Fajdić Josip, Durović Drazen, Gotovac Nikola, Gugić Damir, Stastny Tomislav, Slisurić Ferdinand
Opća zupanijska bolnica Pozega, Pozega, Hrvatska.
Acta Med Croatica. 2011;65(3):279-83.
In this case report we describe rare metastatic appearance of cutaneous malignant melanoma ( MM) in small intestine followed by clinical appearance of acute surgical abdomen. A 42-year old women operated in our hospital in April 2009. due to unusual naevus on her right arm. Pathologicaly it was MM grossly 1.5 cm, microscopically Breslow 11 mm, Clark's level IV (T4), number of mitosis 1.4 per mm2, without ulcerations. She was sent to continue treatment at the National Referal Center for Melanoma in KB "S. milosrdnice" Zagreb, Croatia. A month later wider excision (3 cm free margin) and sentinel lymph node biopsy (SLNB) was made there followed by axillary lymphadenectomy due to positive axillary finding. She received six cycles of chemotherapy. She arrived in our hospital in May 2010, under clinical picture of small intestine ileus and acute surgical abdomen. After preparation she was operated the same day. The cause of ileus was metastasis of MM in the small interstine. We made intestinal resection with termino-terminal anastomosis. The patient was released to home care ten days after operation without any complication. This case report demonstrates rarely described case of MM metastasis in the small intestine found causing ileus.
在本病例报告中,我们描述了皮肤恶性黑色素瘤(MM)在小肠出现罕见转移表现,随后出现急性急腹症的临床症状。一名42岁女性于2009年4月在我院接受手术,原因是其右臂上有异常痣。病理检查显示为MM,大体上为1.5 cm,显微镜下Breslow厚度为11 mm,Clark分级为IV级(T4),有丝分裂数为每平方毫米1.4个,无溃疡。她被送往克罗地亚萨格勒布“圣米洛斯拉夫尼察”KB国家黑色素瘤转诊中心继续治疗。一个月后,在那里进行了更广泛的切除(切缘3 cm)和前哨淋巴结活检(SLNB),由于腋窝检查结果阳性,随后进行了腋窝淋巴结清扫术。她接受了六个周期的化疗。2010年5月,她以小肠梗阻和急性急腹症的临床表现来到我院。经过准备,她于当天接受了手术。肠梗阻的原因是MM转移至小肠。我们进行了肠切除并端端吻合。患者术后十天出院,无任何并发症。本病例报告展示了罕见的MM转移至小肠导致肠梗阻的病例。