CAJ | 학술논문

目的探讨中枢神经系统黑色素肿瘤的临床特征、治疗策略及预后.方法回顾性分析2006年7月至2012年6月北京天坛医院收治经组织病理学证实的24例中枢神经系统黑色素肿瘤临床资料,并进行随访.根据Willis诊断观点,本组原发性黑色素细胞肿瘤8例,转移性恶性黑色素瘤16例.20例术前进行了MRI检查,其中15例表现为短T1短T2信号.所有患者均接受手术治疗.结果肿瘤全切除11例,近全切除9例、大部切除4例.原发性黑色素细胞肿瘤8例均获得随访,其中2例死亡,术后分别存活15及40个月,其余6例患者术后13 ～ 56个月,目前仍存活.转移性黑色素瘤14例获得随访,8例死亡,中位生存时间4.5个月.6例术后1～7个月,目前仍存活.术后免疫组化检测结果为HMB-45阳性比例9/10,S-100阳性比例9/11,Vimentin阳性比例8/11.结论中枢神经系统黑色素肿瘤发病率低,具有特征性影像学表现,免疫组化染色有利于病理诊断,治疗以手术切除为主,临床分型对判断预后有重要意义.
목적 탐토중추신경계통흑색소종류적림상특정、치료책략급예후.방법 회고성분석2006년7월지2012년6월북경천단의원수치경조직병이학증실적24례중추신경계통흑색소종류림상자료,병진행수방.근거Willis진단관점,본조원발성흑색소세포종류8례,전이성악성흑색소류16례.20례술전진행료MRI검사,기중15례표현위단T1단T2신호.소유환자균접수수술치료.결과 종류전절제11례,근전절제9례、대부절제4례.원발성흑색소세포종류8례균획득수방,기중2례사망,술후분별존활15급40개월,기여6례환자술후13 ～ 56개월,목전잉존활.전이성흑색소류14례획득수방,8례사망,중위생존시간4.5개월.6례술후1～7개월,목전잉존활.술후면역조화검측결과위HMB-45양성비례9/10,S-100양성비례9/11,Vimentin양성비례8/11.결론 중추신경계통흑색소종류발병솔저,구유특정성영상학표현,면역조화염색유리우병리진단,치료이수술절제위주,림상분형대판단예후유중요의의.
Objective To explore the clinical manifestations,diagnosis,treatment and prognostic features of melanocytic neoplasms of central nervous system (CNS).Methods A total of 24 patients with melanocytic neoplasms of CNS underwent surgery and were confirmed pathologically our hospital during 2006-2012.Their clinical data were collected.There were primitive melanocytic neoplasms (n =8) and metastatic melanoma (n =16) according to the diagnostic criteria of Willis.The scans of magnetic resonance imaging (MRI) showed hyperintensity on T1 weighted image (n =15) and hypointensity on T2 weighted image (n =20).Results The outcomes were total resection (n =11),subtotal resection (n =9) and partial resection (n =4).All 8 primitive melanocytic neoplasms were followed up.Among them,2 cases died postoperatively at 15 and 40 months respectively.The remaining 6 cases survived 13-56 months after craniotomy.And 14/16 patients of metastatic melanoma were followed up,8 cases died and the mean survival period was 4.5 months.The remaining 6 cases survived 1-7 months after craniotomy.Immunohistochemical staining demonstrated that the positive rate of HMB-45 was 9/10,S-100 9/11 and Vimentin 8/11.Conclusion Melanocytic neoplasms of CNS are rare lesions with characteristic MRI features.Immunohistochemical staining helps to reach a definite pathological diagnosis.Surgical excision is recommended.Differentiation of primary and metastatic neoplasm is critical for prognostic evaluations.