Lukowsky A, Bellmann B, Ringk A, Winter H, Audring H, Fenske S, Sterry W
Department of Dermatology and Allergy, Medical Faculty Charité, Humboldt University of Berlin, Germany.
J Invest Dermatol. 1999 Oct;113(4):554-9. doi: 10.1046/j.1523-1747.1999.00719.x.
The aim of our study was to investigate the metastatic pathways of melanoma cells in sentinel and other regional lymph nodes. The term "sentinel lymph node" means that the first lymph node of the draining site of a primary tumor is never bypassed in malignant melanoma. In this case lymph node dissection would be necessary only when melanoma cells are detected in the sentinel node. Tyrosinase reverse transcriptase-polymerase chain reaction was applied to search for metastatic melanoma in the sentinel lymph node and in further lymph nodes of a complete lymph node basin in patients who underwent lymph node dissection. In 24 patients with malignant melanoma the draining site of the tumor was marked by lymphoscintigraphy and by intraoperative injection of patent blue V in the area around the primary tumor. The lymph nodes of the affected basin were excised and prepared for histopathologic, immunohistochemical, and molecular biologic examinations. Regarding the sentinel lymph node, 10 of 24 patients showed morphologic evidence for metastases, three additional patients showed only tyrosinase transcripts. In 11 of these 13 cases we found one or more nonsentinel lymph nodes with morphologically detectable melanoma cells and/or tyrosinase mRNA. Interestingly, in seven of 24 patients a positive tyrosinase reverse transcriptase-polymerase chain reaction was received in nonsentinel lymph nodes, whereas the sentinel lymph node was negative, not only for all histologic examinations but also by tyrosinase reverse transcriptase-polymerase chain reaction. In five of seven patients of the latter group, gp100 reverse transcriptase-polymerase chain reaction was carried out, showing also gp100 mRNA in nonsentinel lymph nodes only. Our data indicate that the concept of the sentinel lymph node may miss micrometastases. Whether such micrometastases cause a recurrence or a metastasis of malignant melanoma, or can be destroyed by the immune system, remains to be clarified.
我们研究的目的是调查黑色素瘤细胞在前哨淋巴结和其他区域淋巴结中的转移途径。术语“前哨淋巴结”是指在恶性黑色素瘤中，原发肿瘤引流部位的首个淋巴结永远不会被绕过。在这种情况下，只有在前哨淋巴结中检测到黑色素瘤细胞时才需要进行淋巴结清扫。对接受淋巴结清扫的患者，应用酪氨酸酶逆转录聚合酶链反应在前哨淋巴结和完整淋巴结区域的其他淋巴结中寻找转移性黑色素瘤。在24例恶性黑色素瘤患者中，通过淋巴闪烁显像和术中在原发肿瘤周围区域注射专利蓝V来标记肿瘤的引流部位。切除受影响区域的淋巴结并进行组织病理学、免疫组织化学和分子生物学检查。关于前哨淋巴结，24例患者中有10例显示有转移的形态学证据，另外3例患者仅显示酪氨酸酶转录本。在这13例患者中的11例，我们发现一个或多个非前哨淋巴结有形态学上可检测到的黑色素瘤细胞和/或酪氨酸酶mRNA。有趣的是，24例患者中有7例在非前哨淋巴结中酪氨酸酶逆转录聚合酶链反应呈阳性，而前哨淋巴结不仅所有组织学检查呈阴性，酪氨酸酶逆转录聚合酶链反应也呈阴性。在后一组的7例患者中有5例进行了gp100逆转录聚合酶链反应，结果也显示仅在非前哨淋巴结中有gp100 mRNA。我们的数据表明，前哨淋巴结的概念可能会遗漏微转移。这种微转移是否会导致恶性黑色素瘤的复发或转移，或者是否能被免疫系统破坏，仍有待阐明。
