无色素性恶性黑素瘤1例并文献复习

发布时间：2018-10-05 20:30

【摘要】：背景:恶性黑素瘤是一种高度恶性肿瘤,易转移,预后差,早期诊断非常重要。无色素性恶性黑素瘤是临床上比较少见的一种恶性黑素瘤,因其缺乏黑色素,临床表现多样,无明显特异性,所以诊断比较困难,常易误诊为其他皮肤病或肿瘤,应引起重视。病例报告:患者,男,39岁。因头部红色结节、斑块2年来我院门诊就诊。患者2年前头部出现一黄豆大红色结节,无自觉症状。就诊当地医院,诊断为“表皮囊肿”,给予激光治疗。2月后原部位陆续出现多个淡红色结节,并逐渐扩大成斑块,再次就诊当地医院,给予手术治疗,术后未行皮肤病理检查。术后3月局部皮损复发,先后外用抗生素、抗真菌药物及激素等治疗,无明显效果,头部红色斑块不断增大,融合成片,中央糜烂。2月前发现左耳后及颈部肿物,无自觉症状。既往体健,家族中无类似疾病史。皮肤科检查:头部见形状不规则的红色结节,部分融合呈斑块,中央见一溃疡,表面结痂,周围少量鳞屑。左耳后及颈部可见肿大淋巴结、质中、触之无明显压痛。肺CT:双肺见散在密度增高影,考虑肺转移癌。皮损组织病理所见:真皮弥漫性肿瘤细胞浸润,表皮与真皮交界处和真皮内瘤细胞呈巢状分布,肿瘤细胞大小不等,细胞核大,深染,形状不规则,具显著异型性,肿瘤细胞内无明显黑素颗粒;免疫组化染色S-100及melan-A阳性。诊断:无色素性恶性黑素瘤。确诊后患者要求回当地医院治疗,后失访。结论:无色素性恶性黑素瘤因缺乏黑色素,临床表现多样且无明显特异性,容易误诊,临床医师应予以重视。对临床可疑病变应行组织病理活检及免疫组化染色。临床诊断不明确的患者在确诊前应避免激光或冷冻等不恰当的治疗方法反复刺激。
[Abstract]:Background: malignant melanoma is a highly malignant tumor, easy to metastasis, poor prognosis, early diagnosis is very important. Non-pigmented malignant melanoma is a rare malignant melanoma in clinic. Due to its lack of melanin, various clinical manifestations and no obvious specificity, it is difficult to diagnose and is often misdiagnosed as other skin diseases or tumors. Case report: patient, male 39 years old. Due to the red nodule of the head, plaque has been seen in our outpatient clinic for 2 years. The patient developed a soya-bean red nodule on his head 2 years ago without conscious symptoms. Two months later, a number of reddish nodules appeared in the original site and gradually expanded into plaques. The local hospital was again treated with surgery, and no skin pathological examination was performed after the operation. 3 months after operation, local skin lesions recurred, followed by antibiotics, antifungal drugs and hormones. There was no obvious effect. The red plaques of the head were enlarged, fused into pieces, and central erosion. Two months before the left ear and neck masses were found, there were no symptoms. There was no history of similar disease in the family. Dermatology: irregular red nodules were seen on the head, some fused plaques, an ulcer in the center, scabs on the surface, and a small amount of scales around. Enlarged lymph nodes can be seen in the left ear and neck. Lung CT: was seen in both lungs with increased density, considering lung metastases. Histopathological findings of the lesions were as follows: infiltration of dermis diffuse tumor cells, nesting distribution of tumor cells at the junction of epidermis and dermis and intradermal tumor cells, different size of tumor cells, large nucleus, deep staining, irregular shape and marked heterogeneity. No melanin granules were found in tumor cells, and S-100 and melan-A were positive by immunohistochemical staining. Diagnosis: achromatic malignant melanoma. After the diagnosis, the patient requested to return to the local hospital for treatment, and then lost a visit. Conclusion: due to the lack of melanin, the clinical manifestations of non-pigmented malignant melanoma are various and non-specific, which is easy to be misdiagnosed, so clinicians should pay attention to it. Histopathological biopsy and immunohistochemical staining should be performed for suspected clinical lesions. Patients with unclear clinical diagnosis should avoid repeated stimulation of inappropriate treatment methods such as laser or freezing before diagnosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.5

【相似文献】