Latteri Saverio, Teodoro Michele, Malaguarnera Michele, Mannino Maurizio, Currò Giuseppe, La Greca Gaetano
Cannizzaro Hospital, Operative Unit of General Surgery, Catania, Italy.
Research Center, The Great Senescence, University of Catania, Italy.
Ann Med Surg (Lond). 2017 Apr 29;19:74-77. doi: 10.1016/j.amsu.2017.03.039. eCollection 2017 Jul.
Primary anorectal malignant melanoma is a rare and aggressive tumor that carries a poor prognosis. Anorectal melanoma (ARM) is often misdiagnosed as hemorrhoids adenocarcinoma polips and rectal cancer. ARM spreads along sub-mucosal planes and is often to wide-spread for complete resection at time of diagnosis and almost all patients die because of metastases.
A 77-year-old male patient presented a history of recurrent rectal bleeding and whose histopathological diagnosis was melanoma.
The treatment of choice remains controversial. Surgery with complete resection represents the typical treatment. However standard operative procedures related to the area of resection and lymph dissection have yet to be established. Abdominal perineal resection (APR) with or without bilateral inguinal lymphadenectomy or wide local excision (WLE) have been used to manage patients with ARM.
The higher serum levels of LDH and YKL-40 are suggestive for Anorectal Melanoma diagnosis. The decrease of these findings may be associated with good prognosis. The review of both APR and WLE options suggests no significant difference in survival among patients.
原发性肛管直肠恶性黑色素瘤是一种罕见且侵袭性强的肿瘤，预后较差。肛管直肠黑色素瘤（ARM）常被误诊为痔疮、腺癌、息肉和直肠癌。ARM沿黏膜下层扩散，在诊断时往往广泛扩散，无法完全切除，几乎所有患者都因转移而死亡。
一名77岁男性患者有反复直肠出血病史，其组织病理学诊断为黑色素瘤。
治疗选择仍存在争议。完整切除的手术是典型的治疗方法。然而，与切除范围和淋巴结清扫相关的标准手术程序尚未确立。腹会阴联合切除术（APR）加或不加双侧腹股沟淋巴结清扫术或广泛局部切除术（WLE）已被用于治疗ARM患者。
血清LDH和YKL-40水平升高提示肛管直肠黑色素瘤诊断。这些指标的降低可能与良好预后相关。对APR和WLE两种选择的回顾表明，患者的生存率无显著差异。
