Oosting Sjoukje F, Peters Frans Tm, Hospers Geke Ap, Mulder Nanno H
Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9700 RB, Groningen, The Netherlands.
J Med Case Rep. 2010 Jan 15;4:10. doi: 10.1186/1752-1947-4-10.
We report a rare case of gastrointestinal perforation following dacarbazine infusion for metastatic melanoma. The condition is attributed to a responding malignant melanoma in the gastrointestinal tract.
A 52-year-old Caucasian man presented with abdominal pain and distension, malaise, night sweats, dysphagia and early satiety. A computed tomography scan showed massive ascites, lymphadenopathy and liver lesions suspect for metastases. An upper gastrointestinal endoscopy was performed and revealed multiple dark lesions of 5 mm to 10 mm in his stomach and duodenum.When his skin was re-examined, an irregular pigmented lesion over the left clavicle measuring 15 mm x 8 mm with partial depigmentation was found. Histological examination of a duodenal lesion was consistent with a diagnosis of metastatic melanoma. The patient deteriorated and his level of lactate dehydrogenase rapidly increased. The patient was started on systemic treatment with dacarbazine 800 mg/m2 every three weeks and he was discharged one day after the first dose. On the sixth day he was readmitted with severe abdominal pain. A chest X-ray showed the presence of free intraperitoneal air that was consistent with gastrointestinal perforation. His lactate dehydrogenase level had fallen from 6969U/L to 1827U/L, supporting the conclusion that the response of gastrointestinal metastases to dacarbazine had resulted in the perforation of the patient's bowel wall. A laparotomy was discussed with the patient and his family but he decided to go home with symptomatic treatment. He died 11 days later.
Melanoma can originate in, as well as metastasize to, the gastrointestinal tract. Gastrointestinal perforations due to responding tumors are a well-known complication of systemic treatment of gastrointestinal lymphomas. However, as the response rate of metastatic melanoma to dacarbazine is only 10% to 20%, and responses are usually only partial, perforation due to treatment response in metastatic melanoma is rare.Medical oncologists should be aware of the risk of bowel perforation after starting cytotoxic chemotherapy on patients with gastrointestinal metastases.
我们报告了一例在输注达卡巴嗪治疗转移性黑色素瘤后发生胃肠道穿孔的罕见病例。这种情况归因于胃肠道内对治疗有反应的恶性黑色素瘤。
一名52岁的白人男性，出现腹痛、腹胀、不适、盗汗、吞咽困难和早饱感。计算机断层扫描显示大量腹水、淋巴结肿大以及怀疑为转移灶的肝脏病变。进行了上消化道内镜检查，发现其胃和十二指肠有多个5毫米至10毫米的深色病变。再次检查其皮肤时，发现左锁骨上方有一个不规则色素沉着病变，大小为15毫米×8毫米，伴有部分色素脱失。十二指肠病变的组织学检查结果符合转移性黑色素瘤的诊断。患者病情恶化，乳酸脱氢酶水平迅速升高。患者开始接受全身治疗，每三周静脉输注达卡巴嗪800mg/m²，首剂用药一天后出院。第六天，他因严重腹痛再次入院。胸部X线检查显示存在游离腹腔内气体，符合胃肠道穿孔表现。其乳酸脱氢酶水平已从6969U/L降至1827U/L，支持胃肠道转移灶对达卡巴嗪的反应导致患者肠壁穿孔这一结论。与患者及其家属讨论了剖腹手术，但他决定接受对症治疗后回家。11天后他去世。
黑色素瘤可起源于胃肠道，也可转移至胃肠道。因肿瘤反应导致的胃肠道穿孔是胃肠道淋巴瘤全身治疗的一种已知并发症。然而，由于转移性黑色素瘤对达卡巴嗪的缓解率仅为10%至20%，且反应通常只是部分缓解，因此转移性黑色素瘤因治疗反应导致穿孔的情况较为罕见。肿瘤内科医生应意识到对有胃肠道转移的患者开始细胞毒性化疗后发生肠穿孔的风险。
