肛管直肠恶性黑色素瘤10例临床病理学研究

目的探讨肛管直肠恶性黑色素瘤（AMM）的临床病理特征和鉴别诊断。方法收集10例肛管直肠恶性黑色素瘤,观察其临床病理特点,进行免疫组化染色。结果10例平均56.5岁,以“痔疮出血”就诊7例、体检发现2例、无意中发现1例。镜检示肿瘤结构复杂,细胞形态多样,瘤细胞类型可分为大透明细胞、小透明细胞、大上皮（样）细胞、小上皮（样）细胞、瘤巨细胞和梭形细胞6种。免疫组化示HMB45、S-100和Vim（＋）。结论AMM恶性程度高,预后差,应及早发现,并治疗。HMB45和S-100是恶性黑色素瘤较为敏感的标记物,与Vim及CK联合应用对恶黑的诊断具有实际应用价值。

Pathological features of anorectal malignant melanoma

Objective To study the clinicopathological characteristics,differential diagnosis,epidemiology,etiological factor and treatment of anorectal malignant melanoma(AMM).Methods Clinical pathological characteristics and immunohistochemical findings were observed in 10 cases of anorectal malignant melanoma,with review of relatated literature.Results Average age was 56.5 years.7 cases were decteced for bleeding of piles,two by health examination,and the one was unintentional finding.Under microscope,the tumor was complicated constructionally,and the tumor cells were variform.There were six kinds of tumor cells,including big clear cell,small clear cell,big epithelioid cell,small epithelioid cell,giant cell and spindle cell.Immunohistochemiscal staining showed that the tumor cells were positive for HMB45,S-100 and vimentin.Conclusions AMM is a high malignant tumor,with very poor prognosis.So,it should be diagnosed and treated early.HMB45 and S-100 are sensitive tumor markers for AMM,and would have practical significance in the diagnosis if combined application with vimetin and cytokeratin.