Venugopal Balaji, Evans T R Jeffry
Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
Tumori. 2009 Jul-Aug;95(4):518-20. doi: 10.1177/030089160909500419.
Patients with malignant melanoma are at an increased risk of developing subsequent primary melanomas and also nonmelanoma cutaneous cancers. Several studies have reported an association between malignant melanoma and breast cancer, bladder cancer, colorectal cancer, neuroectodermal tumours, non-Hodgkin's lymphoma, leukaemia and renal cell carcinoma. We report a case series of patients with a diagnosis of malignant melanoma who also developed a renal mass. In two of these cases, the renal mass became apparent on diagnostic imaging as part of the staging investigations at the time of initial diagnosis of the malignant melanoma. In both of these cases, biopsy of the renal mass confirmed the presence of a separate primary renal cell carcinoma which had presented concurrently with the malignant melanoma. A third case presented with bone metastases ten years after excision of a thin melanoma. Further imaging revealed pulmonary metastases and a renal mass, biopsy of which confirmed renal cell carcinoma. In contrast, a fourth patient underwent a right nephrectomy for a renal mass having presented with abdominal discomfort. The histology of this lesion was in keeping with metastatic melanoma, and the patient's past history included a diagnosis of ocular melanoma eight years prior to the development of metastatic disease in the right kidney. Survival rates for patients with many types of malignant disease are improving, and there have been significant advances in clinical imaging techniques. Consequently the development and detection of a second primary cancer, either presenting concurrently or on subsequent follow-up, is likely to be increasingly observed. The series of patients reported here highlights the importance of a diagnostic biopsy in patients with malignant melanoma who develop a renal mass in order to establish a diagnosis and to plan optimal treatment.
恶性黑色素瘤患者发生后续原发性黑色素瘤以及非黑色素瘤皮肤癌的风险增加。多项研究报告了恶性黑色素瘤与乳腺癌、膀胱癌、结直肠癌、神经外胚层肿瘤、非霍奇金淋巴瘤、白血病和肾细胞癌之间的关联。我们报告了一系列诊断为恶性黑色素瘤且同时出现肾脏肿物的患者病例。在其中两例中，肾脏肿物在恶性黑色素瘤初诊时作为分期检查的一部分在诊断性影像学检查中显现出来。在这两例中，肾脏肿物活检均证实存在与恶性黑色素瘤同时出现的独立原发性肾细胞癌。第三例在薄型黑色素瘤切除术后十年出现骨转移。进一步影像学检查发现肺转移和一个肾脏肿物，其活检证实为肾细胞癌。相比之下，第四例患者因出现腹部不适而对肾脏肿物进行了右肾切除术。该病变的组织学符合转移性黑色素瘤，患者既往史包括在右肾发生转移性疾病八年前诊断为眼黑色素瘤。多种恶性疾病患者的生存率正在提高，临床影像学技术也有了显著进展。因此，同时出现或在后续随访中发现的第二种原发性癌症可能会越来越多地被观察到。此处报告的这一系列患者强调了对发生肾脏肿物的恶性黑色素瘤患者进行诊断性活检的重要性，以便确立诊断并规划最佳治疗方案。
