Elouali Ibtissam, Imrani Kawtar, Berrada Kenza, Zahi Hiba, Jahid Ahmed, Moatassim Billah Nabil, Nassar Ittimade
Central Radiology Department, IBN SINA University Hospital V, Rabat, Morocco.
Histopathology Department, IBN SINA University Hospital V, Rabat, Morocco.
SAGE Open Med Case Rep. 2023 Aug 22;11:2050313X231194150. doi: 10.1177/2050313X231194150. eCollection 2023.
Mucosal melanoma is a rare subtype of melanoma distinct from the cutaneous type in its clinical and biological aspects, requiring different therapeutical management. Anorectal melanomas represent less than 1% of anorectal cancers and 0.3% of malignant melanomas, and they are by far the most studied type. Proctologic examination, colonoscopy, and biopsy can establish a correct diagnosis. Imaging techniques, especially MRI can show some characteristic features, but it is essentially performed for extension assessment. We report the case of a 63-year-old man who consulted for rectal bleeding. The proctological examination found a brownish ulcerative-vegetating tumor of 3 cm in diameter located 3 cm from the anal rim. The endoscopic examination revealed a predominance of ulcerative budding lesions and the biopsy specimen confirmed a rectal melanoma. The extension assessment, based on a computed tomography scan and MRI did not show locoregional or distant metastases. Radiotherapy and abdominoperineal resection with pelvic node dissection was the treatment of choice with good evolution.
黏膜黑色素瘤是黑色素瘤的一种罕见亚型，在临床和生物学方面与皮肤型黑色素瘤不同，需要不同的治疗管理。肛管直肠黑色素瘤占肛管直肠癌的比例不到1%，占恶性黑色素瘤的0.3%，是目前研究最多的类型。直肠指检、结肠镜检查和活检可确立正确诊断。影像学检查技术，尤其是磁共振成像（MRI）可显示一些特征，但主要用于评估肿瘤范围。我们报告一例63岁因直肠出血就诊的男性病例。直肠指检发现距肛缘3 cm处有一个直径3 cm的褐色溃疡性赘生物肿瘤。内镜检查显示以溃疡性芽状病变为主，活检标本证实为直肠黑色素瘤。基于计算机断层扫描和MRI的肿瘤范围评估未显示局部或远处转移。放疗及腹会阴联合切除加盆腔淋巴结清扫是首选治疗方法，患者病情进展良好。
