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目的 探讨原发性宫颈恶性黑色素瘤(恶黑)患者的临床病理特征、治疗及预后。方法对北京协和医院和江西省妇幼保健院 1996年 9月至 2002年 8月收治的 4例原发性宫颈恶黑患者的临床病理资料进行回顾性分析,全部病例进行随访。所有病理标本进行免疫组化S 100及抗黑色素瘤特异性抗体(HMB-45)测定。结果 免疫组化检测: 4例患者HMB-45及S 100均呈阳性。治疗: 4例患者均接受了手术治疗;其中 3例接受了联合化疗, 3例中 1例同时接受了干扰素和抗雌激素受体治疗。预后: 1例仅接受手术治疗的患者于术后 6个月死亡;其他 3例均存活 3年以上,其中 1例于术后 41个月死亡,另 2例目前仍无瘤生存,分别存活 3、6年以上。1例存活 6年以上的患者在化疗的同时接受了免疫治疗。结论 S 100及HMB-45检测对于确诊恶黑具有重要意义。对于早期患者,手术应作为首选治疗手段,而辅助性化疗及免疫治疗有可能改善其预后。
Objective To investigate the clinicopathological features, treatment and prognosis of patients with primary cervical malignant melanoma. Methods The clinical and pathological data of 4 patients with primary cervical malignant black in Beijing Union Hospital and Jiangxi Maternal and Child Health Hospital from September 1996 to August 2002 were analyzed retrospectively. All patients were followed up. All pathological specimens were detected by immunohistochemistry S 100 and anti-melanoma antibody (HMB-45). Results Immunohistochemical detection: HMB-45 and S 100 were positive in 4 patients. Treatment: Four patients underwent surgery; three received combined chemotherapy and one of three received both interferon and anti-estrogen receptor therapy. Prognosis: One patient who underwent surgery only died 6 months after operation. The other 3 patients all survived for more than 3 years, of which 1 died after 41 months and the other 2 patients remained tumor-free and survived 3 , 6 years or more. One patient who survived more than 6 years underwent chemotherapy while receiving immunotherapy. Conclusion The detection of S 100 and HMB-45 is of great significance for the diagnosis of black evil. For early patients, surgery should be the preferred treatment, and adjuvant chemotherapy and immunotherapy may improve their prognosis.