原发性食管恶性黑色素瘤临床分析
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摘要
目的探讨原发性食管恶性黑色素瘤(PMME)的临床特点、病理情况、诊治及预后。方法回顾性分析2008年5月至2018年4月于首都医科大学附属北京友谊医院收治的4例PMME患者的临床资料,对其临床特点、影像学及内镜表现、病理情况、诊治方法及预后进行总结并结合文献讨论。结果 4例患者中,男性2例,女性2例;年龄47～72岁,平均57. 8岁;临床表现主要为进食哽噎感。肿瘤均为单发,位于食管中段1例,中下段2例,下段1例; 4例患者均接受手术治疗,术后给予辅助性化疗及免疫治疗;肿瘤细胞呈圆形、卵圆形或梭形,核分裂象明显,细胞质内可见黑色素颗粒,邻近食管上皮基底层可见黑色素细胞。免疫表型示瘤细胞弥漫表达HMB-45、Melan-A,S-100散在分布,CK阴性。随访2～48个月,3例死亡,1例无进展生存。结论 PMME是一种罕见的高度恶性肿瘤,临床及影像学表现不特异,确诊有赖于术后病理,以手术为主的综合治疗是主要治疗手段。
Objective To investigate clinical characteristics,pathological features,diagnosis and prognosis of malignant melanoma in esophagus( PMME). Methods Clinical data of four PMME patients who received surgical treatment in Beijing Friendship Hospital from May 2008 to April 2018 were analyzed. Clinical manifestations,endoscopic and radiographic examination results,pathological features,treatment methods were recorded,prognosis was observed and relevant literature was reviewed. Results The mean age of the 4 patients( 2 males and 2 female) was57. 8( 47-72) years. All patients presented dysphagia. The tumor was single and located in the middle and lower esophagus. The patients underwent esophagectomy and received adjuvant chemotherapy and immunotherapy after operation. Histopathologically,the tumor cells had round or polygonalin shape,with frequent pathological mitosis; melanin granules were visible within the cytoplasm. Immunohistochemical staining showed positive HMB-45 and Melan-A,partially positive S-100 and negative CK for tumor cells. The follow-up was 2 to 48 months. 3 patients died and1 lived with disease. Conclusion Primary malignant melanoma of esophagus is a rare and highly malignant tumor with no specific clinical and imaging signs. Immunohistochemical staining helps its diagnosis. Surgery was the crucial part in comprehensive treatment of the disease.
Objective To investigate clinical characteristics,pathological features,diagnosis and prognosis of malignant melanoma in esophagus( PMME). Methods Clinical data of four PMME patients who received surgical treatment in Beijing Friendship Hospital from May 2008 to April 2018 were analyzed. Clinical manifestations,endoscopic and radiographic examination results,pathological features,treatment methods were recorded,prognosis was observed and relevant literature was reviewed. Results The mean age of the 4 patients( 2 males and 2 female) was57. 8( 47-72) years. All patients presented dysphagia. The tumor was single and located in the middle and lower esophagus. The patients underwent esophagectomy and received adjuvant chemotherapy and immunotherapy after operation. Histopathologically,the tumor cells had round or polygonalin shape,with frequent pathological mitosis; melanin granules were visible within the cytoplasm. Immunohistochemical staining showed positive HMB-45 and Melan-A,partially positive S-100 and negative CK for tumor cells. The follow-up was 2 to 48 months. 3 patients died and1 lived with disease. Conclusion Primary malignant melanoma of esophagus is a rare and highly malignant tumor with no specific clinical and imaging signs. Immunohistochemical staining helps its diagnosis. Surgery was the crucial part in comprehensive treatment of the disease.
引文
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[12]Navarro-Ballester A,De Lazaro-De Molina S,Gaona-Morales J.Primary Malignant Melanoma of the Esophagus:A Case Report and Review of the Literature[J].Am J Case Rep,2015,16:491-495.
[13]Walls G,Sehgal V,Haider A,et al.Primary malignant melanoma of the esophagus[J].Endoscopy,2015,47 Suppl 1 UCTN:E81-82.
[14]Kim SG.Primary malignant melanoma of the esophagus[J].Korean JGastroenterol,2011,57(4):262-264.
[15]Weiner JP,Shao M,Schwartz D,et al.Patterns of care and survival outcomes in the treatment of esophageal melanoma[J].Dis Esophagus,2017,30(2):1-6.
[2]Bisceglia M,Perri F,Tucci A,et al.Primary malignant melanoma of the esophagus:a clinicopathologic study of a case with comprehensive literature review[J].Adv Anat Pathol,2011,18(3):235-252.
[3]CSCO黑色素瘤专家委员会.中国黑色素瘤诊治指南(2015版)[M].北京:人民卫生出版社,2015:18-29.
[4]Terada T.A clinicopathologic study of esophageal 860 benign and malignant lesions in 910 cases of consecutive esophageal biopsies[J].Int JClin Exp Pathol,2013,6(2):191-198.
[5]丰世科,刘旺,王海霞,等.miR-205通过调控PKC蛋白影响黑色素瘤细胞的增殖和凋亡[J].临床和实验医学杂志,2018,17(16):1722-1725.
[6]Oshiro T,ShimojiH,Mstsuura F,et al.Primary malignant melanoma of the esophagus arising from a melanotic lesion:report of a case[J].Surg Today,2007,37(8):671-675.
[7]Iwanuma Y,Tomita N,Amano T,et al.Status of primary malignant melanoma of the esophagus:clinical features,pathology,management and prognosis[J].J Gastroenterol,2012,47(1):21-28.
[8]Mihajlovic M,Vlajkovic S,Jovanovic P,et al.Primary mucosal melanomas:a comprehensive review[J].Int J Clin Exp Pathol,2012,5(8):739-753.
[9]Stringa O,Valdez R,Beguerie JR,et al.Primary amelanotic melanoma of the esophagus[J].Int J Dermatol,2006,45(10):1207-1210.
[10]Kobayashi J,Fujimoto D,Murakami M,et al.A report of amelanotic malignant melanoma of the esophagus diagnosed appropriately with novel markers:A case report[J].Oncol Lett,2018,15(6):9087-9092.
[11]刘广杰,王滨,于哲,等.食管原发性恶性黑色素瘤17例临床特征和预后因素分析[J].中国全科医学,2015,18(29):3561-3565.
[12]Navarro-Ballester A,De Lazaro-De Molina S,Gaona-Morales J.Primary Malignant Melanoma of the Esophagus:A Case Report and Review of the Literature[J].Am J Case Rep,2015,16:491-495.
[13]Walls G,Sehgal V,Haider A,et al.Primary malignant melanoma of the esophagus[J].Endoscopy,2015,47 Suppl 1 UCTN:E81-82.
[14]Kim SG.Primary malignant melanoma of the esophagus[J].Korean JGastroenterol,2011,57(4):262-264.
[15]Weiner JP,Shao M,Schwartz D,et al.Patterns of care and survival outcomes in the treatment of esophageal melanoma[J].Dis Esophagus,2017,30(2):1-6.