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| 名称： | |
| 描述： | |
- 左肺肿块空心粗针活检(肺部恶黑，极其罕见)
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| 姓 名： | ××× | 性别： | 男 | 年龄： | 62岁 |
| 标本名称： | 左肺肿块穿刺活检 | ||||
| 简要病史： | 主诉咳嗽，时有胸痛。CT示左肺下叶肿块约4cm，右肺门见结节影2.5cm。 | ||||
| 肉眼检查： | 空心针活检组织2条，长0.5cm。 | ||||
图1 2009年CT检查
图2 2010年4月复查
图3 X25
图4 X50
图5 X200
图6 X400
图7 X400
图8 X400
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本帖最后由 于 2010-06-29 13:37:00 编辑
- 王军臣
×参考诊断
肺原发恶黑
肺原发恶黑罕见，复习文献
Primary malignant melanoma of the lung with rapid progression
| 期刊 | General Thoracic and Cardiovascular Surgery | ||||||
| 出版社 | Springer Japan | ||||||
| ISSN | 1863-6705 (Print) 1863-6713 (Online) | ||||||
| 期 | Volume 57, Number 12 / 2009年12月 | ||||||
| 文章类型 | Case Report | ||||||
| DOI | 10.1007/s11748-009-0454-9 | ||||||
| 页 | 671-674 | ||||||
| 学科分类 | 医学 | ||||||
| SpringerLink Date |
2009年12月15日 Ryo Maeda1
Received: 24 January 2009 Accepted: 6 April 2009 Published online: 15 December 2009 Abstract This report presents a case of primary malignant melanoma of the lung with rapid progression in a 68-year-old man. During a regular checkup, a chest roentgenogram revealed an abnormal shadow in the left lower lung field. Computed tomography (CT) of the chest revealed an ill-defined tumor shadow measuring 4 × 3 cm in the left upper lobe. A CT-guided lung biopsy suggested a large-cell carcinoma, and left upper lobectomy was performed. Histopathologically, the tumor was comprised of malignant epithelial tumor cells with large amounts of acidophilic cytoplasm and prominent nuclei. A dark brown pigment was observed in the tumor cells. Immunohistochemical staining was positive for S-100 protein and HMB45; staining for cytokeratin, CAM5.2, and chromogranin was negative. The final diagnosis was malignant melanoma of the lung. Two months later, multiple brain metastases developed, and he died of the disease 6 months after the surgery. |
- 广州金域病理
Am Surg. 2007 Mar;73(3):287-9.
Primary malignant melanoma of the lung: review of literature and report of a case.
Reddy VS, Mykytenko J, Giltman LI, Mansour KA.
Division of Cardiothoracic Surgery, Joseph P. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Comment in:
Abstract
Less than 25 cases of primary malignant melanoma of the lung have been reported in the literature, with limited mention in the surgical literature. When published criteria are strictly applied, the actual number of cases is even fewer. We report the case of a 74-year-old man who underwent a left lower pulmonary lobectomy for a large left lower lobe mass consistent with malignancy. Clinical and pathological review confirmed primary malignant melanoma of the lung. Relevant clinical and histopathological features and the criteria for diagnosis are reviewed.
- 广州金域病理
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本帖最后由 于 2010-06-29 18:41:00 编辑
肺 原发性恶黑是极其罕见的肿瘤，属于粘膜恶黑的范畴。肺的恶黑多数是转移性的。原发性恶黑需要从如下几个方面鉴别：
1）既往史和现病史：诊断原发性肺部恶黑之前，需要排除原来有恶黑病史，需要详细检查全身皮肤没有恶黑的存在；
2）发生在肺内的部位：外周肺野发生的孤立性病灶，多为转移性的。肺原发性恶黑多数是起源于气管与支气管处粘膜，所以肿瘤部位在理论上应该靠近肺门；
3）组织学：典型病变的排列结构呈分叶状，可能见到气管支气管粘膜面溃疡，肿瘤旁粘膜可见到Paget's病样浸润。瘤细胞特征与皮肤恶黑没有区别；
IHC方面原发与继发没有区别，HMB45、Melan A 和S-100弥漫阳性是鉴别任何部位恶黑的重要的标志物。
鉴别诊断首要的是鉴别原发还是继发，只要除外继发就没有绝对的标准。其次就是鉴别神经内分泌癌，神经内分泌癌表达CK和神经内分泌标志物不同程度阳性。
除外皮肤原发转移，可诊断为肺原发性恶黑。该例后有骨转移和脑转移，一般来说预后较差。如果没有发生转移，手术切除和化疗后，无病生存是有很大可能的。
- 王军臣
| 以下是引用海上明月在2010-6-29 8:52:00的发言：
肺 原发性恶黑是极其罕见的肿瘤，属于粘膜恶黑的范畴。肺的恶黑多数是转移性的。原发性恶黑需要从如下几个方面鉴别： 1）既往史和现病史：诊断原发性肺部恶黑之前，需要排除原来有恶黑病史，需要详细检查全身皮肤没有恶黑的存在； 2）发生在肺内的部位：外周肺野发生的孤立性病灶，多为转移性的。肺原发性恶黑多数是起源于气管与支气管处粘膜，所以肿瘤部位在理论上应该靠近肺门； 3）组织学：典型病变的排列结构呈分叶状，可能见到气管支气管粘膜面溃疡，肿瘤旁粘膜可见到Paget's病样浸润。瘤细胞特征与皮肤恶黑没有区别； IHC方面原发与继发没有区别，HMB45、Melan A 和S-100弥漫阳性是鉴别任何部位恶黑的重要的标志物。 鉴别诊断首要的是鉴别原发还是继发，只要除外原发就没有绝对的标准。其次就是鉴别神经内分泌癌，神经内分泌癌表达CK和神经内分泌标志物不同程度阳性。 除外皮肤原发转移，可诊断为肺原发性恶黑。该例后有骨转移和脑转移，一般来说预后较差。如果没有发生转移，手术切除和化疗后，无病生存是有很大可能的。 |
感谢海上明月老师的精彩点评！
- 许春雷
