Desmoplastic malignant melanoma: A clinicohistopathologic study of 25 cases
Desmoplastic malignant melanoma: A clinicohistopathologic study of 25 cases
复制标题
促纤维增生性恶性黑色素瘤25例临床组织病理学研究
作者：
B. Egbert;Ruth Kempson;R. Sagebiel
本文报告了25例黑素细胞性皮损的临床和组织学回顾。所有病变均位于阳光暴晒部位。平均年龄61.2岁(38~83岁)，中位年龄56岁。其中女性14例，男性11例。促结缔组织增生性恶性黑色素瘤是一种黑素细胞和成纤维细胞的增殖，主要发生在头部和颈部。平淡的组成细胞类似于成纤维细胞，通常排列成束或束状，可垂直于上覆表皮排列。增大的和/或不典型的细胞通常散布在梭形细胞之间。大多数(但不是全部)肿瘤(本系列25例中的24例)与恶性雀斑或不典型的交界性黑素细胞增殖有关。在纤维性肿块的组成细胞中总是可以发现有丝分裂的图形，并且可能存在神经趋向性。促结缔组织增生性黑色素瘤患者通常表现为肿块，偶尔伴有色素损害。恶性雀斑和真皮成纤维细胞样肿块是结缔组织增生性黑色素瘤最常见的形态特征。有23名患者的随访数据可用。随访时间0.1~9年，平均2.7年。对18例患者进行了3年以上的观察。12名患者发生局部复发，5名患者发生转移；3名转移患者在发生转移前已有局部复发。三名转移性黑色素瘤患者在初次切除后2至4年内死于肿瘤。在12个局部复发的病变中，有8个要么最初被诊断为良性病变，要么在最初的切除标本上没有进行组织学检查。看来，复发可能与最初的治疗不当有关。
A clinical and histologic review of 25 patients with melanocytic lesions classified as desmoplastic malignant melanoma is reported. All of the lesions were located in sun‐exposed sites. The average age was 61.2 years (range, 38 to 83), with a median age of 56. There were 14 female and 11 male patients. Desmoplastic malignant melanoma is a melanocytic and fibroblastic proliferation that occurs predominantly in the head and neck area. The bland constituent cells resemble flbroblasts and are often arranged in bundles or fascicles, which may be arrayed perpendicularly to the overlying epidermis. Enlarged and/or atypical cells are usually scattered among the spindled cells. Most, but not all, of the tumors (24 of 25 in this series) are associated with lentigo maligna or an atypical junctional melanocytic proliferation. Mitotic figures are always found within the constituent cells of the fibrous‐appearing mass, and neurotropism may be present. Patients with desmoplastic melanoma typically present with a mass, which is occasionally associated with a pigmented lesion. The lesions in our series were deeply invasive to level IV or V. Lentigo maligna and a dermal fibroblastic‐appearing mass containing atypical cells arranged in fascicles are the most common morphologic features found in desmoplastic melanoma. Follow‐up data is available for 23 patients. The average length of follow‐up was 2.7 years (range, 0.1 to 9 years). Eighteen patients were observed for 3 or more years. Twelve patients developed local recurrences, and five developed metastases; three of the patients with metastases had a local recurrence before the development of metastases. Three of the patients with metastatic melanoma died of tumor between 2 and 4 years after their initial excision. Eight of the 12 locally recurring lesions were either diagnosed initially as a benign lesion or histologic examination was not performed on the initial excision specimen. It appears that recurrence may be related to inadequate initial therapy.