原發性鼻黏膜黑色素瘤一二病例報告

Primary Mucosal Melanoma in the Nasal Cavity - Report of Two Cases

王成平(Cheng-Ping Wang) ； 張逸良(Yi-Liang) ； 葉德輝(Te-Huei Yeh)

《慈濟醫學雜誌》 15卷1期 (2003/02) Pp. 69-74

https://doi.org/10.6440/TZUCMJ.200302.0069

摘要

原發性鼻黏膜黑色素瘤是一種罕見的鼻部惡性腫瘤，僅佔全部惡性黑色素瘤的1%。其臨床症狀以單側鼻塞或鼻出血為主。病理診斷以陽性的S-100及HMB-45免疫組織生化染色為主，並應區分原發性或轉移性病變。由於腫瘤的生物特性迴異於一般常見的皮膚惡性黑色素瘤，因此預後極差。本文報告二例原發性鼻黏膜黑色素瘤。症狀上，均主訴鼻塞以及自發性鼻出血。鼻內視鏡檢查發現鼻腔內有多發性易出血的黑色腫瘤。全身檢查顯示無頸部淋巴與遠處轉移。於是二例均接受廣泛性切除，並接受術後的放射線治療。目前其中一名病患追蹤二年無復發跡象，但另一名患者於術後依年發生肺部轉移死亡。由於診斷不易以及預後不佳，即使只是鼻塞或鼻出血這類常見症狀，都應小心檢查。尤其發現鼻內黑色病變者，都要接受病理檢查，以期早期診斷，提高存活率。(慈濟醫院 2003; 15:69-74)

關鍵字

鼻腔 ； 黏膜黑色素瘤 ； 鼻出血

並列摘要

Primary mucosal melanoma in the nasal cavity is a rare sinonasal malignancy, reptesenting less than 1% of all melanoma. Uilateral nasal obstrction and intermittent epistaxis are the most common symptoms. Immunohistochemical stains,such as S-100 and HMB-45, are critical to the correct diagnosis. Pathological differentiation between primary and metastic tumors is also important in making decisions about optimal managent. The tumor behavior of mucosal melanoma is different from that of the cutanous type. Howerver, the prognosis of the former is rather poor. This paper reports on two patients with primary nasal mucosal melanoma who had nasal obstruction and epistaxis. Endoscopy revealed multiple black lesions which bled easuily. Both patients had no local neck node or systemic metastasis, so they received wide excision of the tumor plus post-operative radiotherapy. One patient was well two years after surgery, but the other died of lung metastasis one year postoperatively. Conclusively, any dark-colored lesion in the nasal cavity must be carefully evaluated disclode the histopathological nature.(Tzu Chi Med J 2003; 15:69-74)

並列關鍵字

Nasal cavity ； mucosal melanoma ； epistaxis