Gilbert Richard William Donald, Harvey Harry Myles, Nessim Carolyn
General Surgery, Ottawa General Hospital, Ottawa, Ontario, Canada.
Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
BMJ Case Rep. 2019 Aug 1;12(7):e230265. doi: 10.1136/bcr-2019-230265.
A 65-year-old woman with a history of proctocolectomy and end ileostomy for ulcerative colitis was referred to our clinic with a slowly growing mass around her ileostomy. She did not report any systemic symptoms. On examination, an exophytic mass was observed around her ileostomy and hard lymph nodes palpated in her groins bilaterally. Punch biopsy of the lesion established a diagnosis of invasive melanoma. Positron emission tomography revealed regional metastatic lymphadenopathy in the right axilla and both groins. There was no evidence of distant metastatic disease. The patient then underwent wide local excision of her ileostomy with bowel resection and ileostomy re-siting, bilateral complete ilioinguinal lymphadenectomy and a right Level III axillary dissection. She is doing well postoperatively and receiving adjuvant systemic therapy with BRAF and MEK inhibitors, now 17 months later with no signs of recurrent disease.
一名65岁女性，有溃疡性结肠炎行直肠结肠切除术及末端回肠造口术病史，因回肠造口周围肿物缓慢生长转诊至我院。她未报告任何全身症状。检查时，在其回肠造口周围观察到外生性肿物，双侧腹股沟可触及坚硬淋巴结。病变组织的穿刺活检确诊为浸润性黑色素瘤。正电子发射断层扫描显示右腋窝及双侧腹股沟有区域转移性淋巴结病。无远处转移疾病证据。患者随后接受了回肠造口广泛局部切除并肠切除及回肠造口重新定位、双侧完全髂腹股沟淋巴结清扫术和右侧Ⅲ级腋窝淋巴结清扫术。术后恢复良好，正在接受BRAF和MEK抑制剂辅助全身治疗，目前17个月后无疾病复发迹象。
