头颈部恶性黑色素瘤的临床及病理研究

目的 研究头颈部恶性黑色素瘤的临床,病理及免疫组织化学特片,以提高临床和病理诊断率,方法 收集头颈部恶性黑色素瘤（除脉络膜外）68例,其中原发于鼻腔和口腔黏膜33例,头颈部皮肤35例。发病高峰年龄为41-60岁。52例为手术切除标本,16例为活检（咬取、切除）标本。复习所有患者的临床及病理资料,并对42例进行S-100、HMB45和NSE免疫组织化学观察。结果 在68例中,手术切除者52例,其中有13例行补充放疖1例进行了化疗单纯放疗0例;抿绝治疗6例,在获得随诊的56例中,存活5年以上者12例,其中头颈部皮肤恶性黑色素瘤9例,占75.0%;鼻腔及口腔黏膜者3例外中25.0%。结论 恶性黑色素瘤在组织学结构上的改变具有重要意义;免疫组织化学对恶性黑色素瘤诊断和鉴别诊断有重要价值;发生于鼻腔和口腔黏膜的恶性黑色素瘤的预后明显比发生在头颈部皮肤的差。     

Malignant melanoma of the head and neck--a clinical analysis of 46 patients

46 patients with malignant melanoma of the head and neck as treated in our hospital from March 1964 to December 1981 are reported. 29 were male and 17 were female. The sex ratio ws 1.7:1. 56.5% of patients were 40-60 years old. The tumor occurred most frequently in the nasal cavity, next in the oral cavity. Lesions originating from the eye and skin in the head and neck region comprised 15.2% of cases. Melanoma of the nasal cavity and eye rarely metastasized into the cervical lymph nodes but melanoma arising from the skin of head and neck had a metastatic rate of 57.1%. 50% of melanoma of the gingiva metastasized to the neck glands. In this series, 29 patients were treated by operation. The overall 3 and 5 year survival rates of these 46 patients are 38% and 15.7%. The 3 and 5 year survival rates of those without regional lymph node metastasis are 51% and 28%. The 3 and 5 year survivals of those with regional lymph node metastasis are 13% and 0%. Other methods, such as surgery plus chemotherapy, chemotherapy alone and radiotherapy plus surgery or chemotherapy were used only in a few cases which could not be evaluated.     

耳鼻颌面部恶性黑色素瘤(附11例分析)

目的：探讨发生于耳鼻颌面部恶性黑色素瘤(恶黑)的诊疗方法。方法：对1986～2001年收治的11例恶黑患的临床资料进行临床病理分析。结果：男性6例、女性5例，年龄6个月～83岁；原发部位：牙龈粘膜2例，外耳道l例，耳廓2例，鼻腔筛蝶窦l例，鼻中隔l例，中耳l例，下睑腮腺l例，上唇2例；手术切除9例，术后化疗2例，术后放疗3例，未治疗2例。0．5～10年随访，死亡6例，生存期6个月～3年；健在5例，生存期1．0—15年。结论：恶黑在皮肤粘膜交界处的色素层或粘膜黑色素斑的基础上发生，肿块多呈黑褐色且常伴溃疡，诊断较易，而对于不含黑色素的恶黑容易误漏诊，须待病理确诊。瘤细胞内含大量黑色素颗粒为其病理特点，免疫组化显示VIM—HMB45和S-100蛋白及Vs38阳性反应均有助于不含色素的恶黑的确诊。本病恶性度极高，可采用手术、放化疗或免疫治疗，但预后差。     

鼻腔原发性恶性黑色素瘤25例临床病理分析

目的观察鼻腔原发性恶性黑色素瘤的形态特点，以帮助临床诊断和治疗。方法对1975年-2006年间诊治的鼻腔原发性恶性黑色素瘤25例的临床资料进行回顾性分析。结果25例中，肿瘤多位于鼻腔外侧壁和鼻中隔，中鼻道10例，鼻中隔6例，中鼻甲4例，下鼻甲3例，鼻底1例，另1例病变范围广无法判断其来源。肿瘤呈黑色或紫褐色21例，呈结节状或菜花状；淡红色表面光滑如息肉状4例；肿瘤触之易出血。结论鼻腔原发性恶性黑色素瘤临床少见，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，活检应谨慎，以免促进肿瘤转移。     

The natural history and patterns of metastases from mucosal melanoma: an analysis of 706 prospectively-followed patients

BackgroundWe examined whether mucosal melanomas are different in their clinical course and patterns of metastases when arising from different anatomic sites. Our hypothesis was that metastatic behavior would differ from primary mucosal melanomas at different anatomical sites.Patients and methodsClinical and pathological data from 706 patients were compared for their stage distribution, patterns of metastases, CKIT/BRAF mutation status, and overall survival for different anatomical sites.ResultsThe anatomic sites of the primary mucosal melanomas were from the lower GI tract (26.5%), nasal cavity and paranasal sinuses (23%), gynecological sites (22.5%), oral cavity (15%), urological sites (5%), upper GI tract (5%), and other sites (3.0%). At initial diagnosis, 14.5% were stage I disease, 41% Stage II, 21.5% Stage III, and 23.0% stage IV. Predominant metastatic sites were regional lymph nodes (21.5%), lung (21%), liver (18.5%), and distant nodes (9%). Oral cavity mucosal melanoma had a higher incidence of regional nodal metastases (31.7% versus 19.8%,P = 0.009), and a higher incidence of lung metastases (32.5% versus 18.5%,P = 0.007) compared to other primary mucosal melanomas. There was a 10% incidence of CKIT mutation and 12% BRAF mutation. Mucosal melanomas from nasal pharyngeal and oral, gastrointestinal, gynecological, and urological had a similar survival with a 1-year survival rate (88%, 83%, 86%), 2-year survival rate (66%, 57%, 61%), 5-year survival rate (27%, 16%, 20%), respectively.ConclusionsThe largest sample size allows, for the first time, a comparison of primary melanoma stage and patterns of metastases across anatomical sites. With few exceptions, the presenting stages, incidence of nodal and distant metastases, the site of predilection of distant metastases, or overall survival were similar despite different primary anatomic sites. These findings suggest that clinical trials involving mucosal melanomas and the administration of systemic therapy can be applied equally to mucosal melanomas regardless of their primary anatomic site.     

Fourteen cases of mucosal melanomas of the oral cavity

Fourteen cases of mucosal melanomas of the oral cavity were treated from January, 1970 to April, 1986 in our department. The patients were 10 males and 4 females and in their fifth and sixth decades with the primary sites in the upper gingiva and palates in the majority. The 3 and 5 year survival rates were 21.4% and 14.3% respectively, with unfavorable prognosis in comparison with cutaneous melanoma. The clinical stages were as follows: stage Ia (1), Ib (8), II (5), which affected the prognosis. The depth of invasion, as described by Breslow et al., were beyond 1.50 mm except in one case, which might be a significant prognostic factor in the study of mucosal melanoma of the oral cavity. Seventy one percent had neck node metastases and 35% had distant metastases. The high occurrence of metastases might be related to their poor prognosis.     

鼻腔恶性黑色素瘤18例报告

目的报告１８例我科自１９８１－１９９６年间收治的鼻腔恶性黑色素瘤。该病时有误诊,应与鼻腔其它恶性肿瘤、血管瘤和鼻息肉相鉴别。方法广泛的手术切除为本病的首选方法,特别是注意中隔的肿瘤周围时有黑色卫星可见,均应彻底切除。结果切除的粘膜越多,局部复发就越少。术后还要配合化疗,由于黑色素瘤对放疗不敏感,很少放疗。结论早期发现,早期诊断,广泛彻底的手术切除是提高本病生存率的关键。     

Primary oral melanoma: population-based incidence

Primary oral melanoma (POM) is a rare form of melanoma, generally diagnosed at a late stage and has poor prognosis. Epidemiological information has scarcely been reported in the literature over the past 40 years. Analyzing the Cancer Incidence in Five Continents volume IX (CI5-IX) database we found a total of 124,436 oral cavity cancers reported from all population-based cancer registries and 319 cases of POM reported by 67 cancer registries. To our knowledge this is the largest number of POM cases analyzed and accounts for 0.26% of all oral cavity cancers. ASR(W) for POM do not exceed 0.01 per 100,000 persons-year in all regions. The most common anatomic sites were palate (47%) and gum (27.6%) and a detailed oral mucosa examination and biopsies of nodular or macular lesions in these sites, especially on elderly patients, is advised to be routinely performed.     

Cancer of the Nasal Cavity and Paranasal Sinuses: A Clinico-pathological Study of 277 Patients

In the period 1963-1991, a total of 277 consecutive patients with malignant tumours of the nasal cavity and paranasal sinuses were treated at Aarhus University Hospital. The major histological types included squamous cell carcinoma (46%), lymphoma (14%), adenocarcinoma (13%), and malignant melanoma (9%). Kaplan-Meier estimates of 5-year corrected survival (death from cancer) showed the best prognosis for adenoid cystic carcinoma (87%), adenocarcinoma (65%) and lymphoma (56%), and the poorest prognosis for undifferentiated carcinoma (17%) and malignant melanoma (24%). The 5-year corrected survival for squamous cell carcinoma was 35%. Of the 180 patients with treatment failure, the vast majority occurred locally (n = 166); a minor proportion was regional (n = 23) or distant (n = 30). For the 195 patients with carcinoma, the following parameters were of statistical prognostic significance (5-year corrected survival): histological differentiation (moderate-well 65% vs. poor 22%), primary T-site (nasal cavity 56% vs. maxillary antrum 39% vs. other sinuses 24%), tumour stage (T2 68% vs. T3 37% vs. T4 29%), nodal stage (NO 48% vs. Nl-3 21%), treatment (radiotherapy + surgery 56% vs. radiation alone 35%).     

232例晚期黏膜黑色素瘤患者的一二线治疗疗效及预后影响因素

目的:探讨晚期黏膜黑色素瘤(mucosal melanoma,MM)患者的临床特征、治疗及预后影响因素.方法:收集2008年1月至2015年12月北京肿瘤医院肾癌黑色素瘤内科收治的232例晚期MM患者的临床资料,一二线治疗方案,对患者生存情况进行随访,并对影响总生存期的多因素预后进行分析统计.结果:本组晚期MM患者共232例(男101、女131例),中位年龄56.0岁;原发部位:直肠肛管29.3％,鼻腔25.0％,泌尿生殖道20.7％,口腔20.3％,食管4.7％;就诊时M分期:M1a 17.2％,M1b 21.6％,M1c 61.2％;多数患者存在多处转移,常见转移部位为肺50.4％、肝34.9％、骨23.3％.中位PFS:一线治疗方案患者4.5个月,二线治疗方案患者2.5个月.所有患者中位OS为11.0个月,其中M1a期16.0个月、M1b期14.0个月、M1c期10.0个月.预后分析发现,就诊时M分期和血清LDH与OS显著相关(P＜0.01),与原发灶部位、性别、年龄、基因突变状态等无显著相关性.结论:鼻腔、口腔是MM的好发部位,就诊时M分期、LDH水平是OS的独立预后因素.     

44例原发性鼻粘膜恶性黑色素瘤的临床特征及预后分析

背景与目的:原发性鼻粘膜恶性黑色素瘤是一种罕见肿瘤,其临床资料主要来源于西方人群。本文总结原发性鼻粘膜恶性黑色素瘤患者的临床资料,分析其临床特征和影响预后的因素。方法:回顾性分析1971年1月至2005年7月中山大学肿瘤防治中心收治的原发性鼻粘膜恶性黑色素瘤66例,其中有完整随访资料的44例。复习病历登记的临床表现和治疗方法,信件或电话随访记录肿瘤复发和患者生存情况。用Kaplan-Meier方法计算生存率,用Cox比例风险模型进行多因素分析。结果:44例有完整随访资料的患者中,37例原发于鼻腔粘膜,5例原发于副鼻窦粘膜,2例原发于鼻咽粘膜。初治时12例患者出现颈淋巴结转移。31例接受以手术为主的治疗,其中8例接受辅助性放疗,13例接受辅助性化疗,6例接受辅助性非特异性免疫治疗。中位随访时间29个月,局部复发率为54.5%(24例),10例(22.7%)患者发生颈淋巴结转移复发,11例(25%)发生远处转移。中位生存时间为24个月,5年生存率为25%。预后分析显示,临床分期影响患者5年生存率,而性别、年龄、原发肿瘤部位、原发肿瘤大小、是否接受辅助治疗与5年生存率无关。结论:原发性鼻粘膜恶性黑色素瘤局部复发率和远处转移率高,且易出现颈淋巴结转移。临床分期影响患者5年生存率。     

鼻及鼻窦黏膜黑色素瘤患者临床资料回顾性研究

目的:研究鼻及鼻窦黏膜黑色素瘤（sinus and nasal mucosal melanoma,SNMM）Ⅲ-Ⅳa期［2010年美国AJCC分期（第7次修订版）］的临床及组织病理学特点、手术治疗及辅助治疗对预后的影响因素。方法:本文对2006年至2017年间收治的满足Ⅲ-Ⅳa期鼻及鼻窦黏膜黑色素瘤患者临床资料进行回顾性研究。结果:最终共纳入16例满足条件的鼻及鼻窦黏膜黑色素瘤患者,其中7例男性,9例女性,平均年龄为63.5（35~81）岁,随访时间为23.5（7~76）个月。患者1年生存率为81.25%,3年生存率为18.75%,5年生存率为12.50%。接受术后辅助治疗患者11例,其中,术后辅助放疗5例,术后辅助生物治疗6例。结论:鼻及鼻窦黏膜黑色素瘤恶性度高,预后差,术后复发和转移发生率较高,彻底清除肿瘤病灶的手术联合术后辅助治疗的综合治疗为首选治疗方法。     

Extranodal non-Hodgkin's lymphoma of the head and neck. A clinicopathologic study in the Kyoto-Nara area of Japan

The clinicopathologic features of 114 Japanese patients with extranodal non-Hodgkin's lymphoma of the head and neck region were analyzed. The median age was 60.5 years and the male:female ratio was 1.5:1. The most common site of involvement was Waldeyer's ring, followed by the oral cavity, thyroid gland, paranasal sinuses, nasal cavity, and larynx. Seventy-five percent of the patients were in Stage I or Stage II at admission. Histologically, diffuse lymphoma accounted for 94% and follicular lymphoma for 6% of cases. The histologic grade according to the Working Formulation System of the National Cancer Institute was low in 11%, intermediate in 75%, and high in 14% of cases. Immunohistochemical study showed that the majority of the cases were of B-cell type and only 13 cases (11%) were of the T-cell type. Peripheral T-cell lymphomas (eight cases) mainly occurred in the nasopharynx and nasal cavity, whereas four of five thymic T-cell lymphomas were found in the palatine tonsil. The over-all 5-year survival rate was 54%, and the factors affecting survival were sex, histologic grade, T/B phenotype, clinical stage, and the site of initial presentation. Five-year survival with nasal cavity and Waldeyer's ring lymphoma was 24% and 46%, respectively. The poor prognosis of lymphomas at these sites might result from the predominance of T-cell lymphoma, the paucity of low grade lymphoma, and the relatively high incidence of cases that were in an advanced stage at presentation. In Stage II, patients treated with combined therapy tended to have a better 5-year survival rate than those treated with radiotherapy alone.     

Results of radiation therapy of extranodal non-Hodgkin's lymphoma of the head and neck--a study of the Japan Lymphoma Radiation Therapy Study Group

During the years 1972-81, 168 patients with extranodal Non-Hodgkin's lymphoma localized in the head and neck were treated with radiation. Five-year survival rates were 62% in stage I, 56% in stage II, and 91% in diffuse well-differentiated lymphocytic, 77% in diffuse mixed, 52% in diffuse poorly-differentiated lymphocytic and diffuse histiocytic each. Marginal relapse was rare after radiation therapy, but relapses were not infrequently noticed in distant extranodal sites. Bone and/or soft tissue relapses were frequently noticed in patients with lesions initially located in the nasal cavity, paranasal sinus and oral cavity.     

HIGH DOSE FRACTION RADIOTHERAPY FOR MUCOSAL MALIGNANT MELANOMA OF THE HEAD AND NECK

Ｍｕｃｏｓａｌｍａｌｉｇｎａｎｔｍｅｌａｎｏｍａｏｆｔｈｅｈｅａｄａｎｄｎｅｃｋ（ＨＮＭＭ）ｒｅｐｒｅｓｅｎｔａｆｅｗｐｅｒｃｅｎｔｏｆａｌｍｅｌａｎｏｍａＴｈｅｒｅｆｅｒｅｎｃｅｖａｒｙｆｒｏｍ０４ｔｏ４％１Ｄｉｓｔａｎｔｍｅｔａｓｔａｓｉｓ...     

Prevalence of oral cavity,pharynx, larynx and nasal cavity malignancies in Amritsar,Punjab

The present study comprised of 1471 cases of carcinoma of oral cavity, pharynx, larynx, and nasal cavity diagnosed in the Department of Pathology, Government Medical College, Amritsar from January, 1972 to December, 1991. The oral cavity was involved in 35.75% of cases and least incidence was of the cancer of nasal cavity. The males outnumbered females with Male: Female ratio being 2.14:1. The maximum incidence was seen in the fourth and fifty decade. Histopathologically 88.18% cases were of epidermoid carcinoma followed by anaplastic carcinoma and least were a single case each of mucoepidermoid carcinoma and fibrosarcoma.     

52例原发鼻腔鼻窦黏膜恶性黑色素瘤疗效分析

目的：分析原发鼻腔鼻窦恶性黑色素瘤疗效及放疗在其治疗中作用。方法回顾分析2001—2014年间我院收治原发鼻腔鼻窦恶性黑色素瘤52例临床资料,其中单纯手术18例,手术联合放疗31例（手术＋术后放疗24例、术前放疗＋手术7例）,单纯放疗3例。使用倾向配比评分法对手术联合放疗组与单纯手术组配对分析。中位随访时间59个月。全组5年LC、DMFS、DFS、OS分别为49％、48％、22％、45％。配对后手术联合放疗5年LC 明显高于单纯手术（88％∶43％,P＝0．028）,但5年DMFS相近（67％∶57％,P＝0．955）、DFS相近（58％∶24％,P＝0．131）、5年OS也相近（67％∶67％, P＝0．727）。术前放疗＋手术组、手术＋术后放疗组手术切缘阴性率分别为100％和50％（ P＝0．004）。结论手术联合放疗可提高原发鼻腔鼻窦恶性黑色素瘤LC率,术前放疗增加手术切缘阴性率。     

Multiple primary malignant melanomas of the oral cavity

Malignant melanoma comprises 2% of all the cancers (Waldron, 1970) and the lesion is very rare in the oral cavity (Jackson and Simpson, 1975), and constitutes only 7% of the total head and neck melanomas. Chaudhari et al (1958) were able to trace out 105 cases of oral melanoma in their exhaustive survey of the literature, but they did not mention the occurrence of multiple lesions in the oral cavity. In 1975, Liversedge collected 65 cases from the literature after Chaudhuri’s classic review, who again did not report the incidence of multiple lesions. These reviews show that primary malignant melanoma at multiple sites in the oral cavity is extremely rare. The multiplicity of the lesion and unusual presentation of an oral melanoma make the present case clinically interesting.     

鼻腔原发性恶性黑色素瘤的临床病理分析

目的：观察鼻腔恶性黑色素瘤临床病理特征,探索提高其诊断准确率的要领。方法：对11例恶性黑色素瘤病例,用HE染色,黑色素染色（Fontana-Masson法）,免疫组织化学（SP法）进行检测。结果：结合形态及组织化学或免疫组化的病理诊断较容易,临床误诊为息肉高达63．6％（7／11）,因病变晚期及结合CT有骨质密度改变甚至骨质破坏而诊断准确者占4／11,结论：灰黑色息肉样外观是鼻腔恶性黑色素瘤的特性,结合CT可提高其诊断准确率。     

Adjuvant therapy for melanoma in dogs: results of randomized clinical trials using surgery, liposome-encapsulated muramyl tripeptide, and granulocyte macrophage colony-stimulating factor.

Spontaneous canine oral melanoma (COM) is a highly metastatic cancer, resistant to chemotherapy, and can serve as a model for cancer immunotherapy. Liposome-encapsulated muramyl tripeptide-phosphatidylethanolamine (L-MTP-PE) can activate the tumoricidal activity of the monocyte-macrophage system following i.v. injection. The objective of these studies was to evaluate the therapeutic effectiveness of L-MTP-PE administered alone and combined with recombinant canine granulocyte macrophage colony-stimulating factor (rcGM-CSF) in dogs undergoing surgery for oral melanoma. Ninety-eight dogs with histologically confirmed, clinically staged, oral melanoma were entered into two randomized, double-blind, surgical adjuvant trials. In trial 1, 50 dogs were stratified based on clinical stage and randomized to once a week L-MTP-PE or lipid equivalent (control). When all of the clinical stages were combined, no difference in disease-free survival or in survival time (ST) were detected. However, within stage I, dogs receiving L-MTP-PE had a significant increase in ST compared with control, with 80% of the dogs treated with L-MTP-PE still alive at >2 years. Within each stage II and stage III, there was no difference detected between the treatment groups. In trial 2, 48 dogs were stratified on the basis of clinical stage and extent of surgery (simple resection or radical excision), treated with L-MTP-PE two times a week, and randomized to rcGM-CSF or saline (placebo) given s.c. daily for 9 weeks. Within each stage and when all of the stages were combined, there was no difference between the treatment groups. In both studies, stage I COM is associated with a better prognosis. No effect on survival was observed with regard to tumor location in the oral cavity, sex, type/extent of surgery, or age. In a subset of dogs tested, pulmonary alveolar macrophage cytotoxicity was enhanced with combined rcGM-CSF and L-MTP-PE but not in dogs treated with L-MTP-PE alone. The present study indicates that after surgery, L-MTP-PE administered alone or combined with rcGM-CSF showed no significant antitumor activity in treating advanced stage COM. In early stage COM, L-MTP-PE was shown to result in a prolongation of ST. Furthermore, this study provides additional rationale for the use of the dog model for human malignant melanoma.