肛管直肠恶性黑色素瘤的诊治进展

目的：探讨肛管直肠恶性黑色素瘤的诊治进展，方法：复习相关文献并对本病病因，临床特点，早期诊断，治疗及预后作一综述报告。结果：肛管直肠恶性黑色素瘤是一种发病率很低的恶性肿瘤，发病原因可能与良性黑痔史，HIV感染，太阳光照射有关，主要症有便血，局部肿块，大便习惯改变等，早期诊断主要依赖对45－80岁的高危发病人群进行常规直肠检查，CEA多克隆抗体标记阳性在病理诊断中有一定帮助，治疗方法现存在争议，多主张在手术治疗（腹会阴联合切除或局部广泛切除）的基础上辅以化疗，放疗或免疫治疗。结论：肛管直肠恶性黑色素瘤早期诊断困难，预后差，应提高警惕，最佳治疗方法还有待进一步探讨。     

直肠肛管恶性黑色素瘤的诊治

目的 探讨直肠肛管恶性黑色素瘤的临床表现、诊断、治疗及预后。方法 回顾性分析了1981－1996年我科诊治的直肠肛管恶性黑色素瘤6例，并进行随访。结果 6例患者肿块位于齿状线附近，肉眼观为紫黑色或褐色，均行手术治疗，其中2例行Mile′s术，2例行后盆腔清扫术，1例行经肛门肿块局部扩大切除术，1例行剖腹探查术，所有患者手术时均已有淋巴结或肝脏转移。6例患者于确诊后5－23个月死亡，平均存活14．7个月。结论 直肠肛管恶性黑色素瘤恶性度极高，死亡率高，较早发生淋巴和血行转移，宜采用根治手术辅以化疗及生物治疗的综合性治疗。     

肛管直肠恶性黑色素瘤

目的　总结肛管直肠恶性黑色素瘤的诊断与治疗经验。　方法　回顾性分析 10例肛管直肠恶性黑色素瘤的临床病例资料。　结果　出现症状至确诊时间平均 8( 2～ 12 )个月 ,首诊确诊 4例 ,误诊 6例。手术 9例 ,8例肿瘤直径 >3cm。其中 8例行腹会阴联合根治术 ,1例以直肠息肉、肛乳头肥大行局部切除 ,1例放弃手术仅行化疗 ,3月后死于肝、肺腹股沟等广泛转移。术后 8例行化疗 ,2例辅助放疗 ,化放疗联合应用 1例。术后 2年内死亡 5例 ,余 4例存活 ,存活最长者已超过 6年。　结论　肛管直肠恶性黑色素瘤恶性程度高 ,早期行腹会阴联合根治术是最优选择。长期生存有赖于早期治疗以及治疗方法的改进     

肛管直肠恶性黑色素瘤的诊治进展

肛管直肠恶性黑色素瘤（anorectalmalignantmelanoma,ARMM）是一种非常罕见且预后极差的恶性肿瘤。ARMM发病率低,缺乏特异性临床表现,容易误诊。单纯常规病理学检查不易诊断ARMM,免疫组化联合S-100蛋白、HMtM5、Vimentin的检测有助于诊断。目前,胃肠道肿瘤的治疗多采用外科手术、放疗、化疗及靶向治疗等综合治疗方式,而ARMM对放化疗敏感性较差,因此外科手术切除仍为本病的主要治疗手段。作者通过查阅近年来有关ARMM的国内外文献报道,对该病的生物学特性、诊断和治疗进展进行综述,以期对其进一步研究及临床诊治有所助益。     

肛管直肠黑色素瘤31例报告

发生在肛管直肠部位的黑色素瘤是一种预后不良的罕见肿瘤［１］,我院自１９８５～１９９７年共收治３１例,均经手术病理证实,现报道如下。１　临床资料一般情况：１９８５～１９９７年间我院共收治肛管直肠恶性肿瘤２９８６例,其中３１例恶性黑色素瘤,占１－０％。男１４例,女１７例。年龄２１～７９岁,平均５５－５岁。病程最短１０天,最长３年,平均６－８个月。临床表现：肛门坠痛２２例,肿物脱出８例,便血２７例,便次增多１１例,排便不畅１２例,里急后重７例,大便干稀交替３例。乏力５例,食欲下降２例,消瘦及体重下降６…     

肛管直肠恶性黑色素瘤3例报告

肛管直肠恶性黑色素瘤临床上较为少见,易误诊,预后极差。1996年12月至1997年11月广西医科大学第一附属医院肛肠外     

肛管直肠恶性黑色素瘤

为了探讨肛管直肠恶性黑色素瘤的疗效，对１９６０～１９９６年收治的２７例肛管直肠恶性黑色素瘤（ＡＲＭＭ）进行了临床分析，其中１６例行经腹会阴联合根治术（Ｍｉｌｅ＇ｓ术），６例行局部切除术，５例行剖腹探查术。２２例获随访，随访时间为１～１２年。结果表明：中位生存时间Ｍｉｌｅ＇ｓ术组２１．５月、局部切除术组１３．５月、剖腹探查术组７．０月。Ｍｉｌｅ＇ｓ术效果优于局部切除术。提示：对ＡＲＭＭ应行Ｍｉｌｅ＇ｓ术，并对伴有腹股沟淋巴结转移或可疑者行腹股沟淋巴结清扫     

4例肛管直肠恶性黑色素瘤临床报告

肛门直肠恶性黑色素瘤是源自上皮组织的肿瘤，在肛门直肠区少见，据统计其发生率＜１％。在人体黑色素瘤中居皮肤、眼睛发病率之后为等三位。我院１９８０年至今共收治肛门直肠恶性黑色素瘤４例，现报告如下。１临床资料病例１，王某某，男，８０岁，便血１个月伴肛内肿物脱出。指诊距肛缘３．５ｃｍ，左前有一个１．５ｃｍ×１．５ｃｍ肿物，基底似有蒂、中等硬，可活动，左后有一个０．５ｃｍ×０．５ｃｍ、光滑、软活动的肿物，乙状结肠镜检报告：瘤状内痔，乳头肥大。病理报告：恶性黑色素瘤，拒绝手术。病例２，穆某某，男．４０岁，便…     

直肠肛管恶性黑色素瘤25例报告

我院自1975年以来共收治直肠、肛管恶性黑色素瘤(ＭｅｌａｎｏｍａｏｆｔｈｅＡｎｏｒｅｃｔａｌＲｅｇｉｏｎ)25例,报告如下。一、临床资料1.一般资料:我院1975年6月～1996年末收治的直肠肛管恶性黑色素瘤25例,男性11例,女性14例,年龄22～75岁。占本院同期收治全部肛管直肠恶性肿瘤2557例的098%。瘤灶位于直肠下部21例,位于肛管部4例。2.检查及诊断:本组病例均依靠肛门直肠检查发现直肠、肛管内肿瘤,经病理形态学检查最后明确诊断。单纯临床检查发现色素沉着而初步诊断者仅13例,占52%。而其它的超声、ＣＴ等辅助检查的意义在于发现转移瘤灶…     

直肠肛管恶性黑色素瘤的外科治疗及预后

目的探讨直肠肛管恶性黑色素瘤的外科治疗及局部复发、预后的影响因素。方法回顾性分析50例直肠肛管恶性黑色素瘤患者的临床病理资料,并对预后进行单因素及多因素分析。结果本组47例患者行肿瘤切除术,其中31例行腹会阴联合根治术,16例行肿瘤局部切除术;术后局部复发率分别为16.1%（5/31）和68.8%（11/16）。χ^2检验显示,手术方式与局部复发相关（P=0.001）。47例患者5年生存率18.2%,单因素分析显示,病灶单发（P=0.0458）和肿瘤侵犯深度（P=0.0053）与预后相关。多因素分析显示,肿瘤侵犯深度（P=0.010）是影响预后最主要因素。结论直肠肛管恶性黑色素瘤预后差,影响预后最主要的因素是肿瘤侵犯深度,腹会阴联合根治术后复发率低。     

The surgical treatment of anorectal malignant melanoma

The clinical presentation and surgical treatment of 21 patients with anorectal melanoma over a 44 year period have been analysed. During the first 24 years of this period total rectal excision was regarded as the treatment of choice and since then wide local excision. Two groups of patients emerge for comparison of the results of surgical treatment. There were no long-term survivors in either group and little difference between survival rates after either procedure. It was concluded that the change from radical to conservative surgery for anorectal melanoma has made no difference in terms of survival and the possible advantages of this change have been discussed.     

Primary anorectal malignant melanoma

A case of primary anorectal malignant melanoma seen in a 46 year old woman is presented herein. Her most marked symptoms were bloody stools and anal pain. Endoscopic examination indicated a tumor with ulceration but without pigmentation in the anorectal region. Histologic examination of the biopsied specimens showed spindle-shaped cells with atypia proliferating in a bandlike arrangement, as in leiomyosarcoma. An abdominoperineal resection was done and detailed histological examination of the tumor comfirmed the nature of the tumor to be malignant melanoma. The postoperative immunochemotherapy consisted of Dimethyl-Triazeno-Imidasole-Carboxamide (DTIC), Amino-Methyl-Pyrimidinyl-Methyl-Chlorethyl-Nitrosourea-Hydrochloride (ACNU), Vincristine (VCR) and OK-432. The patient has been well without recurrence for fifteen months following her operation through the continuous administration of these agents.     

直肠肛管恶性黑色素瘤的临床特征分析

目的了解原发性直肠肛管恶性黑色素瘤的临床特点。方法回顾性分析9例原发性直肠肛管恶性黑色素瘤的临床资料,并复习文献。结果直肠肛管恶性黑色素瘤以女性多见,平均发病年龄56岁,病程5.8个月;首发症状以血便为最常见,其次为肛门肿物突出。94.7%的直肠肛管恶性黑色素瘤在距离肛缘5.0cm范围内;肿瘤最大径(3.3±2.1)cm;其中54.5%可活动;有19.1%的肿瘤表面光滑;6.6%的肿瘤质地软;14.0%同期发现转移,肝转移最常见,腹股沟淋巴结转移其次;的病例出现误诊,超过者被误诊为良性疾病;手术治疗中以Miles术为主,经肛门局部切除术其次。结论直肠肛管恶性黑色素瘤极易误诊。手术治疗为主。     

肛管直肠恶性黑色素瘤的外科治疗

目的 探讨肛管直肠恶性黑色素瘤的临床特征、诊断及治疗经验.方法 总结中国医科大学附属第四医院及附属第一医院33例肛管直肠恶性黑色素瘤患者的临床资料.依据手术方式分组,应用Fisher确切概率法,Kaplan-Meier方法和Log-rank检验进行统计学分析.结果 肛管直肠恶性黑色素瘤以女性多见,发病年龄22～77(54.5 ±7.6)岁.便血、肛门疼痛为最常见的临床表现.首次就诊误诊率为67%(22/33).肿瘤平均直径(3.5 ± 1.7) cm,31例(94%,31/33)的肿瘤距肛缘不足5 cm.术后平均生存期(14.0 ± 6.5)个月,1、3、5年总生存率分别为48%、22%、10%.腹会阴联合切除组与局部切除组术后局部复发率比较,差异有统计学意义(P=0.049),3年特异性生存率差异无统计学意义(x2=0.268,P=0.582).结论 肛管直肠恶性黑色素瘤极易误诊,扩大切除并不能有效延长患者的生存期.

Abstract：

Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.     

肛管直肠恶性黑色素瘤34例治疗与预后分析

目的探讨肛管直肠恶性黑色素瘤（ARMM）的预后影响因素。方法回顾性分析1993年3月至2011年11月问解放军总医院收治的34例肛管直肠恶性黑色素瘤患者的临床资料．分析临床病理因素与预后的关系。并采用Cox比例风险模型进行多因素预后分析。结果34例ARMM患者中,26例行腹会阴联合切除手术（APR）,8例行局部扩大切除术（wLE）;术后行辅助治疗者20例,其中化疗14例,放疗2例。中医中药治疗4例,免疫治疗16例。术后均接受随访,中位随访时间27个月。1、3和5年的总生存率分别为76.3％、39．6％和20．6％,1、3和5年的无病生存率分别为60．6％、30-8％和12．8％。APR和WLE术后局部复发率分别为0（0／26）和5／8,行和未行术后免疫治疗者局部复发率分别为0（0／16）和27．8％（5／18）,差异均有统计学意义（均P〈0．05）。单因素预后分析显示,肿瘤大体分型、浸润程度、淋巴结转移和临床分期与术后总体生存有关,淋巴结转移、术后免疫治疗和辅助治疗与术后无病生存有关（均P〈0．05）。多因素预后分析显示,肿瘤浸润程度和临床分期是术后总体生存的独立预后因素（均P〈0．05）,而术后无病生存的独立预后因素未获证实（均P〉0．05）。结论合理选择手术方式和术后免疫治疗是提高ARMM患者治疗效果的关键。     

The surgical management of anorectal malignant melanoma

The biological vagaries of anal malignant melanoma are illustrated by four cases in Chinese patients. All four died within five years. Their poor prognosis emphasizes the value of preoperative studies to detect clinically occult metastases and obviate futile radical surgery. Many patients already have disseminated disease at the time of diagnosis, and local excision of the tumour provides acceptable palliation. For localized disease, abdominoperineal resection prevents local recurrence and removes the mesenteric nodes which are frequently involved. Palpable inguinal nodes necessitate therapeutic groin dissection, but we perform elective resection only when affected nodes are found at laparotomy. Pelvic lymphadenectomy should be performed in conjunction with abdominoperineal resection. The efficacy of chemotherapy for anorectal melanoma remains uncertain.     

Diagnosis and treatment of malignant melanoma of the foot

BACKGROUND: Patients diagnosed with melanoma of the foot have been reported to have a poor prognosis. We reviewed our experience at a tertiary-care medical clinic to determine the disease course in patients diagnosed with melanoma of the foot. METHODS: A retrospective review was performed of 38 patients with a diagnosis of primary or locally recurrent melanoma of the foot treated between January, 1988, and July, 2004. The main outcome measures included methods of diagnosis, clinical and histopathologic features, and patterns of recurrence. RESULTS: The mean age at diagnosis was 61 years; most were women (58%) and Caucasian (95%). The average time to diagnosis was 17 months. Initial clinical diagnosis had been considered benign in 12 (32%). The median Breslow thickness was 1.75 mm, T1 lesions were the most common, and acral lentiginous melanoma accounted for 42%. Thirteen patients (34%) had ulcerated lesions. Sentinel lymph node biopsy specimens of 25 patients identified four (16%) with metastatic disease. Surgical complications occurred in 12 patients, usually after skin graft or soft-tissue flap reconstruction. Systemic recurrence developed in six patients, four of whom also had regional recurrence. CONCLUSIONS: Most patients were elderly Caucasian women and most presented with early-stage disease, but diagnosis can be difficult and a subgroup presented with thick melanomas. Reconstructive surgical procedures had a high rate of complications; however, overall functional outcomes were good. Stage of cancer at diagnosis was associated with systemic metastases.     

肛管直肠恶性黑色素瘤临床病理误诊分析

目的分析肛管直肠恶性黑色素瘤临床及病理误诊的原因 ,探讨避免误诊的办法 .方法对 15例肛管直肠恶性黑色素瘤进行回顾性分析和免疫组化观察 .结果临床误诊率为 86 7% (13/15).其中误诊为良性病变占 66 7% (10/15),误诊为痔或痔伴有肛周脓肿 7例、息肉 2例及慢性炎症 1例; 3例误诊为肛管直肠癌 .延误诊治时间 3个月至 1年 .活检病理误诊率为 53 3% (8/15),其中误诊为低分化腺癌 6例 ,平滑肌肉瘤、类癌各 1例 . 5例无色素性恶性黑色素瘤全部误诊 .结论肛管直肠恶性黑色素瘤临床误诊率高 ,病理活检难以准确分型 .临床和病理医生应密切配合 ,作直肠指诊 ,及时活检;对病理标本多作切片 ,仔细寻找黑色素颗粒并对可疑标本进行免疫组织化学检查 ,有助明确诊断 .     

Primary anorectal malignant melanoma. A case report

A case of primary anorectal malignant melanoma in a 66-year-old lady is presented and the clinical, radiological and surgical features reviewed. The presenting symptoms similar to the more commonly encountered haemorrhoids led to a delay in the eventual diagnosis and treatment, resulting in limited post-operative survival. The relevant literature is reviewed and an emphasis made on the accurate histological diagnosis of anorectal growths.