恶性黑色素瘤肾上腺转移三例

Melanoma adrenal metastasis： report of 3 cases and Hterature review

目的探讨恶性黑色素瘤肾上腺转移的临床表现、诊断、治疗及预后。方法1985—2007年北京协和医院共收治恶性黑色素瘤肾上腺转移者3例，占同期48例恶性黑色素瘤患者的6．25％。患者男2例，女1例，年龄分别为57、70和84岁，其中原发病灶为皮肤黑色素瘤2例，肛管黑色素瘤1例，发现肾上腺转移距原发病手术分别为25、37和33个月。2例因腰腹部不适就诊发现肾上腺转移灶，1例查体发现。肾上腺转移瘤最大径分别为5cm、8cm和12cm，转移瘤CT值平扫9～45Hu，增强后最高107．5Hu。结果伴淋巴结转移者予白细胞介素2治疗3个月，其余2例患者行手术完整切除病变，1例行腹腔镜手术切除；1例伴下腔静脉癌栓者行开放手术切除，同时行癌栓切除，6个月后对侧肾上腺发上现直径4cm转移灶，再次行腹膜后腹腔镜切除。未手术者6个月时死于肿瘤恶液质；2例手术患者术后未接受辅助治疗，1例随访16个月发现多处转移，21个月死亡；另1例随访30个月仍存活，未发现复发及转移病灶。结论恶性黑色素瘤肾上腺转移患者罕见，总体预后极差，对于转移灶单一或范围局限有根治性切除机会的患者，完整切除转移灶能延长患者生存期。

Objective To investigate the clinical diagnosis, treatment and prognosis of melanoma adrenal metastasis. Methods A total of 48 cases of malignant melanoma from 1985 to 2007 were reviewed. And three cases of melanoma adrenal metastasis were analyzed. There were 2 males and 1 female with an age of 57, 70 and 83 years old respectively. Two cases hod a history of cutaneous melanoma and another one suffered previously from anal melanoma. The disease-free interval to adrenal metastasis were 25, 37, 33 months respectively. Two presented with flank or abdominal discomfort and another one hod adrenal metastasis on routine examination. The maximal diameters of metastasis were 5, 8 and 12 cm respectively. The CT value of adrenal metastasis had a range of 9 -45 Hu in plain scan. And the maximal pest-contrast value was 107.5 Hu. Results One patient with concurrent lymph node metastasis received non-operative therapy with interleukin-2. The other two cases underwent complete resection of melanoma metastasis. One received adrenalectomy via retroperitoneal laparoscopic approach while another patient with tumor thmmbus in inferior vena cava underwent right adrenalectomy and extraction of tumor thrombus out of inferior vena cava in traditional open surgery. When contralateral adrenal metastasis of melanoma was found 6 months later, left adrenalectomy laparoscopically was performed. The patient who was managed non-operatively died of cachexia 6 months later. Two operated patients did not accept adjuvant therapy. One hod multiple metastasis in 16 months and died at 21 months. Another was alive without recurrence or new metastasis at 30 months. Conclusion Melanoma metastasis to adrenal gland is rare and it generally has a poor prognosis. Patients with adrenal metastases from melanoma, either isolated or with a limited number of additional metastases, may achieve a survival benefit from surgical resection if all visible lesions are removed.