CAJ | 학술논문

患者男,69岁,左大腿根部肿块2月余并逐渐增大.左小腿内侧色斑20余年.体检:左大腿根部扪及3 cm×2cm×2cm肿块,无压痛.左小腿内侧多个色素沉着斑,其中一较大的色斑2cm×2cm大小,边缘不规则,色素沉着不均匀.完整切除左大腿根部肿块,组织病理检查:镜下为增生的肿瘤性上皮样细胞伴黏液性基质,大小不等的圆细胞、梭形细胞被黏液样基质分隔;免疫组化染色:肿瘤细胞波形蛋白、S100、Melan-A阳性表达,肌动蛋白、结蛋白、CD56、上皮膜抗原、细胞角蛋白、白细胞共同抗原抗体、CD99、嗜铬蛋白A、突触囊泡蛋白均为阴性表达.左小腿内侧色素沉着斑:表面覆盖鳞状上皮,上皮细胞无异形,表面无破溃,真皮内见分布不均的噬黑素细胞,纤维组织增生伴胶原化,皮肤附件明显减少,少量炎症细胞浸润;AB-PAS染色阴性;免疫组化染色:波形蛋白、Melan-A阳性表达.病理诊断:原发灶消退的转移性黏液型黑素瘤.
환자남,69세,좌대퇴근부종괴2월여병축점증대.좌소퇴내측색반20여년.체검:좌대퇴근부문급3 cm×2cm×2cm종괴,무압통.좌소퇴내측다개색소침착반,기중일교대적색반2cm×2cm대소,변연불규칙,색소침착불균균.완정절제좌대퇴근부종괴,조직병리검사:경하위증생적종류성상피양세포반점액성기질,대소불등적원세포、사형세포피점액양기질분격;면역조화염색:종류세포파형단백、S100、Melan-A양성표체,기동단백、결단백、CD56、상피막항원、세포각단백、백세포공동항원항체、CD99、기락단백A、돌촉낭포단백균위음성표체.좌소퇴내측색소침착반:표면복개린상상피,상피세포무이형,표면무파궤,진피내견분포불균적서흑소세포,섬유조직증생반효원화,피부부건명현감소,소량염증세포침윤;AB-PAS염색음성;면역조화염색:파형단백、Melan-A양성표체.병리진단:원발조소퇴적전이성점액형흑소류.
A 69-year-old male patient presented with a gradually enlarging mass in the left inner upper thigh for more than 2 months,and pigmented patches in the left medial leg for more than 20 years.Physical examination revealed a painless mass measuring 3 cm × 2 cm × 2 cm in size in the left inner upper thigh.Several pigmented patches were observed in the left medial leg,and the largest pigmented patch measured 2 cm× 2 cm in size with an irregular border and uneven pigmentation.The mass in the left inner upper thigh was resected and subjected to histopathological examination,which showed proliferative epithelioid neoplastic cells with mucous matrix,round and spindle cells of varying sizes separated by mucous matrix.The immunohistochemical study of tumor cells showed positive staining for vimentin,S100 and Melan-A,but negative staining for actin,desmin,CD56,epithelial membrane antigen,cytokeratin,leukocyte common antigen,CD99,chromogranin A and synaptophysin.Hematoxylin-eosin staining of pigmented patches on the left medial leg revealed squamous epithelium covering the surface of lesions with no superficial ulceration or atypia in epithelial cells,unevenly distributed melanophages,fibroplasia accompanied by collagen formation,obviously decreased skin appendages,infiltration of a few inflammatory cells in the dermis.AB-PAS staining was negative.The immunohistochemical study of pigmented patches showed positive staining for vimentin and Melan-A.The patient was pathologically diagnosed with metastatic myxoid melanoma with partial regression of the primary lesion.