摘要
目的探讨颅内黑色素细胞病变的临床病理特点,提高对该病的认识。方法回顾性分析2011年2月至2015年10月我院8例颅内黑色素细胞病变的临床资料、病理形态特点及免疫组织化学染色结果。结果 8例颅内黑色素细胞病变中有2例为脑膜原发黑色素细胞增多症,1例为脑膜黑色素瘤病,3例为颅内原发恶性黑色素瘤,2例为颅内转移性恶性黑色素瘤。6例原发颅内黑色素细胞病变患者颅外均未发现黑色素细胞病变,2例转移患者分别有枕部黑色素痣肺转移和肾恶性黑色素瘤病史。2例脑膜原发黑色素细胞增多症最终通过脑脊液细胞学证实,其余6例均为手术切除标本经病理组织学证实。患者临床表现多为头痛,此外有癫痫发作、言语障碍、行为异常等。脑膜黑色素细胞增多症影像学MRI示脑膜增厚,强化后有增强;恶性黑色素瘤影像学多表现为CT高密度,MRI显示T1高信号,T2低信号,强化后有增强。病理组织形态除1例脑膜黑色素瘤病为无色素型外,其余病例细胞学或组织学中都可见到胞浆内含有色素颗粒的异型细胞。肿瘤细胞免疫细胞化学及免疫组织化学表达HMB-45、Melan A及S-100。结论颅内黑色素细胞病变的临床特征缺乏特异性,且原发与转移性病变的鉴别通常较为困难,详细的临床病史、影像学检查及病理脑脊液细胞学、组织学检查辅助免疫细胞化学或免疫组织化学染色可帮助进一步明确病变来源及类型,从而有助于临床诊断及治疗。
Objective To investigate the clinical and pathological features of intracranial melanocytic lesions.Methods The clinical features of 8 cases diagnosed as intracranial melanocytic lesions were retrospectively reviewed.The characteristic of morphology and result of immunohistochemical expression were analyzed. Results In 8 cases of intracranial melanocytic lesions, 2 were primary diffuse leptomeningealmelanocytosis, 3 were primary intracranial malignant melanoma, 1 was primary meningeal melanomatosis, 2 were intracranial malignant melanoma metastases. No extracranial melanoma was found in 6 cases of primary intracranial melanocytic lesions. Of the 2 intracranial malignant melanoma metastases, patients had history of occipital melanocytic nevus and renal malignant melanoma respectively. Patients mainly presented headache, others included seizure, dysphonia and confusion. Primary diffuse leptomeningealmelanocytosis appeared as diffuse meningeal thickening on MRI and enhance homogeneously. For malignant melanoma, CT scan showed a hyperdense lesion and MRI demonstrated hyperintense on T1-weighted and hypointense on T2-weighted with intense homogenous contrast enhancement. The primary diffuse leptomeningealmelanocytosis cases were confirmed by cytologicaltest of cerebrospinal fluid, while the other cases were diagnosed by histopathology through surgical excision. A variable amount of melanin could be found in all these cases except for the case of primary meningeal melanomatosis. Besides, the immunocytochemical and immunohistochemical expression was positive for HMB-45, Melan A, and S-100.Conclusion The clinical characteristic of intracranial melanocytic lesions was lack of specificity, and it was difficult to distinguish the primary and metastatic lesions. So detailed histories, completed imaging examination and pathologic cytology and histology accompanied immunochemical staining could help further clarify the sources and types of lesions,which is of important effect and significance to the clinical diagnosis and trea
出处
《北京医学》
CAS
2016年第5期400-404,I0002,共6页
Beijing Medical Journal
