Chiu Hao-Tse, Pu Ta-Wei, Yen Hao, Liu Tung, Wen Chia-Cheng
Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 10581, Taiwan.
World J Clin Cases. 2022 May 26;10(15):5057-5063. doi: 10.12998/wjcc.v10.i15.5057.
Rectal melanoma is an uncommon neoplasm that accounts for approximately 1 percent of rectal cancer cases. Abdominoperineal resection was regarded as the radical procedure for disease control. Nevertheless, it led to more postoperative complications than sphincter-sparing wide local excision (WLE) and reduced the patient's quality of life (QOL) owing to creation of colostomy. Therefore, in this study, WLE, radiotherapy (RT), and a second WLE were conducted on a patient who had been diagnosed with localized rectal melanoma.
The patient was a 79-year-old woman who had been experiencing anal pain and bloody stool for 1 mo. Colonoscopy, magnetic resonance imaging, positron emission tomography-computed tomography, and histological analysis of tissue biopsy using the histological markers Melan-A (+), S-100 (+), and Ki-67 (+, 50%) lead to the diagnosis of localized rectal melanoma. The patient had initially undergone WLE to resolve problem of anal bleeding, followed by RT to treat the residual lesion with partial response. Subsequently, the residual lesion was removed with margin-free resection by the second WLE. The patient's postoperative course was smooth and uneventful. During the 2-year follow-up, no local recurrence was observed. Additionally, a good functional outcome and improved QOL were reported.
Combining WLE, RT, and repeat WLE is proposed as a viable alternative for treating rectal melanoma accompanied by bleeding symptoms that cannot be completely resected at the beginning.
直肠黑色素瘤是一种罕见的肿瘤，约占直肠癌病例的1%。腹会阴切除术曾被视为控制该疾病的根治性手术。然而，与保留括约肌的广泛局部切除术（WLE）相比，它导致更多的术后并发症，并且由于造口术的实施降低了患者的生活质量（QOL）。因此，在本研究中，对一名被诊断为局限性直肠黑色素瘤的患者进行了WLE、放疗（RT）和第二次WLE。
该患者为一名79岁女性，出现肛门疼痛和便血1个月。结肠镜检查、磁共振成像、正电子发射断层扫描-计算机断层扫描以及使用组织学标志物Melan-A（+）、S-100（+）和Ki-67（+，50%）对组织活检进行组织学分析后，诊断为局限性直肠黑色素瘤。患者最初接受WLE以解决肛门出血问题，随后接受RT治疗残留病变，部分缓解。随后，通过第二次WLE进行无边缘切除残留病变。患者术后病程顺利，无并发症。在2年的随访期间，未观察到局部复发。此外，报告了良好的功能结局和改善的生活质量。
对于伴有出血症状且最初无法完全切除的直肠黑色素瘤，建议联合使用WLE、RT和重复WLE作为一种可行的替代治疗方法。
