恶性黑色素瘤误诊为隆突性皮肤纤维肉瘤研究.docVIP

恶性黑色素瘤误诊为隆突性皮肤纤维肉瘤研究【摘要】 目的 探讨皮肤恶性黑色素瘤误诊的原因。方法 对1例皮肤恶性黑色素瘤误诊为隆突性皮肤纤维肉瘤的临床资料进行回顾性分析。结果 左下肢皮肤肿物的组织学以梭形细胞为主，呈车辐状排列，无明显的色素沉着，与隆突性皮肤纤维肉瘤极为相似，但是免疫组织化学染色结果为：瘤细胞S?00、HMB?45及Melan?A阳性，诊断为皮肤恶性黑色素瘤。结论 恶性黑色素瘤的临床表现复杂，缺乏特异性，组织学表现多样，形态复杂，诊断时应详细了解病史，认真观察切片，加以辅助检查，以减少误诊。? 【关键词】 恶性黑色素瘤；误诊；隆突性皮肤纤维肉瘤；组织学；免疫组织化学 ?? The clinical analysis of cutaneous m alignant melanoma misdiagnosed dermatofibrosarcoma protuberans sarcoma WANG Xiao?hong,GOU Xin?ming,ZHENG Yan?xuan,et al. Department of Pathology,The Fifth Affiliated Hospital of SunYat?sen University,Zhuhai 519000,China ? 【Abstract】 Objective To investigate misdiagnosis reasons of the cutaneous m alignant melanoma.Methods One case of cutaneous m alignant melanoma misdiagnosed as dermatofibrosarcoma protuberans sarcoma were retrospectively analyzed. Results The left lower extremity skin tumor histology to the main spindle cells, arranged like spokes were no obvious pigmentation, sarcoma and dermatofibrosarcoma protuberans were very similar, but the results of immunohistochemical staining: the tumor cells S ?00, HMB?45 and Melan?A positive diagnosis of cutaneous m alignant melanoma. Conclusion The clinical manifestations of m alignant melanoma of the complex, the lack of specificity, histological features varied, complex patterns, diagnosis should learn more about history, careful observation of slices, to be supplemented by checks to reduce misdiagnosis.省略 1 临床资料? 患者女，42岁，因发现左大腿肿物一年，快速增大1个月余就诊。患者一年前无意间发现左大腿近腹股沟处可扪及一直径约0.8 cm的圆形肿物，肿物渐增大，近1个月来，肿物迅速增大至直径2.0~2.5 cm，活动度好，无痛，表面皮肤无红肿、破溃。临床手术切除送病理检查。大体检查：送检结节型肿物一枚，直径2.5 cm，表面似有薄层，完整的包膜，切面灰白色，质地脆。镜下见肿物为淋巴结组织，淋巴结结构破坏，代之以呈巢状、片状或束状弥漫浸润的肿瘤组织，其间被细纤维结缔组织分隔，肿瘤细胞中等大小，胞浆透亮或略嗜酸性，可见嗜碱性或嗜双色性的大核仁。免疫组织化学染色示，瘤细胞广普CK阴性，Vimentin阳性，S?100、HMB?45、Melan?A阳性，CD??34?阴性。诊断为(左侧腹股沟)淋巴结转移性恶性黑色素瘤。追溯病史，患者一年半前曾行左膝盖上方肿物切除术，术后诊断为隆突性皮肤纤维肉瘤。调阅当时的病历，患者二年前发现左膝盖上方皮肤肿物，略突出皮面，肤色或略为淡褐色，无痛，皮肤无破溃，肿物渐增大，于当地医院手术切除，病理提示隆突性皮肤纤维肉瘤。借阅当地医院的病理切片观察，见肿瘤位于真皮层，向下侵犯皮下组织，瘤细胞呈车辐状排列，细胞呈胖梭形，胞浆淡粉色或透亮，可见嗜酸性核仁，无明显的色素颗粒。加做免疫组织化学