CAJ | 학술논문

目的分析颅内恶性黑色素瘤( malignant melanoma, MM)的临床特征及诊治要点,以期提高该病的诊治水平. 方法回顾性分析我科2000年1月-2013年1月手术切除的5例无明确颅外原发灶的颅内MM患者的临床资料,对其临床表现、影像学特征、诊治及预后情况进行分析. 结果本组5例病灶均位于幕上且单发,术前诊断为颅内恶性肿瘤3例,自发性脑出血及颅内转移瘤各1例,术后均经病理检查或免疫组织化学染色确诊;4例肿瘤全切, 1例大部切除,术后予放化疗3例,伽马刀治疗2例. 4例获随访,1例大部切除于术后2个月死亡,1例在首次手术后6个月复发,再次手术后存活3个月死亡,2例术后24个月仍存活良好,生活基本自理. 结论无明确颅外原发灶的颅内MM诊断困难,术前误诊率极高,典型MRI表现对诊断有一定帮助,确诊主要依靠病理诊断,采用以手术为主的综合治疗手段可延长生存时间,早期预防或可降低其颅内转移的发生.
목적 분석로내악성흑색소류( malignant melanoma, MM)적림상특정급진치요점,이기제고해병적진치수평. 방법 회고성분석아과2000년1월-2013년1월수술절제적5례무명학로외원발조적로내MM환자적림상자료,대기림상표현、영상학특정、진치급예후정황진행분석. 결과 본조5례병조균위우막상차단발,술전진단위로내악성종류3례,자발성뇌출혈급로내전이류각1례,술후균경병리검사혹면역조직화학염색학진;4례종류전절, 1례대부절제,술후여방화료3례,가마도치료2례. 4례획수방,1례대부절제우술후2개월사망,1례재수차수술후6개월복발,재차수술후존활3개월사망,2례술후24개월잉존활량호,생활기본자리. 결론 무명학로외원발조적로내MM진단곤난,술전오진솔겁고,전형MRI표현대진단유일정방조,학진주요의고병리진단,채용이수술위주적종합치료수단가연장생존시간,조기예방혹가강저기로내전이적발생.
Objective To analyze the clinical features and key points of diagnosis and treatment of intracranial malignant melanoma ( MM) in order to improve the level of diagnosis and treatment. Methods Clinical data of intracra-nial MM 5 patients without clearly extracranial primary tumor, who underwent surgical excision between January 2000 and January 2013, was retrospectively analyzed, and the clinical manifestations, imaging features, diagnosis, treatment and prognosis of the 5 patients were analyzed. Results All the lesions were supratentorial and solitary, and 3 patients were misdiagnosed as having intracranial malignancy and 1 as having spontaneous cerebral hemorrhage and intracranial meta-static tumor, and then were confirmed by postoperative pathologic or immunohistochemical results. The 4 patients under-went the total resection and 1 patient received partial resection. The 3 patients underwent adjuvant chemoradiotherapy, and 2 patients received the Gamma Knife therapy after the operation. A total of 4 patients were followed up, 1 patient with partial resection died 2 months after the operation;1 patient was recurred 6 months after the first operation, and died 3 months after the second operation;the other 2 patients were alive well and self-independent 24 months after the operation. Conclusion Intracranial MM without clearly extracranial primary tumor has a high misdiagnosis rate, and its diagnosis is difficulty before the operation. The typical MRI finding is to some extent helpful to diagnosis, and its diagnosis is mainly based on pathologic results. The combined therapy giving priority to operation can prolong survival time, and early pre-vention is likely to decrease the incidence rate of intracranial metastasis.