黏膜无色素性恶性黑色素瘤的免疫组化及临床研究

 目的 探讨CD56，CD95（Fas），Ki-67，p53，bcl-2，HMB45和S-100在恶性黑色素瘤（恶黑）中的表达，以提高黏膜无色素性恶黑的病理诊断准确率，减少误诊和漏诊，并为临床估计预后、选择治疗方案提供客观指标。方法 应用组织芯片和免疫组化标记技术，对48例黏膜无色素性恶黑进行标记和分析。结果 HMB45与S-100的阳性率分别是100 %和85.4 %（41／48）。CD56的阳性率为91.6 %（44／48），在转移灶与原发灶中差异无统计学意义（P＞0.05）。CD95的阳性率为85.4 %（41／48），其中在11例有淋巴结转移的病例中，阳性率达100 %。Ki-67与p53阳性率分别为79.2 %（38／48）和58.3 %（28／48），Ki-67的阳性分布与CD95基本一致。bcl-2的阳性率为39.6 %（19／48）。p53和bcl-2在恶黑中的表达阳性率与CD95比较差异具有统计学意义（P＜0.05）。结论 CD56在恶黑中具有重要的辅助诊断价值；CD95（Fas）与Ki-67的表达对判断恶黑浸润范围及淋巴结转移状况和指导临床治疗有一定的意义。

The immuohistochemical investigation of mucose amelanotic malignant melanoma

Objective To investigate expression of CD56, CD95(Fas), Ki-67, p53, bcl-2, HMB45 and S-100 in mucosa amelanotic malignant melanoma in order to improve the pathological diagnosis level reduce wrong diagnosis and avoid missing dignosis, and afford objective factors for prognosis and therapy. Methods The techniques of tissues chips and immunohistochemical lablling were used for analyzing 48 cases of mucosa amelanotic malignant melanoma. Results The positive rates of HMB45 and S-100 were 100 % (48/48) and 85.4 % (41/48) respectively. The positive rate of CD56 was 91.6 % (44/48), there was not statistical difference between original cases and metastatic cases. The positive rate of CD95 was 85.4 %(41/48). In which it is 100 % (11) in 11 cases of having lymphanoid metastasis. The positive rates of Ki-67 and p53 were 79.2 % (38/48) and 58.3 % (28/48) respectively. The positive distribution of Ki-67 was almost same as CD95. The positive rate of bcl-2 was 39.6 % (19/48), the positive expression was significantly different between p53 and bcl-2(P < 0.05). Conclusion CD56 has important role in the diagnosis of mucosa amelanotic malignant melanoma. The expressions of CD95 and Ki-67 contribute to assess the invasion region and lymphanoid metastasis of malignant melanoma, and guide clinical theropy in some degree.