内容紹介
Multidisciplinary Treatment for a Patient with Primary Malignant Melanoma Arising from the Stomach
Summary
A 61-year-old woman was referred to our hospital with the complaint of severe dysphagia. Upper gastrointestinal endoscopy revealed an elevated tumor with an irregular surface located in the upper third of the stomach, and malignant melanoma was confirmed by biopsy specimens. Abdominal CT scan findings revealed that the tumor was invading the lateral segment of the liver and crus of the diaphragm. Total gastrectomy was combined with resection of the lateral segment of the liver and the crus of the diaphragm, and D2 lymphadenectomy and reconstruction by the Roux-en-Y method were carried out. Because of positive peritoneal washing cytology, monotherapy with dacarbazine, and combination therapy, including dacarbazine, nimustine hydrochloride, cisplatin, and tamoxifen citrate, were administered for treating the residual tumor. The patient died from peritoneal relapse 146 days after the initial surgery. Primary malignant melanoma arising from the stomach is reported as an extremely rare disease with a poor prognosis. In our case, multidisciplinary treatment including surgery and chemotherapy was insufficient to achieve long-term survival in a highly advanced malignant melanoma arising from the stomach.
要旨
症例は61歳,女性。つかえ感を主訴に来院し,上部消化管内視鏡検査で胃噴門部隆起性病変を認めた。生検で悪性黒色腫診断となった。腹部骨盤部CT検査所見では肝外側区域,横隔膜脚に直接浸潤を認めていた。肝外側区域・横隔膜脚合併切除を伴う胃全摘術,D2郭清,Roux-en-Y法再建を行った。術中洗浄細胞診が陽性であることから,ダカルバジン単剤療法と,ダカルバジン,ニムスチン,シスプラチン,タモキシフェンによる多剤併用療法(DAC-Tam療法)を術後に施行した。術後第146日目に癌性腹膜炎により原病死した。胃原発の悪性黒色腫はまれであり,非常に予後不良とされている。本症例は発症時から高度進行状態であり,集学的治療を行ったが十分な遠隔成績は得られなかった。
目次
Summary
A 61-year-old woman was referred to our hospital with the complaint of severe dysphagia. Upper gastrointestinal endoscopy revealed an elevated tumor with an irregular surface located in the upper third of the stomach, and malignant melanoma was confirmed by biopsy specimens. Abdominal CT scan findings revealed that the tumor was invading the lateral segment of the liver and crus of the diaphragm. Total gastrectomy was combined with resection of the lateral segment of the liver and the crus of the diaphragm, and D2 lymphadenectomy and reconstruction by the Roux-en-Y method were carried out. Because of positive peritoneal washing cytology, monotherapy with dacarbazine, and combination therapy, including dacarbazine, nimustine hydrochloride, cisplatin, and tamoxifen citrate, were administered for treating the residual tumor. The patient died from peritoneal relapse 146 days after the initial surgery. Primary malignant melanoma arising from the stomach is reported as an extremely rare disease with a poor prognosis. In our case, multidisciplinary treatment including surgery and chemotherapy was insufficient to achieve long-term survival in a highly advanced malignant melanoma arising from the stomach.
要旨
症例は61歳,女性。つかえ感を主訴に来院し,上部消化管内視鏡検査で胃噴門部隆起性病変を認めた。生検で悪性黒色腫診断となった。腹部骨盤部CT検査所見では肝外側区域,横隔膜脚に直接浸潤を認めていた。肝外側区域・横隔膜脚合併切除を伴う胃全摘術,D2郭清,Roux-en-Y法再建を行った。術中洗浄細胞診が陽性であることから,ダカルバジン単剤療法と,ダカルバジン,ニムスチン,シスプラチン,タモキシフェンによる多剤併用療法(DAC-Tam療法)を術後に施行した。術後第146日目に癌性腹膜炎により原病死した。胃原発の悪性黒色腫はまれであり,非常に予後不良とされている。本症例は発症時から高度進行状態であり,集学的治療を行ったが十分な遠隔成績は得られなかった。