摘要
目的探讨肢端黑色素瘤(acral melanoma,AM)的临床病例特征、鉴别诊断及前哨淋巴结(sentinel lymph node,SLN)转移机制。方法收集2019—2021年间内蒙古自治区乌海市人民医院2例确诊为AM伴SLN转移患者的临床资料,回顾性分析其组织病理学特征及免疫表型,并复习相关文献。结果2例患者均为男性,平均年龄63岁,原发灶分别位于左足跟及右手示指;组织病理学特征:病例1真皮内肿瘤细胞以短梭形为主,侵及皮下组织,为肢端雀斑样黑色素瘤;病例2以上皮样细胞为主呈结节状融合并充满真皮,向下垂直浸润生长并侵及骨组织,为结节型黑色素瘤;二者均伴有同侧前哨淋巴结转移。免疫组织化学:2例肿瘤细胞均伴有S-100、HMB45、MelanA广泛表达。2例均经手术切除并予以化疗,但前哨淋巴结仍反复转移。结论大多AM确诊时已是晚期,易发生同侧SLN转移,预后差;及时准确的诊断对于AM治疗及判断预后具有重要意义。
Objective To explore the clinical characteristics,differential diagnosis and the mechanism of sentinel lymph node(SLN)metastasis of aral melanoma(AM).Methods The clinical data of 2 patients with AM and SLN metastasis in Wuhai People's Hospital of Inner Mongolia from 2019 to 2021 were collected.The histological characteristics and immunophenotype were retrospectively analyzed,and the relevant literatures were reviewed.Results The two patients were male with an average age of 63 years.The primary lesions were located in the left heel and the right index finger respectively;historical features showed that:In case 1,the tumor cells in the dermis were mainly short spindle shaped and invaded the subcutaneous tissue,which was an acral freckle-like melanoma;In case 2,cells were mainly nodular fusion and filled the dermis,infiltrated and grew vertically downward and invaded the bone tissue,which was a nodular melanoma.Both were accompanied by bilateral sentinel lymph node metastasis.Immunohistochemistry showed that two cases of tumor cells were accompanied by extensive expression of S-100,HMB45 and Melan A.Conclusion Most of AM are in advanced stage when diagnosed,prone to bilateral SLN metastasis and poor prognosis,and timely and accurate diagnosis is of great significance for the treatment and prognosis of AM.
作者
柴珂
侴晨旭
祝贺
李晋帆
康慧卿
CHAI Ke;CHOU Chen-xu;ZHU He;LI Jin-fan;KANG Hui-qing(Department of Pathology,Wuhai People's Hospital,Wuhai 016000,China;Department of Anaesthesiology in Baotou Medical College,Inner Mongolia Univerisity of Science and Technology,Baotou 041000,China)
出处
《诊断病理学杂志》
2022年第7期586-589,597,共5页
Chinese Journal of Diagnostic Pathology
关键词
肢端黑色素瘤
淋巴结转移
鉴别诊断
免疫组织化学
Acral melanoma
Lymph node metastasis
Differential diagnosis
Immunohistochemistry
