Ahn Ji Yong, Hwang Hee Sang, Park Young Soo, Kim Hyeong Ryul, Jung Hwoon-Yong, Kim Jin-Ho, Lee Seung Eun, Kim Min A
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2014 Aug;21(8):2532-9. doi: 10.1245/s10434-014-3637-2. Epub 2014 Mar 17.
Melanoma that involves the upper gastrointestinal (GI) tract is rare and studies relating to endoscopic and pathologic findings with clinical outcomes are lacking. We reviewed the gross and microscopic patterns of the upper GI tract in primary and metastatic melanoma, and examined their association with clinical outcomes.
Twenty-nine cases of primary esophageal (n = 19) and metastatic gastric and/or duodenal melanoma (n = 10) that were detected during upper GI endoscopy between 1995 and 2011 were retrospectively analyzed.
Three types of gross patterns were recognized-nodular pattern in 7 cases, mass-forming pattern in 18 cases, and flat pigmented pattern in 4 cases. In primary esophageal melanoma, 13 patients (68.4 %) underwent surgery and 9 received palliative therapy. Of all cases, 22 patients (75.9 %) died of disease progression; the median overall survival period was 12 months (interquartile range [IQR] 4.5-24.5 months), and from recognition of upper GI tract melanoma the median overall survival period was 9 months (IQR 3.5-17.0 months). In primary esophageal cases, skin melanoma stage better discriminated the patients with good prognosis than the esophageal cancer stage. The flat pigmented gross pattern proved to be a good prognostic factor in primary and metastatic GI tract melanomas (p = 0.016 and p = 0.046, respectively).
Melanoma of the GI tract is a highly aggressive disease with a poor prognosis, both in primary and metastatic cases. However, in primary esophageal melanoma, careful inspection of the mucosa during endoscopic examination followed by surgical resection may result in extended survival.
累及上消化道（GI）的黑色素瘤较为罕见，目前缺乏关于内镜和病理检查结果与临床结局相关性的研究。我们回顾了原发性和转移性黑色素瘤在上消化道的大体和微观模式，并研究了它们与临床结局的关联。
回顾性分析了1995年至2011年间在上消化道内镜检查中发现的29例原发性食管黑色素瘤（n = 19）以及转移性胃和/或十二指肠黑色素瘤（n = 10）。
确认了三种大体模式：7例为结节型，18例为肿块型，4例为扁平色素沉着型。在原发性食管黑色素瘤患者中，13例（68.4%）接受了手术治疗，9例接受了姑息治疗。所有病例中，22例（75.9%）死于疾病进展；中位总生存期为12个月（四分位间距[IQR] 4.5 - 24.5个月），从上消化道黑色素瘤确诊起的中位总生存期为9个月（IQR 3.5 - 17.0个月）。在原发性食管病例中，皮肤黑色素瘤分期比食管癌分期更能区分预后良好的患者。扁平色素沉着大体模式被证明是原发性和转移性胃肠道黑色素瘤的良好预后因素（分别为p = 0.016和p = 0.046）。
胃肠道黑色素瘤是一种侵袭性很强、预后较差的疾病，无论是原发性还是转移性病例均如此。然而，对于原发性食管黑色素瘤，在内镜检查时仔细检查黏膜并随后进行手术切除可能会延长生存期。
