本帖最后由 pathology 于 2012-6-4 16:13 编辑
本周病例(2012.5.7—2012.5.13)
1、你考虑什么诊断?
转移性黑色素瘤(Metastatic melanoma)
本例病人曾行足部黑痣切除术,术后病理诊断浅表扩散性黑色素瘤。
Primary malignant melanoma of the lung (PMML) is also extremely rare and accounts for approximately 0.01% of lung neoplasms. The clinical diagnostic criteria of PMML are outlined as:
1 —— Absence of a previously resected pigmented skin lesion.
2 —— Absence of an ocular tumor or any history of previous primary melanoma in any organ.
3 —— Gross findings of a solid tumor within the lung surgical specimen.
4 —— Tumor morphology consistent with melanoma involving the respiratory epithelium.
5 —— Histologic evidence of invasive tumor cells arising from junctional change, or intraepithelial nests, in the bronchial epithelium.
本次免疫组化:
PCK
LCA
S-100
HMB45
Melan-A
2、需要做什么鉴别诊断?
低分化癌、神经内分泌肿瘤、淋巴瘤、梭形细胞肉瘤等
3、本病预后如何?
转移性黑色素瘤的预后差,5年生存率小于15%,平均生存期6-9个月。总的来说,发生淋巴结合软组织转移的病例,预后好于发生内脏转移者。在原发自皮肤的黑色素瘤转移至内脏的病例,多数病人在半年内死亡。
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本期病例比较少见,肿瘤形态不典型,在缺乏病史的情况下很难考虑到,一旦纳入鉴别范围,选择恰当的免疫组化则问题迎刃而解。综合回答思路,xhyong累积半分,rewe、chenqijun、jh531927210、yuyisheng0610、zhym2010、ayydz鲜花鼓励!
希望大家一如既往的支持病理每周一题, |