伴浆膜腔积液的恶性黑色素瘤5例临床和细胞病理学检查分析

doi:10.16150/j.1671-2870.2020.05.010

摘要/Abstract

摘要：

目的： 观察伴浆膜腔积液的恶性黑色素瘤患者的临床表现,分析该病的细胞病理学诊断及鉴别诊断特征。方法： 收集5例经浆膜腔积液细胞学检查诊断为恶性黑色素瘤的病例,观察浆膜腔积液细胞涂片的细胞学形态特征,分析浆膜腔积液离心、包埋后行免疫细胞化学染色的结果,总结患者的临床及预后特点。结果： 5例患者中男性2例,女性3例,发病年龄为30~71岁,平均年龄为48.6岁;其中,3例患者为胸腔积液,2例为腹腔积液。5例患者的浆膜腔积液细胞涂片形态学观察、免疫细胞化学染色结果（HMB45、S-100、Pan-mel、SOX10、波形蛋白均为阳性表达）均证实为恶性黑色素瘤。患者随访至2020年4月,累计随访2~11个月,3例患者死亡,1例存活,1例失访。结论： 恶性黑色素瘤引起浆膜腔积液十分罕见,多数患者有明确的既往病史,诊断并不困难。浆膜腔积液细胞学检查诊断恶性黑色素瘤时,需与低分化腺癌、淋巴瘤、恶性间皮瘤进行鉴别,离心包埋细胞蜡块及免疫细胞化学染色有助于诊断。由于转移性恶性黑色素瘤患者存活期较短,及时行浆膜腔积液细胞学检查十分重要。

关键词: 浆膜腔积液, 黑色素瘤, 细胞学诊断, 临床特征

Abstract:

Objective: To study the clinical manifestations, cytopathological diagnosis and differential diagnosis of the malignant melanoma with serosal effusion. Methods: Five cases of malignant melanoma diagnosed by the cytology of serosal effusion in XijingHospital were enrolled. The cytology of serosal smear and the immunocytochemical staining of the paraffin-embedded section prepared from centrifugation of the serous effusion were studied, and the clinical feature and prognosis of the patients were analyzed. Results: Five cases included 2 males and 3 females, the age of onset ranged from 30 to 71 years and the average age was 48.6 years. Three cases had pleural effusion and 2 cases had intraperitoneal effusion. Five cases were diagnosed as malignant melanoma by morphological observation in the serosal smear and immunocytochemistry examination(all case was positive for HMB45, S-100, Pan-mel, SOX10 and vimentin). All patients were followed up until April 2020, with a follow-up period of 2 to 11 months. In 5 cases, three died, one survived and one was lost during follow-up. Conclusions: The serous cavity effusion caused by malignant melanoma is very rare, and the diagnosis is not difficult since most cases have clear history. The malignant melanoma diagnosed by the cytology of serosal effusion need to be differentiated with the poorly differentiated adenocarcinoma, lymphoma, and malignant mesothelioma. Centrifugation of the serosal effusion and immunocytochemical staining is helpful to make diagnosis. It is important to confirm the diagnosis by performing cytological examination of serous effusion accurately and timely because of the low survival rate of metastatic malignant melanoma.

Key words: Serous cavity effusion, Melanoma, Cytological diagnosis, Clinical feature

中图分类号:

R730.261

杨巧, 温玉婷, 杨昌伟. 伴浆膜腔积液的恶性黑色素瘤5例临床和细胞病理学检查分析[J]. 诊断学理论与实践, 2020, 19(05): 499-503.

YANG Qiao, WEN Yuting, YANG Changwei. Five cases of the malignant melanoma with serosal effusion: the clinical and pathological analysis[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(05): 499-503.

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参考文献 11

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例序	性别	年龄(岁)	既往史	临床表现	影像学检查	随访及预后
1	女	36	右上肢恶性黑色素瘤截肢术后（具体不详）	/	双侧大量胸腔积液（具体不详）	失访
2	男	71	5年前右肩胛部恶性黑色素瘤切除术	咳嗽、咳痰伴胸闷气短21 d	胸部CT检查,见左侧大量胸腔积液, 右侧少量胸腔积液	8个月,死亡
3	女	30	5个月前右手拇指恶性黑色素瘤切除术	腹胀,伴恶心,偶有呕吐1个月	腹部超声检查,见下腹囊性包块,腹腔积液（中量）	6个月,死亡
4	男	52	2年前右足跟恶性黑色素瘤切除术	右侧腹股沟、右股部可见多发丘疹、结节	B超检查示,右侧腹股沟多发肿大淋巴结,考虑转移灶;大量腹腔积液	11个月,死亡
5	女	54	1年前左腋窝淋巴结穿刺活检提示恶性黑色素瘤	左肩背部、左胸部出现胀痛感	PET-CT检查示,左侧胸腔大量积液, 左肺受压、萎缩	2个月,存活

例序	标本类型	积液性状	浆膜腔积液的细胞学特征			免疫表型
例序	标本类型	积液性状	肿瘤细胞形态	色素	背景细胞成分	阳性	阴性
1	双侧胸腔积液	棕黄	上皮样形态	多量	少量组织细胞	/	/
2	左侧胸腔积液	浅红	上皮样形态,细胞质丰富, 可见嗜酸性大核仁	极少	少量淋巴细胞及组织细胞	HMB-45、Pan-mel、 S-100、波形蛋白	AE1/AE3、CK7、TTF-1、 P63、CR、D2-40、CD68
3	腹腔积液	浅红	细胞体积大,异型性明显,上皮样形态,可见嗜酸性大核仁	少量	多量淋巴细胞,少量组织细胞及间皮细胞	HMB-45、Pan-mel、波形蛋白	S-100、AE1/AE3、CR、 D 2-40、CD68、SOX10
4	腹腔积液	灰黄	细胞中等大小,上皮样形态, 可见嗜酸性大核仁	少量	少量淋巴细胞、组织细胞及间皮细胞	HMB-45、Pan-mel、 S-100、SOX10、波形蛋白	AE1/AE3、CR、D2-40、 CD68
5	左侧胸腔积液	浅红	细胞中等大小,上皮样形态, 可见嗜酸性大核仁	极少	少量淋巴细胞、中性粒细胞、组织细胞及间皮细胞	/	/

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