食管原发性恶性黑色素瘤临床病理特征及组织发生

目的:讨论食管原发性恶性黑色素瘤的诊断、鉴别诊断、组织发生和生物学行为。方法:报道2例食管原发性恶性黑色素瘤并进行临床表现、组织形态学和免疫组织化学的观察研究,结合文献对其诊断、鉴别诊断和组织来源进行探讨。结果:食管原发性恶性黑色素瘤好发于中老年,临床症状多为进行性吞咽困难,肿瘤多位于食管中下段,大体形态多呈息肉状,Fontana 组织化学染色瘤细胞显示出嗜银性黑色素颗粒;免疫组化染色瘤细胞S-100 和 HMB45均为阳性。结论:食管中下段息肉样肿物在中老年患者应想到食管原发性恶性黑色素瘤的可能,最后确诊特别是无色素性恶性黑色素瘤需要靠免疫组织化学标记或电镜的支持。该肿瘤的组织发生可能来自食管粘膜基底层的黑色素细胞。

Clinicopathologic characteristics and histogenesis of primary malignant melanoma of the esophagus

Objective: To investigate the diagnosis, differential diagnosis, histogenesis and biologicbehaviors of primary malignant melanoma of the esophagus. Methods: Two cases of primary malignantmelanoma of the esophagus were studied with clinicopathological analysis, histopathological analysis andimmunohistochemistry, and literature review. Results: Primary malignant melanoma of the esophagus wasseen in middle and old age persons. The turmors were usually located in the distal third of the thoracicesophagus. The patients presented with dysphagia. Glossly, the tumor tends to be polypoid. The tumorcells were positive reaction to the HMB-45and S-100 antigen. Conclusion: When a polypoid mass of theesophagus occrus in a patient with middle or old age, the possibility of primary malignant melanoma of theesophagus should be considered. Immunohistochemical stain and electron microscopy were helpful in thedefinite diagnosis. Histogenesis of the tumor may arise from melanocytes of esophagus.