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目的分析肛管直肠恶性黑色素瘤临床及病理误诊的原因 ,探讨避免误诊的办法 .方法对 15例肛管直肠恶性黑色素瘤进行回顾性分析和免疫组化观察 .结果临床误诊率为 86 7% (13/15).其中误诊为良性病变占 66 7% (10/15),误诊为痔或痔伴有肛周脓肿 7例、息肉 2例及慢性炎症 1例； 3例误诊为肛管直肠癌 .延误诊治时间 3个月至 1年 .活检病理误诊率为 53 3% (8/15),其中误诊为低分化腺癌 6例 ,平滑肌肉瘤、类癌各 1例 . 5例无色素性恶性黑色素瘤全部误诊 .结论肛管直肠恶性黑色素瘤临床误诊率高 ,病理活检难以准确分型 .临床和病理医生应密切配合 ,作直肠指诊 ,及时活检；对病理标本多作切片 ,仔细寻找黑色素颗粒并对可疑标本进行免疫组织化学检查 ,有助明确诊断 .
Objective To analyze the causes of clinical and pathological misdiagnosis of anorectal malignant melanoma and explore the methods of avoiding misdiagnosis. Methods Retrospective analysis and immunohistochemical observation were performed on 15 cases of anorectal malignant melanoma. Results The clinical misdiagnosis rate was 86 7%. (13/15). Among them, 66.7% (10/15) were misdiagnosed as benign lesions. They were misdiagnosed as 7 cases of perianal abscesses, 2 cases of polyps, and 1 case of chronic inflammation. 3 cases were misdiagnosed as anal canal. Rectal cancer. Delayed diagnosis and treatment time from 3 months to 1 year. The biopsy pathological misdiagnosis rate was 53. 3% (8/15), which misdiagnosed as poorly differentiated adenocarcinoma in 6 cases, leiomyosarcoma and carcinoid in 1 case. 5 cases no. All malignant melanoma pigments are misdiagnosed. Conclusions The misdiagnosis rate of malignant melanoma of the anorectal mesothelioma is high, and pathological biopsy is difficult to accurately classify. Clinicians and pathologists should cooperate closely for digital rectal examination and timely biopsy; for pathological specimens more slices, Careful search for melanin particles and immunohistochemical examination of suspicious specimens will help confirm the diagnosis.