Ho Keiso, Hirata Yuki, Egawa Tomohisa
Dept. of Surgery, Saiseikai Yokohamashi Tobu Hospital.
Gan To Kagaku Ryoho. 2023 Jan;50(1):65-68.
The patient is a 77-year-old woman presented with a 20 mm infiltrative ulcerative lesion in the lower thoracic esophagus, and histopathological examination revealed malignant esophageal melanoma. Contrast-enhanced computed tomography (CT)revealed a 25-mm mass in the lower thoracic esophagus, which was resectable without obvious invasion of the adjacent organs, enlarged lymph nodes, and distant metastatic findings. The patient underwent video assisted esophagectomy and 2 field lymph nodes dissection. Histopathological examination revealed a primary malignant esophageal melanoma, which was diagnosed as pT1b(SM3)N2M0, pStage Ⅱ. At 2 months postoperatively, contrast-enhanced CT scan showed multiple hepatic and pulmonary metastases, and combination immune-chemotherapy of nivolumab and ipilimumab was initiated. However, the patient's general condition deteriorated rapidly, and palliative care was implemented at 4 months postoperatively. Surgery is currently the initial choice for resectable primary malignant esophageal melanoma; however, a multidisciplinary treatment strategy, including preoperative adjuvant chemotherapy, should be reconstructed.
该患者为一名77岁女性，其下胸段食管出现一个20毫米的浸润性溃疡性病变，组织病理学检查显示为恶性食管黑色素瘤。增强计算机断层扫描（CT）显示下胸段食管有一个25毫米的肿块，可切除，且未发现明显侵犯相邻器官、淋巴结肿大及远处转移迹象。患者接受了电视辅助食管切除术和二野淋巴结清扫术。组织病理学检查显示为原发性恶性食管黑色素瘤，诊断为pT1b(SM3)N2M0，p分期Ⅱ期。术后2个月，增强CT扫描显示多发肝转移和肺转移，遂开始使用纳武单抗和伊匹单抗进行免疫化疗联合治疗。然而，患者的一般状况迅速恶化，术后4个月实施了姑息治疗。手术目前是可切除原发性恶性食管黑色素瘤的首选治疗方法；然而，应重新构建包括术前辅助化疗在内的多学科治疗策略。
