CAJ | 학술논문

目的研究头颈部恶性黑色素瘤的临床，病理及免疫组织化学特征，以提高临床和病理诊断率。方法收集头颈部恶性黑色素瘤（除脉络膜外）68例，其中原发于鼻腔和口腔黏膜33例，头颈部皮肤 35例。发病高峰年龄为41～60岁。52例为手术切除标本，16例为活检（咬取、切除）标本。复习所有患者的临床及病理资料，并对42例进行S-100、HMB45和NSE免疫组织化学观察。结果在68例中，手术切除者52例，其中有13例行补充放疗，21例进行了化疗；单纯放疗10例；拒绝治疗6例。在获得随诊的56例中，存活5年以上者12例，其中头颈部皮肤恶性黑色素瘤9例，占75.0%；鼻腔及口腔黏膜者3例，占25.0%。结论恶性黑色素瘤在组织学结构上的改变具有重要意义；免疫组织化学对恶性黑色素瘤诊断和鉴别诊断有重要价值；发生于鼻腔和口腔黏膜的恶性黑色素瘤的预后明显比发生在头颈部皮肤的差。
목적연구두경부악성흑색소류적림상，병리급면역조직화학특정，이제고림상화병리진단솔。방법수집두경부악성흑색소류（제맥락막외）68례，기중원발우비강화구강점막33례，두경부피부 35례。발병고봉년령위41～60세。52례위수술절제표본，16례위활검（교취、절제）표본。복습소유환자적림상급병리자료，병대42례진행S-100、HMB45화NSE면역조직화학관찰。결과재68례중，수술절제자52례，기중유13례행보충방료，21례진행료화료；단순방료10례；거절치료6례。재획득수진적56례중，존활5년이상자12례，기중두경부피부악성흑색소류9례，점75.0%；비강급구강점막자3례，점25.0%。결론악성흑색소류재조직학결구상적개변구유중요의의；면역조직화학대악성흑색소류진단화감별진단유중요개치；발생우비강화구강점막적악성흑색소류적예후명현비발생재두경부피부적차。
Objective　To investigate the clinical and pathogical characteristics of head and neck malignant melanoma. Methods　Sixty-eight cases of head and neck malignant melanoma were reviewed. There were 33 patients with melanoma in the nasal cavity and oral cavity, 35 patients with melanoma in the skin. The age fastigium of the patients was from 41 to 60 years. Surgical specimens in 52 cases and biopsy specimens in 16 cases were studied pathologically. S-100, HMB45 and NSE were examined immunohistochemically.ResultsHistopathology studies showed that the cell mosphology was pleomophic as well as polymorphic both in shape and size of the cells. Immunohistochemical studies helped diagnosis as all of the 42 melonoma specimens were positure for S-100 and 90.5% positive for HMB45. In 52 of the 68 cases, the tumor was excised surgically, with additional radiotherapy in 13 cases or chemotherapy in 21 cases. Ten cases were treated with radiotherapy alone. In 56 patients followed-up, 12 survived for 5 years, including 9 cases of skin melanoma and 3 cases of nasal and oral melanoma.Conclusion　The histo-pathological features of malignant melanoma vary significally. Immunohistochemical staining helps diagnosis and differential diagnosis.The prognosis of malignant melanoma in nasal cavity and oral cavity is poor as compared to that in the skin of head and neck region.