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目的:探讨恶性黑色素瘤的诊断和治疗方法。方法:回顾分析1例结肠原发性恶性黑色素瘤患者的临床资料。结果:患者,男,60岁,因排便困难伴鲜血便入院,肠镜示距肛门约30 cm处见一息肉样肿物阻塞管腔。术前内镜下病理活检报告:坏死、出血、脓性渗出及少许黏液,见少量异形细胞,考虑恶性肿瘤。行乙状结肠癌根治术。术后病理报告:切除肿物为息肉样突起,体积3.5 cm×2.5 cm×2 cm。镜下肿瘤大部分位于黏膜层,向下浸润至黏膜下层,肿瘤表面坏死。肿瘤细胞呈多种形态,为短梭形,卵圆形及多角形,胞浆偏少嗜酸性。细胞核大畸形,核分裂像多见;脉管及神经未见肿瘤侵及,两切端未见瘤,系膜淋巴结15枚,均未见瘤侵及。免疫组化结果:Vim(+),S-100(+),Melan A(+),CD117(+),CK(-),HMB45(-),CD34(血管+),Ki-67(40%+)诊断为恶性黑色素瘤。术后未行放化疗及生物治疗,术后11个月死亡。结论:结肠原发性恶性黑色素瘤是一种高度恶性肿瘤,病死率高、预后极差,结肠原发性恶性黑色素瘤临床上极为罕见,诊断主要依靠免疫组化结果。
Objective: To investigate the diagnosis and treatment of malignant melanoma. Methods: A retrospective analysis of 1 case of primary malignant melanoma in patients with clinical data. Results: The patient, male, aged 60, was admitted to hospital for defecation with difficulty in blood flow. The colonoscopy revealed a polypoid mass obstructing the lumen about 30 cm away from the anus. Preoperative endoscopic biopsy report: necrosis, bleeding, purulent exudation and a little mucus, see a small number of abnormal cells, consider the malignant tumor. Radical sigmoid colon surgery. Postoperative pathology report: resection of the tumor as polypoid protrusions, the volume of 3.5 cm × 2.5 cm × 2 cm. Most of the microscopic tumor located in the mucosa, infiltration down to the submucosa, the tumor surface necrosis. Tumor cells showed a variety of forms, short fusiform, ovoid and polygonal, cytoplasm less eosinophilic. Large degenerations of the nucleus, mitotic common more; no tumor invasion of vessels and nerves, no tumor at both ends, 15 mesangial lymph nodes, no tumor invasion and. Immunohistochemistry results showed that Vim (+), S-100 (+), Melan A (+), CD117 (+), CK (-), HMB45 (-), CD34 (Vascular +), Ki- 67 +) Diagnosed with malignant melanoma. Postoperative radiotherapy and chemotherapy and biological treatment, 11 months after the death. Conclusion: The primary malignant melanoma in colon is a highly malignant tumor with high mortality and poor prognosis. The primary malignant melanoma in colon is extremely rare in clinic. The diagnosis mainly depends on immunohistochemistry.