Parwani Anil V, Chan Theresa Y, Mathew Seema, Ali Syed Z
Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287-6940, USA.
Diagn Cytopathol. 2004 Apr;30(4):247-50. doi: 10.1002/dc.10394.
Hepatic metastases of malignant melanoma are not unusual and frequently occur with a clinically long latent period following resection of a cutaneous or ocular primary. Due to its overlapping cytomorphology with a primary hepatocellular carcinoma, diagnostic difficulties may arise on fine-needle aspiration of these lesions if the clinical history of melanoma is not known. Thirty-two cases of metastatic melanoma in the liver and primary hepatocellular carcinoma were studied. Aspiration was performed under ultrasound guidance using 22-gauge spinal needle. Slides were stained with Diff-Quik and Papanicolaou stain; cell blocks were stained with H&E. A panel of immunostains was performed using conventional methodology. Of the 12 cytologic parameters assessed, the most helpful in making a metastatic melanoma diagnosis were the presence of sheet-like architecture, plasmacytoid and/or biphasic (epithelioid/spindled cell) morphology, cytoplasmic tails, necrosis, and cytoplasmic melanin-like pigment. For hepatocellular carcinoma, the presence of trabeculae, perivascular cellular clustering, endothelial wrapping, and centrally located nuclei with granular cytoplasm were helpful features. In selected cases, IPOX studies were critical in arriving at the correct diagnosis.
恶性黑色素瘤肝转移并不罕见，且常在皮肤或眼部原发性肿瘤切除后出现较长的临床潜伏期。由于其细胞形态与原发性肝细胞癌重叠，如果不知道黑色素瘤的临床病史，对这些病变进行细针穿刺时可能会出现诊断困难。对32例肝脏转移性黑色素瘤和原发性肝细胞癌进行了研究。在超声引导下使用22号脊椎穿刺针进行抽吸。玻片用Diff-Quik和巴氏染色法染色；细胞块用苏木精和伊红染色。使用传统方法进行一组免疫染色。在评估的12个细胞学参数中，对诊断转移性黑色素瘤最有帮助的是片状结构、浆细胞样和/或双相（上皮样/梭形细胞）形态、细胞质尾、坏死以及细胞质黑色素样色素的存在。对于肝细胞癌，小梁、血管周围细胞聚集、内皮包裹以及位于中央的细胞核伴有颗粒状细胞质是有帮助的特征。在某些病例中，IPOX研究对做出正确诊断至关重要。
