Seyama A, Morikage N, Takahashi T, Esato K, Fujita Y
First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Jan;42(1):110-5.
A case of multiple primary malignant melanoma of the esophagus was reported. A 66-year-old male was referred to the hospital with complaints of appetite loss and dysphagia. A barium swallow revealed two polypoidal tumors of approximate equal size, one in the lower third of esophagus and the other in the cardiac region of stomach. The tumors were shown blackish at endoscopy and biopsy yielded a histological diagnosis of malignant melanoma. Abdominal CT, abdominal ultrasonography and hepatic arteriography showed metastasis to liver and rt paracardiac lymph nodes. However, no primary lesion of malignant melanoma but esophagus was found through the preoperative clinical examination. Partial resection of the esophagus along with the proximal of stomach and the paracardiac lymph nodes was performed. Microscopically, the typical finding of junctional activity adjacent to the tumor mass was not obtained but we diagnosed as primary esophageal tumor because melanocytes were present along the basal layer of normal esophageal mucosa and groups of melanophages were found in the submucosal layer. However, we could not conclude which polypoidal tumor was the primary lesion. The patient received systemic chemotherapy postoperatively and is alive 5 months after surgery.
报告了一例食管多原发性恶性黑色素瘤病例。一名66岁男性因食欲减退和吞咽困难被转诊至医院。钡餐检查发现两个大小近似的息肉样肿瘤，一个位于食管下三分之一处，另一个位于胃贲门区。内镜检查显示肿瘤呈黑色，活检组织学诊断为恶性黑色素瘤。腹部CT、腹部超声和肝动脉造影显示肝转移及右心旁淋巴结转移。然而，术前临床检查未发现恶性黑色素瘤的原发灶，仅发现食管有病变。遂行食管部分切除术，同时切除胃近端及心旁淋巴结。显微镜下，未发现肿瘤块邻近典型的交界活性表现，但由于正常食管黏膜基底层有黑素细胞，黏膜下层有成群的噬黑素细胞，故诊断为原发性食管肿瘤。然而，我们无法确定哪个息肉样肿瘤是原发灶。患者术后接受了全身化疗，术后5个月仍存活。
