原发性食管恶性黑色素瘤1例报告及文献复习

A Case of Primary Malignant Melanoma of the Esophagus Report and Literature Review

目的探讨原发性食管恶性黑色素瘤的临床特点及其诊断和治疗。方法对本科收治的1例和计算机检索得到的29例原发性食管恶性黑色素瘤的临床资料结合文献复习,进行综合分析。结果最常见主诉为吞咽不适,进食后胸骨后疼痛,伴体重下降或消瘦。肿瘤多位于食管的胸中下段,肿瘤长径平均5.26cm,其中5.0cm以上者19例,占73.1%。食管钡餐检查病灶表现为轮廓较清晰,边缘光滑规则的充盈缺损。胃镜多见腔内息肉样肿物,表面多呈褐色、黑色、灰白色或其它深色改变。术前临床诊断明确率为19.2%。25例接受外科手术治疗。结论原发性食管恶性黑色素瘤预后极差,应提高对其临床特点的认识,以提高术前确诊率。手术是治疗原发性食管恶性黑色素瘤的首选方法,可有效改善临床症状。

Objective To discuss the clinical characteristics, diagnosis and treatment regimen of primary malignant melanoma of the esophagus. Methods we analyzed one PMME patient who admitted in our hospital and 29 patients of PMME who were reported in literatures available online in domestic. Results The most frequent chief complaint was discomfort of swallow and pain of back breastbone after eating, concomitant with weight loss or wasting. The tumor mostly localized in middle and lower segment of the esophagus ,The tumor was averaging 5.26 cm, in long diameter, and of them 19 cases （ aceounting for 73.0% ） tumor was longer than 5.0 cm in diameter. Under barium meal the esophagus radiography, most of tumors displayed with clearer outline and smooth brim and regular filling defect. Under gastrofiberscope, most tumors appeared as polyp and the surface and color of tumor was frequently black, brown and grey or other dark color. The rate of accurate diagnosis prior to operation was only 5 of 26 cases ,accounting for 19.2%. 25 patients received surgical operation. Conclusion The prognosis of PMME was very awful. Operation could efficiently improve elinieal symptoms and situation of the patients and was the first treatment choice after accurate diagnosis. However,it was generally considered that awareness and understanding of elinieal characteristics of PMME should be emphasized to elevate the rate of accurate diagnosis prior to operation.