Tsukamoto Ryoichi, Ihara Hiroaki, Takase Masaru, Shimazu Ai, Takei Masahiko, Miura Hiroyoshi, Sakamoto Kazuhiro, Namekata Koji
Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan.
J Surg Case Rep. 2021 Oct 13;2021(10):rjab393. doi: 10.1093/jscr/rjab393. eCollection 2021 Oct.
Melanoma is a malignant tumor derived from melanocytes. Esophageal melanomas occur infrequently, especially primary amelanotic malignant melanoma of the esophagus (PAMME), which is extremely rare. Here, we report the case of a 74-year-old man with an esophageal amelanotic melanoma on the esophagogastric junction (EGJ) found on esophagogastroduodenoscopy. Radical surgery for the tumor at the EGJ was performed with total gastrectomy and D2 lymph node dissection. Diagnosis of PAMME was confirmed postoperatively by immunohistochemical staining. Four months after the surgery, abdominal computed tomography revealed multiple liver metastases. The patient received seven cycles of nivolumab monotherapy and two subsequent cycles of nivolumab and ipilimumab, and these metastases diminished. Recently, new therapeutic agents including immunotherapy have been developed for malignant melanoma and these agents have the potential of improving the prognosis of PAMME. Here, we present new insights into the diagnosis and therapeutic methods that can be used against primary esophageal melanoma.
黑色素瘤是一种源自黑素细胞的恶性肿瘤。食管黑色素瘤很少见，尤其是原发性食管无色素恶性黑色素瘤（PAMME），极为罕见。在此，我们报告一例74岁男性，在食管胃十二指肠镜检查时发现食管胃交界（EGJ）处有食管无色素黑色素瘤。对EGJ处的肿瘤进行了根治性手术，包括全胃切除术和D2淋巴结清扫术。术后通过免疫组化染色确诊为PAMME。手术后四个月，腹部计算机断层扫描显示多发肝转移。患者接受了七个周期的纳武单抗单药治疗以及随后两个周期的纳武单抗和伊匹单抗联合治疗，这些转移灶缩小。近来，包括免疫疗法在内的新型治疗药物已被开发用于恶性黑色素瘤，这些药物有可能改善PAMME的预后。在此，我们展示了针对原发性食管黑色素瘤的诊断和治疗方法的新见解。
