Yokoyama R, Mukai K, Hirota T, Beppu Y, Fukuma H
Department of Orthopedic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Cancer. 1996 Jun 15;77(12):2471-5. doi: 10.1002/(SICI)1097-0142(19960615)77:12<2471::AID-CNCR9>3.0.CO;2-P.
To the authors' knowledge, there has been no previous report of primary malignant melanoma of bone.
A 33-year-old woman presented with a tumorous lesion in the olecranon of the right ulna. The histologic diagnosis was malignant melanoma with close similarity to clear cell sarcoma. To exclude the possibility of malignant melanoma metastatic to the bone, clinical investigations including gallium 67-citrate scintigraphy, brain, chest, and abdominal computed tomography, and upper and lower gastrointestinal endoscopic examinations were performed. Conventional histopathologic, immunohistochemical, and electron microscopic studies were also performed.
Clinical investigations showed no lesion suggestive of a primary melanoma other than that in the right ulna. Histologically, the tumor was comprised of polygonal or fusiform cells with clear or granular cytoplasm and vesicular nuclei containing one or two prominent nucleoli. The features were similar to those of clear cell sarcoma (malignant melanoma of soft parts). Fontana preparations and immunohistochemical staining for S-100 protein and HMB-45 (melanoma specific antigen) also revealed that the tumor cells had the characteristics of malignant melanoma. The patient has remained alive and well for more than 5 years after the initial treatment.
The clinicopathologic findings in this case strongly suggested that the lesion was a primary malignant melanoma of bone. Therefore, this is the first report to indicate that malignant melanoma and related diseases can occur even in bone tissue.
据作者所知，此前尚无原发性骨恶性黑色素瘤的报道。
一名33岁女性因右尺骨鹰嘴处出现肿瘤性病变就诊。组织学诊断为恶性黑色素瘤，与透明细胞肉瘤极为相似。为排除恶性黑色素瘤骨转移的可能性，进行了包括枸橼酸镓67闪烁扫描、脑、胸部和腹部计算机断层扫描以及上下消化道内镜检查等临床检查。还进行了常规组织病理学、免疫组织化学和电子显微镜研究。
临床检查显示，除右尺骨病变外，未发现提示原发性黑色素瘤的其他病变。组织学上，肿瘤由多边形或梭形细胞组成，细胞质清晰或呈颗粒状，泡状核内有一个或两个明显核仁。这些特征与透明细胞肉瘤（软组织恶性黑色素瘤）相似。Fontana染色以及S-100蛋白和HMB-45（黑色素瘤特异性抗原）的免疫组织化学染色也显示肿瘤细胞具有恶性黑色素瘤的特征。该患者在初始治疗后已存活5年以上，情况良好。
该病例的临床病理表现强烈提示该病变为原发性骨恶性黑色素瘤。因此，这是第一份表明恶性黑色素瘤及相关疾病甚至可发生于骨组织的报告。
