Hirokawa Mitsuyoshi, Miyauchi Akira, Otsuru Minoru, Daa Tsutomu
Department of Diagnostic Pathology, Kuma Hospital, Kobe, Hyogo, Japan.
Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan.
Int J Surg Case Rep. 2016;20:118-22. doi: 10.1016/j.ijscr.2016.01.029. Epub 2016 Feb 2.
We report a case of malignant melanoma arising in medullary thyroid carcinoma that has not yet been described.
A 66-year-old woman presented with a mass in her thyroid. The resected mass was black in color, and was composed of a mixture of classic medullary thyroid carcinoma and pleomorphic atypical cells containing melanin pigments. The pleomorphic atypical cells were morphologically consistent with malignant melanoma, and expressed Melan-A, HMB-45, and S-100 protein as determined by immunohistochemistry. Some of these cells were also positive for calcitonin and chromogranin A. Although the malignant melanoma metastasized to the lymph nodes, the patient remained free from local recurrence and distant metastasis and the primary malignant melanoma lesion was not identified for up to 11 years after the thyroidectomy.
11 melanin-producing MTC cases have been reported to date. In the reported cases, the term "malignant melanoma" was not used, likely because the melanin-containing carcinoma cells were not morphologically consistent with malignant melanoma, but with medullary carcinoma.
Malignant melanoma arising in MTC may have a favorable prognosis.
我们报告了一例尚未见报道的甲状腺髓样癌合并恶性黑色素瘤的病例。
一名66岁女性因甲状腺肿物就诊。切除的肿物呈黑色，由典型的甲状腺髓样癌和含有黑色素的多形性非典型细胞混合组成。多形性非典型细胞在形态上与恶性黑色素瘤一致，免疫组化检测显示其表达Melan-A、HMB-45和S-100蛋白。其中一些细胞降钙素和嗜铬粒蛋白A也呈阳性。尽管恶性黑色素瘤转移至淋巴结，但患者无局部复发和远处转移，甲状腺切除术后长达11年未发现原发性恶性黑色素瘤病灶。
迄今为止，已报道11例产生黑色素的甲状腺髓样癌病例。在这些报道的病例中，未使用“恶性黑色素瘤”这一术语，可能是因为含黑色素的癌细胞在形态上与恶性黑色素瘤不一致，而与髓样癌一致。
甲状腺髓样癌合并的恶性黑色素瘤可能预后良好。
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