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目的探讨原发性鼻腔鼻窦黏膜恶性黑色素瘤(SMMM)的临床病理特点、鉴别诊断、治疗与预后。方法回顾性分析4例SMMM的临床病理资料,观察其组织形态特征及免疫组化特点,并复习相关文献。结果患者男性1例,女性3例,平均年龄75.5岁(65～90岁),临床主要表现为鼻塞、出血及鼻腔新生物,镜下瘤细胞形态多样,异型性较明显,以上皮样细胞和小圆细胞为主,伴有局部少量梭形细胞样细胞,仅部分显示黑色素。其中1例可见黏液样变,1例色素性黏膜恶性黑色素瘤局部复发后细胞体积明显增大,色素减少,多数细胞胞质透明,呈气球样变。免疫组化示HMB45、vimentin、S-100均不同程度(+),NSE、LCA、SMA、CD99和desmin(-),局部CK、CD68弱(+)各1例,Ki-67程度不一。结论鼻腔原发性黑色素瘤少见,恶性程度较高,形态多样,免疫组化对诊断及鉴别较为重要。
Objective To investigate the clinicopathological features, differential diagnosis, treatment and prognosis of primary nasal sinus mucosal malignant melanoma (SMMM). Methods The clinicopathological data of 4 cases of SMMM were retrospectively analyzed. The morphological characteristics and immunohistochemical characteristics of SMMM were observed, and the related literatures were reviewed. Results There were 1 males and 3 females, with an average age of 75.5 years (range, 65-90 years). The main clinical manifestations were nasal obstruction, hemorrhage and nasal neoplasms. The morphology of the tumor cells was diverse and the atypia was obvious. Small round cells, accompanied by a small amount of local spindle cells, only part of melanin. One case showed mucoid change, a case of pigmented mucosal malignant melanoma after local recurrence significantly increased the volume of cells, decreased pigment, the majority of cells cytoplasm transparent balloon-like change. Immunohistochemistry showed that HMB45, vimentin and S-100 were all different degrees (+), NSE, LCA, SMA, CD99 and desmin (-), local CK and CD68 weak (+ Conclusion Primary nasal melanoma is uncommon and has a high degree of malignancy and various forms. Immunohistochemistry is more important for diagnosis and differential diagnosis.