论文部分内容阅读
目的:探讨女性原发性生殖道恶性黑色素瘤的临床病理特点及鉴别诊断,分析影响预后的因素。方法:收集女性原发性生殖道恶性黑色素瘤21例,观察其临床病理特点,进行免疫组织化学染色,并用寿命表分析法和Kaplan-Meier法分析影响预后的因素。结果:免疫组化结果显示,S-100、HMB45、Melan-A和Vim均呈阳性表达。预后分析显示,中位生存时间为42个月,5年生存率为24%。外阴、阴道和宫颈恶性黑色素瘤患者的中位生存时间分别为43、60和34个月。外阴恶性黑色素瘤患者单纯手术治疗的生存时间长于手术加其他辅助治疗或单纯辅助治疗,差异有统计学意义,χ2=11.592,P=0.003;阴道恶性黑色素瘤患者手术加其他辅助治疗的生存时间长于单纯手术治疗或单纯辅助治疗,差异有统计学意义,χ2=10.368,P=0.006。Ⅰ、Ⅱ和Ⅲ期患者平均生存时间分别为88、53和27个月,Ⅰ期患者的生存时间长于Ⅲ期患者,差异有统计学意义,χ2=4.947,P=0.026。原发肿瘤部位、肿瘤大小、复发及转移与生存时间无相关性,P>0.05。结论:女性原发性生殖道恶性黑色素瘤恶性程度高,预后差。S-100、HMB45、Me-lan-A和Vim联合标记可提高诊断恶性黑色素瘤的准确率。
Objective: To investigate the clinicopathological features and differential diagnosis of female primary reproductive tract malignant melanoma and to analyze the factors influencing the prognosis. Methods: Twenty-one cases of female primary reproductive tract malignant melanoma were collected. The clinicopathological features were observed and the immunohistochemical staining was performed. The prognostic factors were analyzed by life table analysis and Kaplan-Meier analysis. Results: The results of immunohistochemistry showed that S-100, HMB45, Melan-A and Vim were all positive. Prognostic analysis showed that the median survival time was 42 months and the 5-year survival rate was 24%. The median survival in patients with vulvar, vaginal and cervical malignant melanoma was 43, 60 and 34 months, respectively. The survival time of patients with vulvar malignant melanoma surgery alone was longer than surgery plus other adjuvant therapy or simple adjuvant therapy, the difference was statistically significant (χ2 = 11.592, P = 0.003); Survival time of patients with vaginal malignant melanoma plus other adjuvant therapy was longer than Simple surgical treatment or simple adjuvant therapy, the difference was statistically significant, χ2 = 10.368, P = 0.006. The average survival time of stage Ⅰ, Ⅱ and Ⅲ were 88, 53 and 27 months respectively. The survival time of stage Ⅰ patients was longer than that of stage Ⅲ patients, the difference was statistically significant (χ2 = 4.947, P = 0.026). No significant correlation was found between primary tumor site, tumor size, recurrence and metastasis and survival time (P> 0.05). Conclusion: Female primary reproductive tract malignant melanoma has a high degree of malignancy and a poor prognosis. S-100, HMB45, Me-lan-A and Vim combined markers can improve the accuracy of the diagnosis of malignant melanoma.