内容紹介
A Case of Advanced Malignant Melanoma of the Esophagus with Distant Metastases
Summary
A 65-year-old woman with dysphagia visited our outpatient clinic. Esophagogastric endoscopy revealed a number of black-brown, irregularly elevated lesions covering the mucosal layer of nearly the entire esophagus. Following a series of examinations including histological examinations of the biopsies and whole body FDG-PET/CT, the patient was diagnosed with malignant melanoma primarily of the esophagus with metastasis to the distant lymph nodes, duodenum, pancreas head, and left brachial bone[cT3N3M1, StageⅣb]. Since surgical resection was not indicated, dacarbazine(DTIC: 1,000 mg/m2 body surface area)was intravenously administered 7 times every 3 weeks on an outpatient basis. However, the disease was progressive and metastasized to the stomach, duodenum, and small intestine, and finally to the brain. The patient died 8 months after the diagnosis was made. Malignant melanoma of the esophagus is a relatively rare pathology, and no reliable therapeutic modalities have been established yet. Based on the present case, the effectiveness of DTIC in an advanced case is proposed to be limited. In addition, whole body FDG-PET/CT is very useful for detecting metastatic lesions that could be missed otherwise.
要旨
症例は65歳,女性。咽頭つかえ感を主訴に受診。上部消化管内視鏡検査で食道のほぼ全長にわたり,全周性に黒褐色調の不整な隆起性病変がみられた。組織生検とFDG-PET/CTを含む全身精査の結果,胸腔内リンパ節や左上腕骨転移を有する食道原発悪性黒色腫(進行度cT3N3M1,StageⅣb)と診断された。dacarbazine(DTIC: 1,000 mg/m2・点滴静注,3週ごと・全7回)単剤療法を行ったが,経過中に胃・十二指腸・小腸への転移がみられ,最終的には脳転移を来し,診断から8か月で死亡した。 本症例をとおして,悪性黒色腫の進行例においてはDTIC単剤の効果は限定的であること,FDG-PET/CTが病変の進展度診断に有用であることが示唆された。
目次
Summary
A 65-year-old woman with dysphagia visited our outpatient clinic. Esophagogastric endoscopy revealed a number of black-brown, irregularly elevated lesions covering the mucosal layer of nearly the entire esophagus. Following a series of examinations including histological examinations of the biopsies and whole body FDG-PET/CT, the patient was diagnosed with malignant melanoma primarily of the esophagus with metastasis to the distant lymph nodes, duodenum, pancreas head, and left brachial bone[cT3N3M1, StageⅣb]. Since surgical resection was not indicated, dacarbazine(DTIC: 1,000 mg/m2 body surface area)was intravenously administered 7 times every 3 weeks on an outpatient basis. However, the disease was progressive and metastasized to the stomach, duodenum, and small intestine, and finally to the brain. The patient died 8 months after the diagnosis was made. Malignant melanoma of the esophagus is a relatively rare pathology, and no reliable therapeutic modalities have been established yet. Based on the present case, the effectiveness of DTIC in an advanced case is proposed to be limited. In addition, whole body FDG-PET/CT is very useful for detecting metastatic lesions that could be missed otherwise.
要旨
症例は65歳,女性。咽頭つかえ感を主訴に受診。上部消化管内視鏡検査で食道のほぼ全長にわたり,全周性に黒褐色調の不整な隆起性病変がみられた。組織生検とFDG-PET/CTを含む全身精査の結果,胸腔内リンパ節や左上腕骨転移を有する食道原発悪性黒色腫(進行度cT3N3M1,StageⅣb)と診断された。dacarbazine(DTIC: 1,000 mg/m2・点滴静注,3週ごと・全7回)単剤療法を行ったが,経過中に胃・十二指腸・小腸への転移がみられ,最終的には脳転移を来し,診断から8か月で死亡した。 本症例をとおして,悪性黒色腫の進行例においてはDTIC単剤の効果は限定的であること,FDG-PET/CTが病変の進展度診断に有用であることが示唆された。