Vettoretto N, De Cesare V, Cervi E, Villanacci V, Ruzzenenti N, Cervi G
Scuola di Specializzazione in Chirurgia Generale Clinica Chirurgica, Università degli Studi, Brescia.
Minerva Chir. 2000 Nov;55(11):787-91.
Metastatic disease involving the gastrointestinal tract is a rare pathology and melanoma is the extra-intestinal neoplasm more frequently concerned. Two cases of gastric metastases, revealed by symptoms of upper gastrointestinal bleeding, are reported. In the first case the disease-free interval, after excision of the primary lesion located in the right lower limb, was 13 years; in the second case the primary lesion remained unknown, although it probably originated from a giant congenital nevus of the left foot. Both patients had been affected before by inguinal nodes metastases, treated by radical groin lymphadenectomy; the concomitant multiple metastases to other sites (adrenal glands, retro-peritoneum, liver, lung, small bowel, brain, ovaries) limited surgery to a likely prospect of palliation, conditioning an unfavourable prognosis. Resection of gastrointestinal metastases is justified for the relief of intestinal hemorrhage (as in these reported cases), perforation and obstruction, even if treatment of single non-complicated lesions can have a curative intent. The conclusion is drawn that more aggressive diagnostic and staging procedures are indicated for the early detection of gastrointestinal metastases whenever non-specific abdominal symptoms and a history of melanoma are present.
涉及胃肠道的转移性疾病是一种罕见的病理情况，黑色素瘤是最常累及的肠外肿瘤。本文报告了两例因上消化道出血症状而发现的胃转移病例。第一例中，位于右下肢的原发性病变切除后无病间期为13年；第二例中，原发性病变不明，尽管可能起源于左脚的巨大先天性痣。两名患者此前均有腹股沟淋巴结转移，接受了根治性腹股沟淋巴结清扫术；同时发生的其他部位（肾上腺、腹膜后、肝脏、肺、小肠、脑、卵巢）的多处转移使手术仅可能达到姑息目的，预后不良。切除胃肠道转移灶对于缓解肠道出血（如本文报告的病例）、穿孔和梗阻是合理的，即使治疗单个无并发症的病变可能具有治愈意图。得出的结论是，当出现非特异性腹部症状和黑色素瘤病史时，应采用更积极的诊断和分期程序以早期发现胃肠道转移。
