Mohammadzadeh Narjes, Nilforoushan Neda, Ashouri Mohammad
Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Imam Khomeini Hospital Complex, Dr Gharib St, Keshavarz Blvd, Tehran, Postal Code:1419733141, Iran.
Ann Med Surg (Lond). 2022 Jul 14;80:104195. doi: 10.1016/j.amsu.2022.104195. eCollection 2022 Aug.
INTRODUCTION & IMPORTANCE: Gastrointestinal tract is an uncommon site for primary melanoma and its annual incidence is reported 0.47 cases in million. Thus, limited information is available about its medical or surgical treatment, long-term complications of melanoma, and survival rates of each therapeutic method.
A 47-year-old male was admitted to the emergency department with massive rectorrhagia. with not notable medical history except recent episodes of dyspepsia, melena, malaise and weight loss. Melena and weight loss in a 47-year-old patient is considered as suspicious signs for malignancy and should be investigated. The patient was finally diagnosed with primary gastrointestinal melanoma (PGIM). He underwent -hiatal total esophagectomy and proximal gastrectomy with gastric pull-up and lymph node dissection. Immunotherapy with Interferon-α was chosen as adjuvant therapy for this patient. After 10 months, CT scan of abdomen with intravenous and oral contrast revealed multiple foci in liver and spleen consistent with metastasis without any evidence of recurrence at primary tumor excision site.
In this article, we presented a rare case of PGIM with later metastasis in liver and spleen. Gastric pull up was preferred to colon interposition for conduit reconstruction after esophagectomy in this case. However due to the rarity of this category of tumor more information must be gathered on the amount of margin to be resected and long-term outcome of different surgical approaches.
Based on the poor prognosis of PGIM, less invasive surgical procedure which provides the radical resection and adequate onco-surgical dissection should be considered.
胃肠道是原发性黑色素瘤的罕见发病部位，据报道其年发病率为百万分之0.47例。因此，关于其医学或手术治疗、黑色素瘤的长期并发症以及每种治疗方法的生存率的信息有限。
一名47岁男性因大量直肠出血被收入急诊科。除近期有消化不良、黑便、不适和体重减轻外，无显著病史。47岁患者出现黑便和体重减轻被视为恶性肿瘤的可疑迹象，应进行调查。该患者最终被诊断为原发性胃肠道黑色素瘤（PGIM）。他接受了经裂孔全食管切除术、近端胃切除术、胃上提术和淋巴结清扫术。选择α干扰素免疫治疗作为该患者的辅助治疗。10个月后，经静脉和口服造影剂的腹部CT扫描显示肝脏和脾脏有多个病灶，符合转移表现，而原发肿瘤切除部位无复发迹象。
在本文中，我们介绍了一例罕见的PGIM病例，后期出现肝脏和脾脏转移。在该病例中，食管切除术后，胃上提术比结肠代食管术更适合用于管道重建。然而，由于这类肿瘤罕见，必须收集更多关于切除边缘量和不同手术方法长期结果的信息。
鉴于PGIM预后较差，应考虑采用能实现根治性切除和充分肿瘤外科解剖的微创外科手术。
