Malignant melanoma of the rectum: a case report

直腸惡性黑色素細胞瘤： 病例報告

謝忠志(Chung-Chih Hsieh) ； 蔡明宏(Ming-Hong Tsai) ； 詹佳穎(Chia-Ing Jan) ； 蔡振華(Chen-Hua Tsai) ； 張幗孫(Ngot-Swan Chong)

《放射治療與腫瘤學》 13卷3期 (2006/09) Pp. 225-229

https://doi.org/10.6316/TRO/200613(3)225

摘要

直腸部位之惡性黑色素細胞瘤是一極罕見但快速惡化的疾病，即使接受治療，大多數病人仍死於疾病擴散，能長期存活的很少。對於疾病侷限於局部或區域的患者，手術切除是主要治療。大多數的研究顯示：接受腹部會陰聯合切除術的病人與接受寬邊緣局部切除的病人相較，在存活率上並無差別，儘管腹部會陰聯合切除術可以達到較佳的局部控制。某些研究者提出以保守性手術切除腫瘤，合併輔助性放射治療的方式， 以期能同時保留器官功能與提升局部控制率。
我們以經肛門腫瘤切除術，加上術後放射治療，針對腫瘤原發部位與骨盆區域淋巴系統照射，治療一位罹患下段直腸惡性黑色素細胞瘤的六十七歲女性患者。從開始治療至今十五個月，她身體狀況良好， 排便功能正常， 且無腫瘤復發現象。

並列摘要

Malignant melanoma of the rectum is a very rare but aggressive malignancy.
Long-term survival is rare as most patients die of disseminated disease regardless of
treatment. Surgery is the mainstay of treatment for patients with local-regional disease.
Most studies did not show difference in survival between patients who underwent abdominoperineal resection (APR) and those who underwent wide local excision, although APR was noted to result in improved local-regional control rate. Some
investigators propose to treat these patients with conservative surgery and adjuvant radiotherapy in an attempt to both preserve the sphincter function and improve local-regional control.
We managed a 67-year-old female patient with malignant melanoma of the lower rectum with transanal wide excision and postoperative irradiation to the primary tumor site and pelvic regional lymphatics. At present, she is well and continent without evidence of recurrence 15 months after the initial treatment.