乳腺恶性黑色素瘤5例临床分析并文献复习

目的探讨乳腺恶性黑色素瘤的临床病理特点和治疗要点。方法回顾性分析5例经病理证实的乳腺恶性黑色素瘤的临床病理资料并结合文献,探讨其临床和病理特点以及治疗要点。结果本组5例患者的临床表现主要为质硬肿块,形态不规则,边界不清,活动度差,其中有3例发现腋窝淋巴结肿大。其辅助检查结果示本组病例肿块在乳腺彩超下表现为边界尚清晰的减弱回声团,彩色多普勒血流显像CFDI示肿块周边血流信号丰富,部分病例腋窝可见肿大的淋巴结,在乳腺钼靶摄片下本组病例肿块多表现为乳腺内软组织高密度肿块及结节影,乳腺癌可能性大,纤维瘤待排。1例病例术前全身核素骨扫描提示全身广泛骨转移。术中切开肿块可见切面呈灰白灰红色或者呈黑褐色,无包膜,镜检可见瘤细胞大小较一致,形态多变,胞质相对较少,胞核体积增大,圆形或不规则等,部分瘤组织中可见散在分布的色素颗粒。3例行乳腺癌改良根治术患者中,1例在彩超下发现淋巴结肿大的病检结果有2枚淋巴结出现癌转移,1例在彩超下未发现淋巴结肿大的病例仍发现了1枚腋窝淋巴结转移;另外1例术后病检未发现淋巴结癌转移。免疫组化结果中都提示HMB45（＋）,S100（＋）,ER（–）,PR（–）。本组病例中3例在我院行了乳腺癌改良根治术,并在术后予以紫杉醇类药物化疗6疗程,随访至今,未见复发及转移,1例患者仅行乳腺肿块切除术而要求行化疗,患者于术后10月因肺转移死亡,术前发现全身广泛性骨转移的患者放弃治疗,现已死亡。结论乳腺恶性黑色素瘤临床表现与其他乳腺恶性肿瘤不易鉴别,需要病理确诊,治疗上需广泛的局部切除并加以全身化疗,放疗及免疫治疗。     

小肠恶性黑色素瘤临床病理分析(附1例报告并文献复习)

目的探讨小肠恶性黑色素瘤的临床病理特点。方法对我院2010年收治的1例发生于十二指肠的恶性黑色素瘤的临床表现、组织形态学、组织化学及免疫组化进行分析,并复习相关文献。结果患者临床表现主要为黑便和贫血。光镜下十二指肠黏膜固有层中见弥漫浸润的小圆细胞,细胞胞浆较丰富,核仁明显,部分细胞的胞浆内可见黑色素颗粒。免疫组织化学染色显示肿瘤细胞HMB45、vim、M elan-A和S-100阳性;CK(AE1/AE3)、LCA、Syn和CgA阴性。Gomori氏网织纤维染色显示单个肿瘤细胞周边阳性。结论免疫组织化学是小肠恶性黑色素瘤诊断的重要辅助手段。原发性小肠恶性黑色素瘤预后更差,没有找到原发灶不能肯定肿瘤是原发。     

阴道巨大恶性黑色素瘤一例

恶性黑色素瘤好发于头、颈、足部和外阴,原发于阴道的极少,经计算机检索近１０年有关文献报告约２００例［１３］。而有关其ＭＲＩ表现,只有Ｍｏｏｎ等［１］报告２例,笔者未见国内文献报告。患者　女,６４岁。发现阴道肿物半年,偶有少量出血,近２个月肿物增大较快,伴尿频。体检：阴道口部见一约４ｃｍ×５ｃｍ大小的肿物,棕灰色,表面糜烂,无活动。内诊可触及该肿物自阴道口部延续至前穹窿,质硬、表面光滑,无出血,宫颈及宫体萎缩。实验室检查无阳性发现。ＭＲＩ检查：肿物巨大,周围伴多个子灶。侵及宫颈,与附近肌肉相比,…     

恶性黑色素瘤致截肢1例

患者男性，56岁，藏族，已婚，西藏昌都县人。患者8个月前无意中发现右足出现一桃仁大包块，无疼痛，无溃烂，包块突出皮肤，无行动不便和其它任何症状。因不影响生活，未行治疗。以后包块逐渐长大，菜花状生长，约鸡蛋大小。于2006年03月28日入我院。患者长年在昌都县牧区居住，无烟酒及其他特殊嗜好。无疫水、疫源接触史、无毒物、放射性物质及传染病患者接触史。患病以来，体重无明显变化。入院查体：体温36．5℃，脉搏96次／分，     

软组织恶性黑色素瘤影像学表现(附1例报告及文献复习)

目的 分析软组织恶性黑色素瘤(MMSP)的影像学表现,提高对MMSP认识.方法 报道1例10岁男性经手术及病理证实为MMSP,复习相关文献,分析其临床特征及影像学表现.结果 本例肿瘤影像表现为位于左侧大腿中上段后内侧肌间隙内,并以股骨内后侧为中心包绕左侧股骨1/2周长.病变T1WI呈稍高不均匀信号,T2WI呈不均匀高信号影,STIR呈不均匀高信号影,病变累及邻近左侧股骨髓腔及大收肌,并以局部骨皮质缺损处向软组织块内发出放射样线样短T2信号影.结论 MSSP非常少见,其影像学表现具有一定的特征性,但其确诊还是要依据病理学诊断.     

子宫颈原发性恶性黑色素瘤1例

患者 女,40岁.因发现宫颈口肿物1年半,阴道出血20天入院.妇科检查:宫颈口可见紫黑色组织物堵塞,于宫颈左侧上下唇及左侧缘致密粘连,质硬,触及出血.     

1例鼻腔巨大恶性黑色素瘤摘除术的护理

20 0 1年 5月 ,我部收治了 1例恶性黑色素瘤患者 ,现报告如下。1　临床资料患者 ,男 ,46岁 ,于 2 0 0 1年 5月 2日入院。 5ａ前开始鼻阻 ,流清涕。 1999年 6月曾在吉林某医院行鼻息肉摘除术 ,术后 6个月又开始左侧鼻阻 ;2 0 0 1年初再次行鼻息肉摘除术 ,4个月后又复发双侧鼻阻 ,于 2 0 0 1年 5月 2日到我部检查。体温 36 5℃ ,脉搏 80次 /ｍｉｎ ,呼吸 18次 /ｍｉｎ ,血压 16 /11 3ｋＰａ(12 0 / 85ｍｍＨｇ)。专科检查 :外鼻膨隆 ,向右侧偏 ,双侧鼻孔内充满灰白色肿物 ,质软 ,有出血 ,后鼻孔有出血性肿物 ,上颌窦压痛。于 2 0 0 1年 5月 2…     

下肢恶性黑色素瘤1例

患者,男,80岁,因"左足底黑色斑块进行性增大2月余"就诊,患者缘于2个月前无意中发现左足底近足跟处有一芝麻大小黑色素痣,随后逐渐增长至豌豆大小,颜色加深并突出皮面,并伴有疼痛、瘙痒不适,于2004-03-12因"左足底色素痣"收住入院。入院后经行病灶活检术,病理报告示:"左足底恶性黑色素瘤"。遂在腰麻下行"左足底肿瘤扩     

鼻腔恶性黑色素瘤1例

患者,女,58岁。因＂左侧鼻阻1年,加重1月＂于2012-10-29入院。鼻腔检查鼻外观畸形,左侧鼻腔膨隆,肿物挤压致鼻中隔向右侧偏移,充满整个左侧鼻腔,色灰白,覆盖有坏死组织,质脆,触之易出血副鼻窦。CT扫描示：左侧鼻腔内可见一较大软组织占位,呈膨胀性生长,堵塞鼻腔,病灶与周围组织分界不清,左侧下鼻甲显示不清。     

原发鼻腔恶性黑色素瘤11例临床分析

目的观察鼻腔原发性恶性黑色素瘤的临床特点,以帮助临床诊断和治疗。方法对1992—2007年12月间诊治的鼻腔原发性恶性黑色素瘤11例临床资料进行回顾性分析。结果 11例中,肿瘤多位于鼻腔外侧壁和鼻中隔,其中中鼻道5例,鼻中隔4例,中鼻甲1例,下鼻甲1例,肿瘤呈黑色或紫褐色8例,呈结节状或菜花状,淡红色表面光滑如息肉状3例;肿瘤触之易出血。结论本病临床少见,易误诊,应与鼻腔癌、血管瘤、鼻息肉相鉴别。对鼻腔发现的黑色或紫褐色肿物,触之易出血者可作该病的临床诊断,而不必取活检,以免促进肿瘤转移。     

不典型肛管直肠恶性黑色素瘤诊断并文献复习

目的探讨不典型肛管直肠恶性黑色素瘤的MRI表现、病理特征及鉴别诊断。方法回顾性分析1例经手术病理证实的肛管直肠恶性黑色素瘤病人的MRI表现及病理资料,并复习相关文献。结果 MRI显示肛管直肠交界区一T1等信号、T2稍高信号影,较为均质,呈椭圆形,大小约3.3 cm×4.2 cm×4.3 cm,直肠系膜及系膜筋膜外亦可见多发结节及肿物,大者3.2 cm×2.5 cm×3.8 cm。术中观察显示肿物呈实性,边界清,表面光滑。病理诊断:恶性黑色素瘤。免疫组化显示HMB45(+)、Melan-A(+),提示恶性黑色素瘤。结论不典型肛管直肠恶性黑色素瘤罕见,临床及影像表现通常无特异性,确切诊断需依靠病理学与免疫组织化学检查。     

颅内转移性恶性黑色素瘤9例临床分析

目的探讨颅内转移性恶性黑色素瘤的临床表现、诊断及手术切除效果。方法回顾性分析我科自2000年1月～2010年1月10年间手术切除的9例颅内转移性恶性黑色素瘤的临床和影像学资料,跟踪随访患者术后疗效。结果 9例患者均可见原发病灶;颅内转移灶中,7例全切,2例大部切除;随访期间所有患者死亡,生存时间最短4个月,最长23个月。结论颅内转移性恶性黑色素瘤恶性程度高,彻底切除颅内病灶可延长患者生存期,但预后仍差。     

Photoacoustic tomography for assessment and quantification of cutaneous and metastatic malignant melanoma - A systematic review

BackgroundPhotoacoustic tomography (PAT) is an emerging noninvasive imaging technique combining high sensitivity optical absorption contrast, such as melanin, with high-resolution ultrasound for deep tissue imaging. The ability of PAT to provide real-time images of skin structures at depth has been studied for diagnosis of primary and metastatic malignant melanoma (MM).ObjectiveTo provide an overview of the rapidly expanding clinical use of PAT for determination of melanoma thickness and architecture, visualization of metastases in lymph nodes and detection of circulating melanoma cells.MethodsMedline, PubMed, EMBASE, Web of Science, Google Scholar, and Cochrane Library were searched for papers using PAT to assess cutaneous malignant melanoma and melanoma metastases in humans or human specimens.ResultsThe research resulted in 14 articles which met the search criteria.ConclusionsResults from current studies suggest that PAT is a promising tool for assessing both primary and metastatic malignant melanoma in the clinic. The potential of PAT to noninvasively visualize tumour boundaries, as well as assist in the evaluation of metastatic status, could facilitate more effective treatment, resulting in better clearance and reducing the need for additional biopsies. However, larger and methodologically sound studies are warranted.     

脉络膜恶性黑色素瘤的CT诊断

目的：探讨脉络膜恶性黑色素瘤的CT诊断价值。方法：回顾性分析27例经手术病理证实的脉络膜恶性黑色素瘤的CT表现。结果：脉络膜恶性黑色素瘤表现为宽基底扁平状7例，半球状及蘑菇状突向玻璃体腔内20例，3例有囊性变，全部病例均未见钙化，合并视网膜脱离12例。结论：CT可准确的确定肿瘤的位置、大小、形态、密度、有无球外侵犯、有无合并视网膜脱离，对指导制定治疗方案，估计预后有较大价值。     

Uveal melanoma incidentally diagnosed with neuroimaging,a case series of 3 patients

Uveal melanoma is the most common primary intraocular malignancy and can occur in the choroid, the ciliary body, or the iris. It is most often diagnosed based on clinical examination by an ophthalmologist. Nearly all patients present with visual symptoms. Characteristic findings on clinical examination include pigmented or pale choroidal masses with serous retinal detachments and acoustic hollowness seen with ocular ultrasonography. CT and MRI of the orbits are not traditionally utilized for the diagnosis of uveal melanoma. We present 3 cases in which uveal melanoma was an incidental finding on neuroimaging for unrelated conditions in asymptomatic patients. Radiologists should maintain a high suspicion for uveal melanoma when an intraocular mass of greater than 2 mm in thickness is seen on CT or MRI.     

无水乙醇栓塞治疗耳部动静脉畸形

目的 介绍22例耳部动静脉畸形无水乙醇介入栓塞治疗的经验.方法 对22例耳部动静脉畸形患者,通过局部穿刺或经导管内超选择径路达到耳部病变的异常血管团内,根据病变的血管团构筑,采用无水乙醇或稀释乙醇进行栓塞,间隔1个月进行电话随访,间隔3～4个月进行临床随访,根据临床检查或血管造影评价临床效果.结果 22例患者共进行了38次无水乙醇栓塞,每次无水乙醇的用量为4～65 ml.9例病变局限患者,1～2次栓塞后达到临床治愈;13例病变广泛患者,无水乙醇栓塞3～5次后,溃疡愈合,出血停止,耳呜消失或减弱.血管造影见9例异常血管团完全消失;8例血管团消失50%～75%;5例血管闭消失小于50%.最常见的并发症为可逆性局部坏死和水疱形成.结论 无水乙醇栓塞是耳部动静脉畸形安全、有效的治疗方式,并有可能成为首选的治疗方式.     

Cranial computed tomography of patients with malignant melanoma

Summary Sixty-eight patients with malignant melanoma were examined by CCT and the findings analyzed. Cerebral metastases were detected in 19 patients. Meningiomas were found in three patients, one with neurological symptoms and two without. Typical metastases less than 10 mm in diameter were located superficially in the grey matter, regular, homogenous, hyperdense, with no edema. Extensive peripheral edema was often associated with metastases measuring more than 10 mm. CCT revealed cerebral metastases in 6 (13%) of 46 asymptomatic patients. The metastases measured less than 10 mm in four and less than 20 mm in two of these patients. Scintigraphy was falsly negative in six patients with metastases smaller than 10 mm. Therefore, CCT is the method of choice for screening asymptomatic patients. Angiography may be of value in the differentiation between meningioma and melanoma metastases.     

MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review

Objective. To evaluate MR imaging and pathology findings in order to define the characteristic features of clear cell sarcoma of the soft tissues (malignant melanoma of the soft parts). Design and patients. MR examinations of 21 patients with histologically proven clear cell sarcoma of the musculoskeletal system were retrospectively reviewed and assessed for shape, homogeneity, delineation, signal intensities on T1- and T2-weighted images, contrast enhancement, relationship with adjacent fascia or tendon, secondary bone involvement, and intratumoral necrosis. In 19 cases the pathology findings were available for review and for a comparative MR-pathology study. Results. On T1-weighted images, lesions were isointense (n=3), hypointense (n=7) or slightly hyperintense to muscle (n=11). Immunohistochemical examination was performed in 17 patients. All 17 specimens showed positivity for HMB-45 antibody. In nine of 11 lesions with slightly increased signal intensity on T1-weighted images, a correlative MR imaging-pathology study was possible. All nine were positive to HMB-45 antibody. Conclusions. Clear cell sarcoma of the musculoskeletal system often has a benign-looking appearance on MR images. In up to 52% of patients, this lesion with melanocytic differentiation has slightly increased signal intensity on T1-weighted images compared with muscle. As the presence of this relative higher signal intensity on T1-weighted images is rather specific for tumors displaying melanocytic differentiation, radiologists should familiarize themselves with this rare entity and include it in their differential diagnosis when confronted with a well-defined, homogeneous, strongly enhancing mass with slightly higher signal intensity compared with muscle on native T1-weighted images. Received: 18 October 1999 Revision requested: 19 November 1999 Revision received: 21 January 2000 Accepted: 25 January 2000