快速冰冻免疫组化染色诊断阴道恶性黑色素瘤1例及其应用价值(1)
摘要：阴道恶性黑色素瘤是一类非常罕见，但恶性程度高且复发率高的肿瘤，其发病率在全球范围内呈上升趋势，严重威胁了女性的生命健康。本文报道一例天津市中心妇产科医院快速冰冻切片免疫组化染色诊断阴道恶性黑色素瘤的病例。该患者为老年女性，19年前因子宫肌瘤行子宫全切术，现因阴道分泌物增多伴出血就诊，阴道镜检查发现宫颈黑色病变，TCT检测见部分含有黑色素的细胞，患者术中送检组织进行冰冻检测，但因送检组织小，不具备诊断恶性黑色素瘤的标准，遂行快速冰冻免疫组化染色HMB45和MelanA均呈阳性，冰冻诊断考虑为恶性黑色素瘤，石蜡切片HE及免疫组化染色支持阴道恶性黑色素瘤。通过报道该病例，探讨快速冰冻切片免疫组化染色的临床意义及应用价值。
关键词：恶性黑色素瘤，快速冰冻免疫组化，HMB45，MelanA
Diagnosis of Vaginal Malignant Melanoma by Rapid Frozen Immunohistochemical Staining：A Case Report and Its Application Value
, 百拇医药
SONG Jian-chan，SI Jing-wen，CHEN Ling，ZHANG Xin-ying，SHI Yi-quan，LIU Yi-xin
(Department of Pathology，Tianjin Central Hospital of Gynecology Obstetrics，Tianjin，300100，China)
Abstract：Vaginal malignant melanoma is a very rare，but high degree of malignancy and high recurrence of the tumor，the incidence rate in the global context is on the rise，a serious threat to women's life and health.This paper reports a case of Tianjin Central Obstetrics and Gynecology Hospital rapid frozen section immunohistochemistry staining in diagnosis of vaginal malignant melanoma cases.The patient was an old women，19 years ago due to uterine fibroids hysterectomy，due to increased vaginal secretions with hemorrhage treatment，cervical lesions found in black colposcopy and TCT detection showed some melanin containing cells.For patients with frozen tissue detection，but because the inspection organization is small，does not have the diagnosis of malignant melanoma of the standard，carry out the frozen immunohistochemistry staining of HMB45 and MelanA were positive，frozen for diagnosis of malignant melanoma，paraffin HE and immunohistochemical staining in support of malignant melanoma in the vagina.Through the case study reports，to investigate the clinical significance and application value of rapid frozen section immunohistochemical staining.
, 百拇医药
Key words：Malignant melanoma；Rapid frozen immunohistochemistry；HMB45；MelanA
1资料与方法
1.1病例 患者，女性，67岁，主因子宫肌瘤行子宫全切术后19年，阴道分泌物增多伴出血就诊于外院，诊断为阴道炎，为进一步明确诊断转入天津市中心妇产科医院。阴道镜检查发现宫颈黑色病變，采集宫颈细胞样本进行液基细胞学技术(Thinprep cytologic test，简称TCT)检测，镜下见含有黑色素的细胞，见图1。遂于2016年8月29日进行手术，术中送检阴道内组织及病灶(小米大～直径0.5 cm)共8块做快速冰冻检测，由于送检组织小，细胞异型小，无典型恶性黑色素瘤形态特点，术中正确诊断对于患者手术方式选择至关重要，且该患者年龄较大，无法耐受二次手术，遂决定行术中快速冰冻免疫组化检测，HMB45和MelanA染色，肿瘤细胞均呈阳性表达，冰冻诊断为：阴道黑色素肿瘤，考虑为恶性黑色素瘤。之后临床对肿物进行了扩大切除，进一步切除了双侧附件、宫旁组织、阴道壁及双侧髂总、髂内、髂外、闭孔、腹股沟淋巴结。
1.2方法
1.2.1快速冰冻切片免疫组织化学染色 快速免疫组化的检测系统采用迈新公司的即用型快捷免疫组化MaxVisionTM试剂盒，一抗HMB45为中杉金桥公司的ZM-0187鼠单抗，MelanA为中杉金桥公司的ZM-0398鼠单抗，显色分别用Dako公司的Dako RealTM DAB和中杉金桥公司的ZLI-9036 AEC酶底物试剂盒。, 百拇医药(宋剑婵 司婧文 陈凌 张新莹 师宜荃 刘易欣)
关键词：恶性黑色素瘤，快速冰冻免疫组化，HMB45，MelanA
Diagnosis of Vaginal Malignant Melanoma by Rapid Frozen Immunohistochemical Staining：A Case Report and Its Application Value
, 百拇医药
SONG Jian-chan，SI Jing-wen，CHEN Ling，ZHANG Xin-ying，SHI Yi-quan，LIU Yi-xin
(Department of Pathology，Tianjin Central Hospital of Gynecology Obstetrics，Tianjin，300100，China)
Abstract：Vaginal malignant melanoma is a very rare，but high degree of malignancy and high recurrence of the tumor，the incidence rate in the global context is on the rise，a serious threat to women's life and health.This paper reports a case of Tianjin Central Obstetrics and Gynecology Hospital rapid frozen section immunohistochemistry staining in diagnosis of vaginal malignant melanoma cases.The patient was an old women，19 years ago due to uterine fibroids hysterectomy，due to increased vaginal secretions with hemorrhage treatment，cervical lesions found in black colposcopy and TCT detection showed some melanin containing cells.For patients with frozen tissue detection，but because the inspection organization is small，does not have the diagnosis of malignant melanoma of the standard，carry out the frozen immunohistochemistry staining of HMB45 and MelanA were positive，frozen for diagnosis of malignant melanoma，paraffin HE and immunohistochemical staining in support of malignant melanoma in the vagina.Through the case study reports，to investigate the clinical significance and application value of rapid frozen section immunohistochemical staining.
, 百拇医药
Key words：Malignant melanoma；Rapid frozen immunohistochemistry；HMB45；MelanA
1资料与方法
1.1病例 患者，女性，67岁，主因子宫肌瘤行子宫全切术后19年，阴道分泌物增多伴出血就诊于外院，诊断为阴道炎，为进一步明确诊断转入天津市中心妇产科医院。阴道镜检查发现宫颈黑色病變，采集宫颈细胞样本进行液基细胞学技术(Thinprep cytologic test，简称TCT)检测，镜下见含有黑色素的细胞，见图1。遂于2016年8月29日进行手术，术中送检阴道内组织及病灶(小米大～直径0.5 cm)共8块做快速冰冻检测，由于送检组织小，细胞异型小，无典型恶性黑色素瘤形态特点，术中正确诊断对于患者手术方式选择至关重要，且该患者年龄较大，无法耐受二次手术，遂决定行术中快速冰冻免疫组化检测，HMB45和MelanA染色，肿瘤细胞均呈阳性表达，冰冻诊断为：阴道黑色素肿瘤，考虑为恶性黑色素瘤。之后临床对肿物进行了扩大切除，进一步切除了双侧附件、宫旁组织、阴道壁及双侧髂总、髂内、髂外、闭孔、腹股沟淋巴结。
1.2方法
1.2.1快速冰冻切片免疫组织化学染色 快速免疫组化的检测系统采用迈新公司的即用型快捷免疫组化MaxVisionTM试剂盒，一抗HMB45为中杉金桥公司的ZM-0187鼠单抗，MelanA为中杉金桥公司的ZM-0398鼠单抗，显色分别用Dako公司的Dako RealTM DAB和中杉金桥公司的ZLI-9036 AEC酶底物试剂盒。, 百拇医药(宋剑婵 司婧文 陈凌 张新莹 师宜荃 刘易欣)
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