肛管直肠恶性黑色素瘤26例临床分析

目的总结肛管直肠恶性黑色素瘤的临床特征、诊断及治疗经验。方法回顾性分析1977-2005年江苏省肿瘤医院收治的26例肛管直肠恶性黑色素瘤病人的临床资料。结果临床表现为便血23例(88.5%),肛门疼痛或不适14例(53.8%),肛门肿物7例(26.9%)。肿瘤距肛缘5cm以内26例(100%)。首次就诊误诊率84.6%(22/26),术前病理确诊率44.0%(11/25)。免疫组化示HMB45、S100、Vimentin阳性率分别为85.7%(6/7)、100%(7/7)、83.3%(5/6)。累积生存1、3、5年分别为12、4、3例。结论肛管直肠恶性黑色素瘤少见,易误诊,预后差,便血是最常见的症状,直肠指诊对该病的诊断十分重要,免疫组化有助确诊。

Anorectal malignant melanoma:an analysis of 26 cases

Objective To summarize experiences on clinical features,diagnosis and treatment of anorectal malignant melanoma (AMM).Methods The clinicopathologic data of 26 patients with AMM admitted from 1977 to 2005 in Jiangsu Provincial Cancer Hospital were analyzed retrospectively.Results The most common complaints of AMM patients were hematochezia (88.5%),anus pain or discomfort (53.8%),anus mass (26.9%) and so on.The distances from the tumor to anal verge of all the patients were no more than 5cm.The misdiagnosis rate was 84.6%.The rate of definite pathologic diagnosis before surgery was 44%.The positive rates of immunohistochemical staining results of HMB45,S100 and Vimentin were 85.7%(6/7),100%(7/7),83.3%(5/6),respectively.The overall 1-,3-,5-year survival were 12,4,3 cases,respectively.Conclusions AMM is a rare disease with poor prognosis.And it tends to be misdiagnosed.Hematochezia is the most common symptom.Digital rectal examination is very important to the diagnosis of AMM.Immunohistochemical staining is helpful to pathologic diagnosis of AMM.