Bhagwati N, Seno R, Dutcher J P, Oleksowicz L
Department of Oncology, Albert Einstein Cancer Center, USA.
Hematopathol Mol Hematol. 1998;11(2):101-8.
A 34-year-old male acutely presented with widely disseminated malignant melanoma, a microangiopathic hemolytic anemia, and disseminated intravascular coagulation. Although the patient had a history of intense childhood exposure to ultraviolet light and an occupational exposure to organic dyes, he had no history of a precursor skin lesion. The histopathology of the patient's bone marrow revealed sheets of malignant cells immunoreactive with S-100, HMB-45, and vimentin and also staining positively for melanin. A bone marrow aspirate revealed myeloid precursors filled with melanin-bearing vacuoles. Immunophenotypic analysis of the patient's bone marrow by flow cytometry revealed a paucity of hematopoietic cells. A karyotypic analysis of the patient's tumor cells demonstrated an abnormal hypertriploid composite clone characterized by multiple numerical and structural abnormalities. Although the patient was treated aggressively with transfusional support, heparin, and chemotherapy, he expired 3 weeks after diagnosis. This is the first recognized case of metastatic melanoma occurring in association with a microangiopathic hemolytic anemia.
一名34岁男性急性出现广泛播散的恶性黑色素瘤、微血管病性溶血性贫血和弥散性血管内凝血。尽管该患者童年时有强烈的紫外线暴露史且职业接触有机染料，但无前驱皮肤病变史。患者骨髓的组织病理学显示成片的恶性细胞，对S-100、HMB-45和波形蛋白呈免疫反应，且黑色素染色呈阳性。骨髓穿刺显示充满含黑色素空泡的髓系前体细胞。通过流式细胞术对患者骨髓进行免疫表型分析显示造血细胞数量稀少。对患者肿瘤细胞的核型分析显示存在异常的超三倍体复合克隆，其特征为多个数量和结构异常。尽管对该患者积极给予输血支持、肝素和化疗，但他在诊断后3周死亡。这是首例被认识到的与微血管病性溶血性贫血相关的转移性黑色素瘤病例。
