淋巴结转移性恶性黑色素瘤25例

 目的 总结并探讨淋巴结内转移性恶性黑色素瘤的临床及病理诊断方法。方法 对76例恶性黑色素瘤中的25例淋巴结内发生转移的临床及病理资料进行回顾性分析，主要追问其原发病灶或病史。结果 25例均诊断为淋巴结内转移黑色素瘤，部分病例做了免疫组化检查，其中18例有恶性黑色素瘤病史，1例有黑痣激光治疗史，6例原发灶不明，恶性黑色素瘤易发生于四肢且易于淋巴结转移。结论 病史不明或无原发灶的病例诊断较困难，黑色素瘤抗体（HMB45）和S-100蛋白等标志物有助于诊断。     

阴茎原发性恶性黑色素瘤1例报告并文献复习

目的:探讨阴茎原发恶性黑色素瘤的生物学行为、临床病理特征、诊断、治疗方法及其预后。方法:报告1例阴茎原发性恶性黑色素瘤的诊断治疗及随访情况,并结合国内外文献进行分析。结果:本例患者肿瘤分期为Ⅰ期,行阴茎部分切除术及双侧腹股沟淋巴结清扫术,同时给予化疗及生物治疗。术后随访24 个月,体格检查正常,行盆腔 MRI 检查未见复发及远处转移。结论:阴茎原发恶性黑色素瘤临床罕见,恶性程度高,总体预后差,其确诊依靠病理,外科手术为主要治疗手段,术后结合化疗以及生物治疗可延长生存期。     

原发灶不明的恶性黑色素瘤腹股沟及髂血管淋巴结转移1例并文献复习

恶性黑色素瘤是一种黑色素细胞来源的高度恶性的皮肤肿瘤,发病率呈逐年升高趋势,且因其容易转移,可以在其他器官中发现[1].临床上恶性黑色素瘤多具有明确的原发灶,但小部分恶性黑色素瘤患者在临床诊治中不能找到明确的原发灶.根据两项系统评价结果,原发灶不明的恶性黑色素瘤(melanoma of unknown primary,MUP)在恶性黑色素瘤人群中的发生率为3％左右[2-3].南京大学医学院附属鼓楼医院烧伤整形科收治1例53岁MUP女性患者,其右侧腹股沟区域出现肿块后就诊.术后病理显示转移性恶性黑色素瘤.体格检查及病史发现右小腿可疑色素沉着区域,但病理报告及其他检查无法发现原发灶,进行转移性淋巴结清扫术后患者开始靶向治疗,随访4个月,目前患者无病生存中.本文主要对MUP的病因、诊断、治疗及预后进行探讨.     

恶性黑色素瘤广泛转移2例

例1 患者女,53岁。因左耳后黄豆大黑色肿块增大1年,于1996年8月5日行左耳大部切除术,病理诊断:结节型恶性黑色素瘤。术后行免疫治疗。1997年2月11日因左颈部淋巴结肿大,行左颈淋巴结廓清术,病理诊断为淋巴结转移性黑色素瘤(5/7),术后治疗同上。1999年6月16日因右股后肿块6个月入院。查体右股后皮下触及一约4cm×4cm肿块,边界清楚、质硬、固定、轻压痛,皮色正常。全身浅表淋巴结未触及。胸部X线及腹部B超检查未发现异常。6月21日在局麻下行右股后肿块切除,术中见肿块约4cm×4cm×3cm,呈暗黑色,边界尚清,基底与肌膜粘连,完整切除肿块及周边组织。病理诊断:转移性结节型恶性性黑色素瘤,血管内见瘤栓。患者拒绝治疗,仍在随访中。 例2 患者男,51岁。因左上臂肿块40年渐大1年于1997年4月24日入院。查体:左上臂6cm×4cm菜花样黑色肿块,表面破溃、出血。左腋下触及一直径约1cm肿大淋巴结,固定、无压痛。鼻、咽部无异常。胸部X线及腹部B超检查均正常。于1997年5月6日行左上臂肿块及左腋窝肿大淋巴结切除,病理诊断:左上臂恶性雀斑型黑色素瘤,血管内见瘤栓,淋巴结瘤转移(1/1)。出院后未行任何治疗。     

八例鼻腔恶性黑色素瘤的诊断和放射治疗

鼻腔恶性黑色素瘤约占全身恶性黑色素瘤的 1%。现报道本院 1991～ 1997年间收治的 8例鼻腔恶性黑色素瘤的诊断和放射治疗情况。1　材料和方法1.1　临床资料 :男性 6例 ,女性 2例。年龄 31～ 75岁。临床表现为鼻出血 (6例 )、鼻塞 (5例 )、耳鸣 (1例 )和头痛 (1例 )。1.2　诊断 :6例常规病理和免疫组织化学均诊断为恶性黑色素瘤 ,另外 2例常规石蜡切片染色病理诊断分别为恶性淋巴瘤和低分化鳞癌 ,后经免疫组织化学证实为恶性黑色素瘤。ＣＴ扫描显示病灶局限于鼻腔内 4例 ,侵犯筛窦 4例 ,其中同时侵犯蝶窦和上颌窦 3例 ,同时侵犯鼻咽 2例和侵…     

肺原发性恶性黑色素瘤1例报告

肺恶性黑色素瘤绝大多数为转移性的 ,原发性恶性黑色素瘤 (ＰｒｉｍａｒｙＭａｌｉｇｎａｎｔＭｅｌａｎｏｍａｏｆｔｈｅＬｕｎｇ,ＰＭＭＬ)则很罕见。据文献记载 ,符合ＰＭＭＬ诊断标准者共 33例。我们报告 1例有尸检材料证实的ＰＭＭＬ ,并复习文献 ,对其诊断、鉴别诊断、组织发生及预后进行讨论。病例报告 :男性 ,72岁 ,咯血痰 1个月入院。ＣＴ检查 :左肺下叶背段结节样致密影 ,边缘毛糙 ,密度不均。给予抗炎、抗结核治疗 1个月后复查阴影有增大趋势 ,因高度怀疑肺癌行左肺下叶切除术。术后病理诊断 :左肺下叶背段恶性黑色素瘤 ,建议检…     

原发性肺恶性黑色素瘤并多脏器转移1例报道

恶性黑色素瘤是起源于成色素细胞的恶性肿瘤,可发生于人体任何部位,皮肤恶性黑色素瘤较多见,而肺原发性恶性黑色素瘤(primary malignantmelanoma of the lung,PMML)较罕见,仅占肺部肿瘤的0.01％[1].国内公开报道符合PMML诊断标准者共33例[2],本院于201 1年收治1例,经皮肺穿刺病理检查确诊为原发性肺恶性黑色素瘤,现探讨该疾病的诊断和治疗,报道如下.     

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。     

球结膜恶性黑色素瘤术后颧部转移一例报告

通常认为，恶性黑色瘤在恶性肿瘤中的恶性程度最高，早期易发生远处转移，且对放疗不敏感。本文报道１例球结膜恶性黑色素瘤行眼球摘除术后出现局部转移。患者，男性，７６岁。１９９８年１月因右眼球新生物１月来本院眼科就诊，检查见右眼鼻侧结角膜缘有灰黑色结节状隆起，质硬、边缘不齐，约３ｍｍ×５ｍｍ×４ｍｍ大小，表面粗糙，局部有小溃疡形成，其上覆有灰黄稠厚分泌物，周围球结膜充血水肿，邻近角膜组织水肿混浊。入院初步诊断：右眼球结膜恶性黑色素瘤，局麻下行右眼球摘除术，术后病理诊断：右眼球结膜恶性黑色素瘤，梭形细胞Ｂ…     

15例胃肠道恶性淋巴瘤的内镜与病理分析

目的:探讨提高胃肠道恶性淋巴瘤早发现、早诊断的方法。方法:对15例胃肠道恶性淋巴瘤患者内镜表现及病理特点进行分析。结果:胃肠道恶性淋巴瘤内镜下表现不特异,病理诊断仍为金标准。结论:常规行内镜检查,并对可疑病灶例行病理检查,可望作到胃肠道恶性淋巴瘤的早发现、早诊断。     

A case report of long-term survival in the patient with anorectal malignant melanoma

Malignant melanoma of the anorectal region is rare, and the prognosis is considered to be poor. We present a case of long-term survival in a 56-year-old patient with primary malignant melanoma in the anorectal area, who complained of anal bleeding. Barium enema showed an elevated lesion in the anorectal region. Colonoscopy revealed a 3 cm sessile tumor with focal pigmentation, and a satellite nodule, 1 cm in diameter. Based on diagnosis of malignant melanoma by biopsy, abdominoperineal resection with lateral node dissection was performed. Pathologically the tumor remained in the mucosa, and no lymph node metastasis was found. This patient refused any adjuvant chemotherapy after the operation, and remains well without any sign of recurrence for seven years.     

外泌体与妇科恶性肿瘤相关性的最新研究进展

妇科恶性肿瘤是影响女性健康、降低女性生活质量的恶性疾病,并逐渐呈年轻化趋势。由于大多数妇科恶性肿瘤的早期临床表现不明显,因此很多患者就诊时已达中晚期。妇科恶性肿瘤患者,术后5年生存率与患者初次诊断时间呈正相关,所以其早诊断早治疗尤为重要。近年来多项研究表明外泌体积极参与了妇科恶性肿瘤的发生、侵袭、转移和免疫反应的调节,因此外泌体对于肿瘤的早期诊断、治疗及预后都提供了新的研究思路。本文就外泌体作为妇科恶性肿瘤的早期筛查标志物及其对临床治疗中抗肿瘤药物的研发方面进行综述。     

circRNA＿0016418及circRNA＿0017247异常表达对恶性黑色素瘤诊断及其预测淋巴结转移的价值

目的:探讨circRNA＿0016418及circRNA＿0017247异常表达对恶性黑色素瘤诊断及其预测淋巴结转移的价值。方法:选取2018年01月至2021年10月我院收治的68例恶性黑色素瘤患者,将其分为淋巴结转移组26例和无淋巴结转移组42例。采用实时荧光定量PCR法检测恶性黑色素瘤组织及正常组织中circRNA＿0016418及circRNA＿0017247的水平。应用受试者工作特征(receiver operating characteristic, ROC)曲线分析circRNA＿0016418及circRNA＿0017247异常表达对恶性黑色素瘤诊断及其预测淋巴结转移的价值。Pearson相关分析检测恶性黑色素瘤患者中circRNA＿0016418水平与circRNA＿0017247水平的相关性。结果:恶性黑色素瘤组织中circRNA＿0016418水平(2.64±1.17 vs 0.95±0.36)及circRNA＿0017247水平(5.18±2.50 vs 1.52±0.63)均明显高于正常组织(P<0.001)。淋巴结转移组circRNA＿0016418水...     

A case of malignant melanoma from the esophagus responding to weekly paclitaxel therapy

A 44-year-old man had a tumor in the lower thoracic esophagus at a health check, and was initially diagnosed as an undifferentiated carcinoma of the esophagus by the esophago-gastric endoscope. Although curative chemoradiotherapy was scheduled after the diagnosis, the interim evaluation revealed that the tumor was malignant melanoma of the esophagus with right renal metastasis. Since then, CVD (cisplatin, vindesine and dacarbazine) therapy, palliative radiotherapy and DAC-Tam (dacarbazine, nimustine, cisplatin and tamoxifen) therapy were carried out, but all of them proved ineffective, and multiple newly metastatic lesions appeared in liver and lymph nodes. Oral intake was impossible because of progressing stricture of the esophagus. As a fourth-line therapy, weekly paclitaxel therapy was started, and his oral intake was improved after the second course. He received the therapy as an outpatient for four months. After the third course, tumor lesions were evaluated as a partial response by CT. Consequently, five courses of the therapy were performed with modest adverse effects. Weekly paclitaxel therapy was reasonably safe as reported in other reports and considered to be a promising regimen for malignant melanoma of the esophagus.     

Central nervous system as exclusive site of disease in patients with melanoma: treatment and clinical outcome of two cases

The central nervous system (CNS) is a favourite site of metastasis in advanced melanoma and, despite the improvement obtained in the control of brain metastasis, most patients die as a result of extracranial progression of the disease. CNS primary malignant melanoma is a rare entity and the diagnosis is generally made after the exclusion of a primary cutaneous or mucosal/retinal malignant melanoma, as differential histological diagnosis between primary and metastatic origins is often difficult. From a review of the literature, patients with primary brain melanoma or exclusive (and limited) brain metastasis in the absence of extracranial melanoma present a relatively good prognosis if adequately treated with aggressive locoregional treatments (neurosurgery and/or radiotherapy) and, later, with drugs able to cross the blood-brain barrier (i.e. fotemustine). In this letter, we describe the history, treatment and favourable clinical outcome of two patients with melanoma and CNS as the exclusive site of disease.     

A case of liver metastasis from anorectal malignant melanoma treated by chemoembolization

Anorectal malignant melanoma is relatively rare and its prognosis is very poor because of distant metastasis via the blood or lymphatic vessels. This paper reports a case of liver metastasis from anorectal malignant melanoma treated by chemoembolization. A 68-year-old man was admitted to our hospital because abdominal enhanced computed tomography revealed multiple liver metastases. Angiography also revealed metastasis, so a chemoembolization with nedaplatin was performed. Two months later some lesions fell into necrosis but new ones appeared, and the same treatment was performed another three times. Accessory vessels from the inferior diaphragma artery developed and prevented these treatments. The patient died from the progress of metastases to the liver, bone and skin three years and two months after the operation, or one year and three months after the liver recurrence. The chemoembolization showed some effects on liver metastases from malignant melanoma, but they were temporary.     

Primary malignant melanoma of the penis: a case report

We present the case of a patient with malignant melanoma of the glans penis and urethral meatus, which was found in a 60-year-old man with non-healing ulcerative penile lesion and bilateral clinically palpable inguinal lymphadenopathies at diagnosis. A diagnostic biopsy showed the characteristics of a malignant melanoma. Incisional biopsies from the cutaneous lesions on his glans penis and urethra were performed. Histopathological examination of both specimens showed generally ulceronecrotic surface and numerous atypical melanocytic cells. The diagnosis of giant cell melanoma was made. Two months later, bilateral inguinal lymph nodes dissection was performed. Histopathological examination of both specimens demonstrated malignant melanoma metastasis. Three months after the diagnosis, the patient underwent partial penectomy. High-dose interferon-alpha-2b treatment was started. Early diagnosis is of paramount importance, as the prognosis becomes very poor with an advanced tumor stage.     

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.     

肢端恶性黑色素瘤前哨淋巴结活检35例报告

目的：探索99Tcm 标记的右旋糖苷结合γ射线探测仪在淋巴结显像中的用药规律和前哨淋巴结活检的准确性;探讨前哨淋巴结活检在恶性黑色素瘤早期转移诊治中的临床意义。方法2012年3月至2013年5月,我科收治35例肢端恶性黑色素瘤患者,其中手部8例、足部27例。所有病灶Breslow厚度均＞1 mm,且无临床及影像学淋巴结转移的证据。除外淋巴结已有转移的患者。术前4～6 h 在病灶周围注射1～2 mCi的99Tcm标记的右旋糖苷,注射后30 min、2、4 h行核素显像,获得前哨淋巴结的显像图。然后在麻醉下切取前哨淋巴结,术中用γ射线探测仪帮助定位和切取前哨淋巴结。术后淋巴结行3 mm一层的切片,行HE 染色和 HMB-45,S-100,Melan-A 免疫组化染色。前哨淋巴结活检结果阳性的行局部淋巴结清扫。结果核素注射后4 h前哨淋巴结显像稳定。27例足部黑色素瘤患者前哨淋巴结中有7例窝及腹股沟均显像,其余20例仅腹股沟淋巴结显像;8例手部黑色瘤患者中有2例滑车上及腋窝淋巴结均显像,其余6例仅腋窝淋巴结显像。35例均检出前哨淋巴结,前哨淋巴结检出率为100%。前哨淋巴结的个数为1～3个。5例患者的前哨淋巴结病理检查发现有转移,阳性率为14.3%。此5例均行淋巴结清扫术。结论用99Tcm标记的右旋糖苷作为显像剂、术中应用γ射线探测仪的前哨淋巴结活检技术在肢端黑色素瘤中是一种可靠的技术。     

Post-menopausal bleeding: a rare presentation of metastatic uveal melanoma

Uveal melanoma differs from cutaneous melanoma in many ways, including its pattern of metastasis, and exhibits latency with clinical evidence of metastasis sometimes appearing many years after primary diagnosis. Most patients develop metastasis within the liver, but some may present with metastasis to other sites. We report a case of uveal melanoma that presented with post-menopausal bleeding due to metastasis. Further investigation revealed widespread metastatic disease and the patient was not fit for chemotherapy. She died two months after presentation: autopsy revealed metastases in many sites, including the uterus, right ovarian fibroma, kidney, mesentery, liver, lung, thyroid, bone marrow and skin. The immediate cause of death was cardiac tamponade due to a malignant effusion secondary to cardiac metastasis. This case illustrates the widespread metastatic potential of uveal melanoma and highlights the potential for unusual presentation of metastatic disease from this eye tumor.(Pathology Oncology Research Vol 12, No 3, 184–187)