A Case of Submucosal Anorectal Malignant Melanoma with Early Postoperative Recurrence

端山軍 1) 橋口陽二郎 1) 塚本充雄 1) 八木貴博 1) 赤羽根拓弥 1) 島田竜 1) 岡本耕一 1) 土屋剛史 1)T1AMM 15 例と合わせて考察し報告する．キーワード：直腸肛門部悪性黒色腫，腹腔鏡下腹会陰式直腸切断術，所属リンパ節転移はじめに直腸肛門部に発生する悪性黒色腫は比較的まれである．直腸肛門部悪性黒色腫(anorectal malignant melanoma；以下，AMM と略記)は早期に転移を認めるため極めて予後不良な疾患である 1 )～ 3 ) ．AMM が早期で発見されることはほとんどなく治療法も確立されていない 4 ) 5 ) ．今回，我々は深達度が T1 であった AMM に対して根治的な腹腔鏡下腹会陰式直腸切断術を施行したので報告する．症例症例 1：78 歳，女性主訴：排便時出血家族歴，生活歴：特記事項なし．既往歴：特記事項なし．現病歴：2014 年 9 月に排便時出血を認め近医を受診した．肛門鏡検査にて直腸に腫瘍性病変を認め経肛門的切除術を施行した．病理の結果，悪性黒色腫の診断で当科紹介受診となった．血液生化学検査所見：WBC 6,200/μl，Hb 14.7 g/dl，PLT 18.4×10 4 /μl，TP 7.3 g/dl，ALB 4.7 g/dl，AST 20 U/l，ALT 9 U/l，CK 52 U/l，BUN 13.2 mg/dl，CR 0.73 mg/dl，Na 142 mEq/l，K 4.6 mEq/l，Cl 104 mEq/l， CRP 0.01 mg/dl，PT-INR 1.09 と CEA 1.0 ng/ml，CA19-9 16.0 U/ml，特記すべき異常所見を認めなかった．〈2018 年 6 月 27 日受理〉別刷請求先：端山軍〒 173-8605 板橋区加賀 2-11-1 帝京大学医学部外科学講座日本消化器外科学会雑誌．2018;51(9):590-598

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腹腔鏡下腹会陰式直腸切断術を行った深達度t1直腸肛門部悪性黒色腫の2例

Hayama

Hashiguchi

Tsukamoto

et al. 2018

Jpn J Gastroenterol Surg, Nihon Shokaki Geka Gakkai zasshi

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腹腔鏡下腹会陰式直腸切断術を施行した直腸肛門部悪性黒色腫の3例

Yoshida

Suzuki

Tomochika

et al. 2021

Jpn J Gastroenterol Surg, Nihon Shokaki Geka Gakkai zasshi

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We report three cases of anorectal malignant melanoma (AMM) that were treated with laparoscopic abdominoperineal resection (APR). The first case was a 73-year-old woman with a chief complaint of melena. She was diagnosed with pT1bN2aM0 (9th edition of the Japanese classification of colorectal, appendiceal, and anal carcinoma) and adjuvant chemotherapy was performed after radical surgery. Four months after surgery, lateral lymph node metastasis was found. The second case was a 45-year-old man on hemodialysis with a chief complaint of an anal mass. He was diagnosed with pT2N1bM0 and adjuvant chemotherapy was not performed. Two months after surgery, inguinal lymph node metastasis was found. The third case was a 66-year-old woman with a chief complaint of melena. She was diagnosed with pT1bN0M0 and nivolumab was used as adjuvant chemotherapy for 1 year. She remains alive without recurrence 20 months after surgery. There are reports of 51 AMM cases in which APR was performed in Japan, and these show that regional lymph node metastasis is a risk factor for early distant recurrence after surgery.

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A Case of Submucosal Anorectal Malignant Melanoma with Early Postoperative Recurrence

Cited by 2 publications

References 6 publications

腹腔鏡下腹会陰式直腸切断術を行った深達度t1直腸肛門部悪性黒色腫の2例

腹腔鏡下腹会陰式直腸切断術を行った深達度t1直腸肛門部悪性黒色腫の2例

腹腔鏡下腹会陰式直腸切断術を施行した直腸肛門部悪性黒色腫の3例

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