Suto Daisuke, Yoshida Masashi, Otake Takaaki, Osawa Yosuke, Yamada Hidehiko, Sato Kiichi, Akita Takayuki, Ohdaira Hironori, Suzuki Yutaka, Kohgo Yutaka
Department of Gastroenterology.
Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, Japan.
Ann Med Surg (Lond). 2023 Feb 7;85(2):214-218. doi: 10.1097/MS9.0000000000000207. eCollection 2023 Feb.
The initial appearance of malignant melanoma localized in the stomach has never been reported previously. We encountered a patient with gastric melanoma in the stomach, which was histologically confirmed to be confined to the mucosa.
The patient, when in her 40s, had undergone surgery for malignant melanoma of the left heel. However, there were no detailed records of pathological findings. The patient had a 4-mm black elevated lesion in her stomach observed on esophagogastroduodenoscopy after the eradication of A year later, esophagogastroduodenoscopy showed that the lesion had increased to 8 mm. A biopsy was performed, but no malignancy was found; the patient continued to be followed up. Esophagogastroduodenoscopy performed at the 2-year follow-up revealed that the melanotic lesion had increased to 15 mm, and biopsy was performed and revealed a malignant melanoma.
Endoscopic submucosal dissection was performed for gastric malignant melanoma. The margin of the resected malignant melanoma was negative; vascular and lymphatic invasions were not observed, and the lesion was confined to the mucosa.
We suggest that even if the first biopsy of a melanotic lesion shows no evidence of malignancy, the lesion should be closely monitored. This is the first reported case of endoscopic submucosal dissection of localized gastric malignant melanoma confined to the mucosa.
胃原发性恶性黑色素瘤的最初表现此前从未有过报道。我们遇到了一名胃黑色素瘤患者,经组织学证实病变局限于黏膜层。
该患者40多岁时曾接受过左脚跟恶性黑色素瘤手术。然而,病理检查结果并无详细记录。根除幽门螺杆菌一年后,患者在食管胃十二指肠镜检查中发现胃内有一个4毫米的黑色隆起病变。一年后,食管胃十二指肠镜检查显示病变增大至8毫米。进行了活检,但未发现恶性病变;患者继续接受随访。在2年随访时进行的食管胃十二指肠镜检查显示,黑色素病变增大至15毫米,再次活检发现为恶性黑色素瘤。
对胃恶性黑色素瘤进行了内镜下黏膜下剥离术。切除的恶性黑色素瘤切缘阴性;未观察到血管和淋巴管侵犯,病变局限于黏膜层。
我们建议,即使黑色素病变的首次活检未显示恶性证据,也应对该病变进行密切监测。这是首例局限于黏膜层的局部胃恶性黑色素瘤内镜下黏膜下剥离术的报道病例。