袭性强、易发生早期转移及死亡率高等特点。血管瘤样黑素瘤（angiomatoid melanoma,AMM）是近期报道的一黑素瘤的组织学亚型,极为罕见,组织学上易误诊为血管性肿瘤。AMM的组织学改变可见于原发性黑素瘤,也可见于转移性黑素瘤。施启丰等［1］报道1例原发性AMM,现将我们诊治的1例转移性AMM报道如下……     

结节性恶性黑素瘤一例

结节性黑素瘤是一种处于垂直生长期的恶性黑素瘤亚型,占所有黑素瘤的10%～15%。皮损可为隆起的丘疹或斑块,偶尔呈息肉样,可发生于身体的任何部位。本患者,女,30岁。左上臂伸侧暗红色结节5年余,加重1年。皮损组织病理:真皮层见大量肿瘤细胞弥漫性浸润,细胞核大、异形,可见大量核分裂像。免疫组化:MelanA、SOX-10、Ki-67、P53、S-100均为阳性,Clark分级,IV级。诊断:结节性恶性黑素瘤。     

A case of tumor-to-tumor metastasis of cutaneous malignant melanoma

We report a case of tumor-to-tumor metastasis of a cutaneous malignant melanoma to a synchronous thyroid Hurthle cell carcinoma. A 42-year-old male underwent a biopsy of right inguinal lymphadenopathy which showed metastatic melanoma. The primary lesion was identified on his right posterior leg, and staging workup discovered a synchronous left thyroid lobe nodule concerning for a follicular neoplasm. He underwent excision of the primary melanoma, right inguinal lymphadenectomy, and total thyroidectomy. The resected thyroid contained a 6.6-cm, well-encapsulated left-sided nodule, red-brown in color and homogenous in consistency, with areas of focal hemorrhage and no grossly identifiable calcification. Microscopically, large tumor cells with distinct cell borders were present, with deeply eosinophilic and granular cytoplasm, large nuclei with prominent nucleoli, and loss of polarity consistent with oncocytes. A microscopic single focus of vascular invasion was identified, and a diagnosis of angioinvasive Hurthle cell carcinoma was made. Within the Hurthle cell carcinoma, multiple deposits of metastatic melanoma were seen. These findings were indicative of tumor-to-tumor metastasis of the cutaneous melanoma to the angioinvasive Hurthle cell carcinoma. Our findings show the ability of melanoma to metastasize to a pre-existing neoplasm.     

太田痣并发脉络膜黑素瘤

报告1例太田痣并发脉络膜黑素瘤.患者女,58岁.因右眼前黑影飘动、视物遮挡感伴视力下降6个月就诊.患者自14岁起右眼睑下方渐出现一淡青灰色斑片,随年龄增长而缓慢扩大,近5年来颜色明显加深.荧光素眼底血管造影及CT检查符合脉络膜黑素瘤表现,诊断为太田痣并发脉络膜黑素瘤.行~(106)Ru(钌)放射敷贴器置入术治疗.     

Congenital malignant melanoma: a case report

Congenital malignant melanoma (MM) is an uncommon condition that is defined as MM recognized at birth. Its incidence is difficult to determine because of the small number of reported cases and because of problems associated with diagnosis. Generally, Spitz naevus and melanoma have many clinical and histopathological similarities, so it is difficult to differentiate between the two. We describe a rare case of congenital MM in which differential diagnosis from Spitz naevus was problematic. In addition, we review the literature and comment on the prognostic differences among the three types of congenital and infantile MM.