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食管恶性黑色素瘤合并胃低分化黏液腺癌:一例报告。

Malignant melanoma of the esophagus complicated with poorly differentiated mucinous adenocarcinoma of the stomach: A case report.

作者信息

Li Ji, Liu Yan, Wang Bin, Sun Xun, Meng Xiangwei

机构信息

Department of Gastroenterology.

Department of Infectious Disease.

出版信息

Medicine (Baltimore). 2019 Mar;98(10):e14783. doi: 10.1097/MD.0000000000014783.

Abstract

RATIONALE

Primary malignant melanoma of the esophagus (PMME) is a rare malignancy that only accounts for <2% of all primary esophageal tumors. Here, we report the even rarer occurrence of PMME in combination with poorly differentiated mucinous adenocarcinoma of the stomach.

PATIENT CONCERNS

A 64-year-old man was presented to the hospital with >1 month of eating dysphagia. Enhanced computed tomography (CT) scan only found a space-occupying lesion in the lower esophagus with moderate enhancement. However, gastroscope showed not only esophageal masses, but also gastric mucosa changes.

DIAGNOSES

Poorly differentiated mucinous adenocarcinoma and PMME were diagnosed based on pathological biopsy and immunohistochemical methods.

INTERVENTIONS

The patient underwent laparoscopic gastric cancer radical surgery, esophageal resection, and colonic replacement of the esophagus.

OUTCOMES

Abdominal CT and esophagography performed 1 week after surgery showed that it was consistent with postoperative changes without other abnormalities. However, the patient died 3 months after discharge without receiving any other treatment.

LESSONS

This case suggests more attention should be drawn to the diagnosis of multiple primary malignant neoplasms in elder patients, and also highlights the need to fulfill comprehensive examinations before surgery in case of misdiagnosis. Besides, it is challenging to finding a reasonable treatment for such rare condition.

摘要

原理

原发性食管恶性黑色素瘤(PMME)是一种罕见的恶性肿瘤,仅占所有原发性食管肿瘤的不到2%。在此,我们报告了PMME合并胃低分化黏液腺癌这种更为罕见的情况。

患者情况

一名64岁男性因进食吞咽困难1个多月入院。增强计算机断层扫描(CT)仅发现食管下段有一个占位性病变,呈中度强化。然而,胃镜检查不仅发现了食管肿物,还发现了胃黏膜改变。

诊断

根据病理活检和免疫组化方法诊断为低分化黏液腺癌和PMME。

干预措施

患者接受了腹腔镜胃癌根治术、食管切除术及结肠代食管术。

结果

术后1周进行的腹部CT和食管造影显示与术后改变相符,无其他异常。然而,患者出院后3个月未接受任何其他治疗而死亡。

经验教训

该病例提示应更加关注老年患者多原发性恶性肿瘤的诊断,同时强调术前需进行全面检查以防误诊。此外,针对这种罕见情况找到合理的治疗方法具有挑战性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e8c/6417549/5d60550f41df/medi-98-e14783-g001.jpg

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