原发性消化道黑色素瘤的临床分析

Clinical analysis of primary malignant melanoma of digestive tract

目的总结原发性消化道黑色素瘤的临床特点。方法回顾性分析我院近10年住院治疗的8例原发性消化道黑色素瘤临床资料并复习文献。结果8例原发性消化道黑色素瘤中,原发灶位于直肠6例、小肠1例、食管1例,除1例直肠黑色素瘤术前得到确诊外,其余7例均被误诊。直肠黑色素瘤以便血、肛门疼痛和排便困难为主要症状;多表现为息肉样,均位于距齿状线以上5cm以内;少有色素沉着。小肠黑色素瘤以梗阻、腹痛、贫血为主要症状;造影和CT有助于发现病变,但确诊仍需病理学。食管黑色素瘤多为黏膜下;胃镜可发现色素沉着;病理活检可协助诊断。结论原发性消化道黑色素瘤的临床表现与其他肿瘤类似,极易误诊。病理活检是确诊的主要手段。

Objective To summarize the clinicopathological characteristics of primary malignant melanoma of digestive tract(PMDT). Methods Clinical data of 8 patients with PMDT were reviewed retrospectively, including clinical manifestations, treatment and prognosis. Results Six patients had lesions in rectum, one in esophagus and one in small intestine. All cases except one of rectal melanoma were misdiagnosed before operation. The patients with rectal melanoma presented with hematochezia, anorectal pain and dyschezia. The lesions in rectum were polypoid, pigmented and within 5 cm to dentate line. Intestinal obstruction, abdominal pain and anemia were main manifestations in small intestinal melanoma, while dysphagia in esophageal melanoma. Biopsy was essential to confirm the diagnosis. Conclusions PMDT is easily misdiagnosed because of lack of special clinical manifestations. Biopsy is the most important method to confirm the diagnosis.