Miyazawa Hajime, Yanagi Teruki, Yamaguchi Yasuyuki, Imafuku Keisuke, Kitamura Shinya, Hata Hiroo, Uehara Jiro, Ichikawa Nobuki, Ohno Yosuke, Yoshida Tadashi, Homma Shigenori, Kawamura Hideki, Taketomi Akinobu, Shimizu Hiroshi
Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo.
Department of Dermatology, Asahikawa Medical University, Asahikawa.
J Dermatol. 2017 Aug;44(8):959-962. doi: 10.1111/1346-8138.13825. Epub 2017 Mar 11.
We report two cases of melanomas in patients who developed intestinal metastasis despite other metastatic sites responding to nivolumab and despite the patients having favorable findings such as vitiligo and normal lactate dehydrogenase. The first case is an 85-year-old man who had been administrated nivolumab for lung/cutaneous metastases. After 22 courses of nivolumab therapy, fever and anorexia had appeared and his bodyweight had decreased. An intussusception on the ileocecal valve was revealed by computed tomography, and emergency surgery revealed metastatic lesions on the colon. The second case is an 87-year-old woman treated with nivolumab for lymph node metastases. After 10 courses, laboratory tests had revealed anemia and positive fecal occult blood. Her bodyweight had decreased. Capsule endoscopy showed scattered tumors and clots, indicating metastases of melanoma. The frequency of symptomatic intestinal metastasis of melanoma is very low. Further, intestinal metastasis of melanoma is difficult to detect through routine examinations. Our cases suggest that fecal occult blood test and decreased bodyweight are indications of intestinal metastases.
我们报告了两例黑色素瘤患者，尽管其他转移部位对纳武单抗有反应，且患者有诸如白癜风和乳酸脱氢酶正常等有利表现，但仍发生了肠道转移。第一例是一名85岁男性，因肺/皮肤转移接受了纳武单抗治疗。在接受22个疗程的纳武单抗治疗后，出现了发热和厌食，体重下降。计算机断层扫描显示回盲瓣处有肠套叠，急诊手术发现结肠有转移病灶。第二例是一名87岁女性，因淋巴结转移接受纳武单抗治疗。10个疗程后，实验室检查显示贫血和粪便潜血阳性。她的体重下降。胶囊内镜显示有散在的肿瘤和血凝块，提示黑色素瘤转移。黑色素瘤有症状的肠道转移发生率非常低。此外，黑色素瘤的肠道转移很难通过常规检查发现。我们的病例表明，粪便潜血试验和体重下降是肠道转移的指征。
