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NEJM：黑色素瘤？银汞合金牙体修复后所致的粘膜变色

2016-04-28 sunshine 译 MedSci原创

黑色素瘤银汞合金
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女性患者，49岁，因舌腹侧面出现无症状的色素性病变4个月而就诊于皮肤病诊所，患者无黑色素瘤个人史和家族史。初步怀疑为黑色素瘤病变。无饮酒和吸烟史，且患者自述其病损患处无创伤史。但是，病损出现前3个月患者曾接受牙体修复治疗。

女性患者，49岁，因舌腹侧面出现无症状的色素性病变4个月而就诊于皮肤病诊所，患者无黑色素瘤个人史和家族史。初步怀疑为黑色素瘤病变。无饮酒和吸烟史，且患者自述其病损患处无创伤史。但是，病损出现前3个月患者曾接受牙体修复治疗。

体格检查显示，病损为灰褐色的色素斑块，两侧不对称，大小为1.0 cm × 1.2 cm，病损中心退化（图A，患者口腔内白色物质为口香糖）。除此之外并无其他皮肤或粘膜异常表现。




完全切除病损。组织病理学检查显示，真皮层出现纤维化和薄的间质沉积，细长的黑色素沉积，无炎性细胞浸润（图B，HE染色）。并未发现黑色素细胞增生或癌变表现。



最终诊断为银汞合金充填体中金属元素浸润所致的粘膜变色。对患者随访1年，未发现复发迹象。

原始出处：

Cristián Vera-Kellet, Pablo Del Barrio-Díaz. Oral Amalgam Tattoo Mimicking Melanoma. N Engl J Med 2016; 374:e21April 28, 2016DOI: 10.1056/NEJMicm1510216.

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    2016-06-16 windight

    #银汞合金#

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    2016-07-09 ms3153534357578991

    #汞合金#

    0

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    2016-07-22 guoyibin

    #粘膜#

    0

  4. 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createdName=ms3153534357578991, createdTime=Sat Jul 09 21:41:00 CST 2016, time=2016-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1690950, encodeId=62a1169095001, content=<a href='/topic/show?id=7adce62603e' target=_blank style='color:#2F92EE;'>#粘膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76260, encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=090129165428, createdName=guoyibin, createdTime=Fri Jul 22 18:41:00 CST 2016, time=2016-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1680331, encodeId=cf13168033167, content=<a href='/topic/show?id=9e5c86e0712' target=_blank style='color:#2F92EE;'>#色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86707, encryptionId=9e5c86e0712, topicName=色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=343027846633, createdName=sunylz, createdTime=Wed Jul 20 02:41:00 CST 2016, time=2016-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=124614, encodeId=e6a51246141d, content=好文章，还会关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 13 10:57:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=123887, encodeId=28b012388e2b, content=赞了！好文，深入学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Sep 12 19:14:00 CST 2016, time=2016-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1465395, encodeId=cc631465395ad, content=<a href='/topic/show?id=662a388823e' target=_blank style='color:#2F92EE;'>#合金#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38882, encryptionId=662a388823e, topicName=合金)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=81df6719716, createdName=楚秀娟, createdTime=Sat Apr 30 11:41:00 CST 2016, time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558742, encodeId=4e781558e42c0, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Sat Apr 30 11:41:00 CST 2016, time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564751, encodeId=19661564e5112, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Sat Apr 30 11:41:00 CST 2016, time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=83362, encodeId=97b783362ae, content=合金侵润, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160313/IMG56E50DEC424F44672.jpg, createdBy=ce5b1699635, createdName=Lisa971, createdTime=Sat Apr 30 08:51:00 CST 2016, time=2016-04-30, status=1, ipAttribution=)]
    2016-07-20 sunylz

    #色素#

    0

  5. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Sep 12 19:14:00 CST 2016, time=2016-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1465395, encodeId=cc631465395ad, content=<a href='/topic/show?id=662a388823e' target=_blank style='color:#2F92EE;'>#合金#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38882, encryptionId=662a388823e, topicName=合金)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=81df6719716, createdName=楚秀娟, createdTime=Sat Apr 30 11:41:00 CST 2016, time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558742, encodeId=4e781558e42c0, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Sat Apr 30 11:41:00 CST 2016, time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564751, encodeId=19661564e5112, content=<a href='/topic/show?id=e27610332666' target=_blank style='color:#2F92EE;'>#黑色素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103326, encryptionId=e27610332666, topicName=黑色素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=150614999302, createdName=cqlidoudou, createdTime=Sat Apr 30 11:41:00 CST 2016, time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=83362, encodeId=97b783362ae, content=合金侵润, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160313/IMG56E50DEC424F44672.jpg, createdBy=ce5b1699635, createdName=Lisa971, createdTime=Sat Apr 30 08:51:00 CST 2016, time=2016-04-30, status=1, ipAttribution=)]
    2016-09-13 1e10c84am36(暂无匿称)

    好文章，还会关注

    0

  6. 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time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=83362, encodeId=97b783362ae, content=合金侵润, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160313/IMG56E50DEC424F44672.jpg, createdBy=ce5b1699635, createdName=Lisa971, createdTime=Sat Apr 30 08:51:00 CST 2016, time=2016-04-30, status=1, ipAttribution=)]
    2016-09-12 ylzr123

    赞了！好文，深入学习。

    0

  7. 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time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=83362, encodeId=97b783362ae, content=合金侵润, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160313/IMG56E50DEC424F44672.jpg, createdBy=ce5b1699635, createdName=Lisa971, createdTime=Sat Apr 30 08:51:00 CST 2016, time=2016-04-30, status=1, ipAttribution=)]
    2016-04-30 楚秀娟

    #合金#

    0

  8. 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time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=83362, encodeId=97b783362ae, content=合金侵润, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160313/IMG56E50DEC424F44672.jpg, createdBy=ce5b1699635, createdName=Lisa971, createdTime=Sat Apr 30 08:51:00 CST 2016, time=2016-04-30, status=1, ipAttribution=)]
    2016-04-30 cqlidoudou

    #黑色素#

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=2023696, encodeId=bb1520236969f, content=<a href='/topic/show?id=55a09664518' target=_blank style='color:#2F92EE;'>#银汞合金#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96645, encryptionId=55a09664518, topicName=银汞合金)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec9955, createdName=windight, createdTime=Thu Jun 16 20:41:00 CST 2016, time=2016-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2054053, encodeId=5dcf205405384, content=<a href='/topic/show?id=5dd064322d7' target=_blank style='color:#2F92EE;'>#汞合金#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64322, encryptionId=5dd064322d7, topicName=汞合金)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=606c2500035, 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time=2016-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=83362, encodeId=97b783362ae, content=合金侵润, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160313/IMG56E50DEC424F44672.jpg, createdBy=ce5b1699635, createdName=Lisa971, createdTime=Sat Apr 30 08:51:00 CST 2016, time=2016-04-30, status=1, ipAttribution=)]
    2016-04-30 cqlidoudou

    #黑色素#

    0

  10. 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    2016-04-30 Lisa971

    合金侵润

    0

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 1996年是黑色素瘤治疗领域具有里程碑意义的一年。当年发布的群际黑色素瘤临床试验的结果表明黑色素瘤患者中的一些人群或许可以从淋巴结部分切除中获益。阳光地带黑色素瘤试验（Sunbelt Melanoma Trial）是一项前瞻性随机临床试验。该项试验评价了高剂量干扰素α-2b治疗（HDI）或者淋巴结完全切除（CLND）治疗由前哨淋巴结（SLN）活体组织切片分级的黑色素瘤患者。 

JCO：20年临床研究表明干扰素治疗对多数III期黑色素瘤病人无益

                         一项名为“Sunbelt Melanoma Trial”的临床研究最终结果表明，根据目前的临床诊断手段，对于大多数黑色素瘤癌症三期病人来说干扰素治疗并不会给他们带来获益。来自美国路易斯维尔大学的研究人员将相关研究结果在

NEJM：震撼！全身皮肤变黑案例报道

男性，76岁，因全身乏力而入院就诊。

外泌体或可作为黑色素瘤诊断和预后的生物标志物

恶性黑色素瘤是一种侵略性肿瘤，其发病率越来越高。胞外体是一种主动分泌的微囊泡，它的特征反映其起源于何种细胞。近日发表在《临床化学学报》（Clinica Chimica Acta，CCA）的研究，西班牙科学家确定并评估了胞外体中黑色素瘤标志物的存在，包括MIA、S100B和酪氨酸酶相关蛋白2（Tyrp2）等，及胞外体中的这些标记物的潜在临床应用价值。 实验收集了黑色素瘤IV期患者、非黑色素瘤患者和