PD-1抑制剂治疗胸腺恶性黑色素瘤1例报道及文献复习

Treatment of thymus malignant melanoma with PD-1 inhibitors:a case report and review of the literature

胸腺恶性黑色素瘤是一种罕见的胸腺异位型肿瘤,侵袭性高,对无法手术切除的晚期胸腺肿瘤患者,放化疗是传统治疗方式,但效果不佳。近期免疫检查点抑制剂展现出了良好的抗肿瘤作用,根据既往报道,胸腺肿瘤、胸腺癌治疗中使用免疫检查点抑制剂引起严重的免疫相关不良反应比例较高,目前尚未见到免疫检查点抑制剂治疗胸腺恶性黑色素瘤的报道。本例患者于2021年10月4日就诊于江苏省徐州市中心医院,经穿刺病理及基因检测明确诊断为原发性胸腺恶性黑色素瘤,行6个周期特瑞普利单抗治疗后,胸闷、憋喘症状缓解,肿瘤缩小,治疗效果评估为部分缓解,目前仍在治疗及随访中。本文通过对此患者的诊断、治疗及随访过程进行报道,回顾相关文献并总结,胸腺恶性黑色素瘤较罕见,需通过病理检查与其他胸腺肿瘤鉴别,使用免疫检查点抑制剂在胸腺恶性黑色素瘤患者治疗时可能表现出良好作用,出现免疫相关不良反应概率较其他胸腺肿瘤低,可为今后相似患者提供治疗思路。

Thymic malignant melanoma is a rare ectopic thymic tumor with high invasivity.For patients with advanced thymic tumor that cannot be surgically resected,radiotherapy and chemotherapy are the traditional treatment methods,but the effect is poor.Recently,immune checkpoint inhibitors have shown good anti-tumor effects.According to previous reports,the use of immune checkpoint inhibitors in the treatment of thymic tumors and thymic carcinoma causes a high proportion of serious immune-related adverse reactions.There has been no report of immune checkpoint inhibitors in the treatment of thymic malignant melanoma.This case on October 4,2021 in the Xuzhou Central Hospital,Jiangsu Province,by biopsy and gene detects the definite diagnosis of primary melanoma of the thymus gland malignant,after six cycles of Tririplizumab treatment,chest tightness and wheezing symptoms were relieved,and the tumor was reduced,the treatment effect was evaluated as partial remission,and the patient is still under treatment and follow-up.This article through to the patient’s diagnosis,treatment and follow-up process,review and summarize the related literatures,the thymus gland malignant melanoma is relatively rare,need to identify with other thymic tumor pathologically,using immune checkpoint inhibitors in thymus treatment in patients with malignant melanoma may show a good effect,immune related adverse reaction probability than other thymic tumor is low,it can provide treatment ideas for similar cases in the future.