肛管直肠恶性黑色素瘤临床病理特征分析.docVIP

肛管直肠恶性黑色素瘤临床病理特征分析 　　作者：何兴状,吴应轩,刘别影,牟辉　　作者单位： 四川，广元市第一人民医院病理科(何兴状、吴应轩、牟 辉)，肛肠外科(刘别影) 　　【摘要】目的研究肛管直肠恶性黑色素瘤的临床病理特征、手术方式、免疫组化特点及临床及病理误诊原因。方法回顾性分析11例肛管直肠原发性恶性黑色素瘤临床及病理资料，所有标本均进行HE及免疫组化染色，免疫组化采用Envision法。 结果 本组病例男3例，女8例，平均年龄58.3岁。主要症状便血、肛门坠胀感、肛门不适及肛门脱出物。病理大体外观：肿瘤多在齿状线附近呈结节状、息肉状、菜花状、溃疡型及平坦型，病理形态：上皮样细胞为主6例，梭形细胞为主4例，小细胞为主1例。免疫组化染色：Vimentin、S100、Melan-A在11例标本中均为阳性表达，HMB45在10例中阳性，其中1例为阴性。在这11例肛管直肠恶性黑色素瘤的病例中临床误诊率为81.8%(9/11)，术前活检标本误诊率为27.27%(3/11)，根治术后标本误诊率为9.1%(1/11)。结论 肛管直肠恶性黑色素瘤是一种恶性程度极高、预后极差的恶性肿瘤。 临床及病理极易误诊。免疫组化S100、HMB45、Melan-A/MART-1三者联合应用能提高恶性黑色素瘤病理诊断的准确性。发现肿瘤厚度与患者的预后密切相关。 　　【关键词】 肛管直肠,黑色素瘤,临床病理 　　Abstract Objective To study the clinicopathological features, surgical methods, immunohistochemical features, the clinical and pathological causes of misdiagnosis of anorectal malignant melanoma (AMM).Methods A retrospective analysis was made to the clinical and pathological data of 11 cases (3 male and 8 female with the average age of 58.3 year old) with AMM; HE and immunohistochemical stain with Envision method were performed.Results The chief symptoms were hematochezia, sensation of rectal tenesmus, anal discomfort and prolapse; the pathological view with the naked eye indicated that the tumor were nodular, or polypoidal, or cauliflower-like, or ulcerative, or flat, located mostly along the dentate line; the histopathological view indicated 6 cases mainly with epithelioid cells, 4 cases mainly with spindle cells and 1 case with small cells; the immunohistochemical stain indicated positive expression of Vimentin, S100 and Melan-A in the 11 cases while positive HMB45 in 10 cases and negative in 1 case; the clinical misdiagnosis was 81.8% (9/11), the misdiagnosis of biopsy specimens before operation was 27.27 (3/11), and the misdiagnosis of specimens after radical resection was 9.1% (1/11). Conclusions AMM is a tumor of high malignancy and worse prognosis, and it is often misdiagnosed in clinic and in pathological study; the combined application of S100, HMB45 an