恶性黑色素瘤57例临床病理分析

目的：探讨恶性黑色素瘤的临床病理特征。方法对57例恶性黑色素瘤的临床病理资料进行回顾性分析。结果（1）组织学类型检测：上皮细胞为主型33例，占57．89％；梭形细胞为主型16例，占28．07％；混合细胞型8例，占14.04％。（2）免疫组织化学检测：人黑色素瘤标记物45（human melanoma marker 45， HMB45）阳性53例，占92．98％；S-100蛋白阳性55例，占96．49％；波形蛋白（vimentin）阳性52例，占91．23％；Ki-67阳性57例，占100％；上皮膜抗原（epithelial membrane antigen， EMA）阳性3例，占5．26％；细胞角蛋白（cytokeratin， CK）阳性5例，占8．77％；白细胞共同抗原（leukocyte common antigen， LCA）、平滑肌肌动蛋白（smooth muscle actin， SMA）以及结蛋白（desmin）均阴性表达。（3）发生部位：下肢24例（其中足部19例），躯干7例，头颈部9例，上肢7例，黏膜部位10例。（4）术前诊断：色素痣25例，恶性黑色素瘤13例，待查19例。结论恶性黑色素瘤恶性度高，好发于四肢，细胞形态及组织学结构多样，免疫组织化学对恶性黑色素瘤的诊断和鉴别诊断具有重要价值。

Clinical pathologic analysis of 57 cases of malignant melanoma

Objective To investigate the clinical pathological features of malignant melanoma .Methods A retrospective a-nalysis was made of the medical data of the 57 cases of malignant melanoma .Results (1) Concerning histological types , there were 33 cases with epithelial cells as the main the type , accounting for 57.89%;there were 16 cases with spindle cells as the main the type , accounting for 28.07%, and there were 8 cases with hybrid cells as the main the type , accounting for 14.04%.(2)Concerning immu-nohistochemistry tests, there were 53 positive cases of Human melanoma marker 45(HMB45), accounting for 92.98%;there were 55 positive cases of S-100, accounting for 96.49%;there were 52 positive cases of Vimentin , accounting for 91.23%;there were 57 posi-tive cases of Ki-67, accounting for 100%;there were 3 positive cases of epithelial membrane antigen (EMA), accounting for 5.26%;and there were 5 positive cases of Cytokeratin (CK), accounting for 8.77%.However, no expressions of leukocyte common antigen (LCA), smooth muscle actin(SMA)and desmin could be detected.(3)As for the site of affection, there were 24 cases of malignant melanoma at lower limbs , of which 19 cases were at the foot;there were 7 cases at trunk;9 cases at neck and another 7 cases at the up-per limbs;and 10 cases at mucosa.(4)With regard to pre-surgical diagnosis, there were 25 cases of pigmented nevus, 13 cases of ma-lignant melanoma and 19 cases to be further confirmed .Conclusion Malignant melanoma was highly heterogenous and commonly oc-curred at limbs, and its cellular morphology and histological structure were complex .Immunohistochemistry was of important value in the diagnosis and identification of malignant melanoma .