González-Sáez Luis, Pita-Fernández Salvador, Lorenzo-Patiño Maria José, Arnal-Monreal Francisco, Machuca-Santacruz José, Romero-González José
Department of Surgery, University Hospital Complex of A Coruña, C/As Xubias de Arriba, 84, E-15006 La Coruña, Spain.
J Med Case Rep. 2011 Jul 2;5:273. doi: 10.1186/1752-1947-5-273.
Primary melanoma of the adrenal gland is exceptionally rare as demonstrated by the few cases reported in the medical literature, and it has a high fatality rate. We present the case of a patient with two relapses and survival to date.
We describe the case of a 58-year-old Caucasian woman who consulted her doctor with symptoms of asthenia, anorexia and weight loss. A mass was palpated in her abdomen at the height of the left hypochondrium. A computed tomographic scan revealed a retroperitoneal mass measuring 10 cm × 15 cm originating in the left adrenal gland. A left nephroadrenalectomy and splenectomy were performed. Histopathologically, the retroperitoneal mass corresponded to a melanoma, and no primary melanoma was found in any other location. The patient was treated with interferon-α-2b. Three years after her diagnosis the patient presented with a retroperitoneal relapse of the mass measuring 7.2 cm, which was removed. Five years after the first relapse a new retroperitoneal relapse mass was diagnosed, which was also removed. Since then the patient has been healthy and free from illness.
Histological and immunohistochemical studies, together with the criteria described by Ainsworth et al. and Carstens et al., allowed us to diagnose primary melanoma of the adrenal gland.
肾上腺原发性黑色素瘤极为罕见,医学文献报道的病例很少,且死亡率很高。我们报告了一例出现两次复发且至今存活的患者。
我们描述了一名58岁白种女性的病例,她因乏力、厌食和体重减轻症状就医。在其左季肋部高度可触及腹部有一肿块。计算机断层扫描显示一个起源于左肾上腺的10厘米×15厘米的腹膜后肿块。进行了左肾肾上腺切除术和脾切除术。组织病理学检查显示,腹膜后肿块为黑色素瘤,其他部位未发现原发性黑色素瘤。患者接受了α-2b干扰素治疗。诊断三年后,患者出现一个7.2厘米的腹膜后肿块复发,予以切除。首次复发五年后,诊断出一个新的腹膜后复发性肿块,也予以切除。从那时起,患者一直健康无病。
组织学和免疫组化研究,以及安斯沃思等人和卡斯滕斯等人描述的标准,使我们能够诊断肾上腺原发性黑色素瘤。