肛门直肠黑色素瘤:并非所有发黑、出血和疼痛的肿块都是痔疮

Vargas Castillo Elvis, Pérez Mariangela, Melo Amaral Ingrid, Garcilazo Dimas, Prados Manuel
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摘要

肛门直肠黑色素瘤在所有胃肠道肿瘤中所占比例不到 1%。这些肿瘤并不常见,具有侵袭性,治疗方法也不尽相同。预后通常较差,五年生存率不到 20%。肛门直肠是胃肠道粘膜黑色素瘤最常见的发病部位。因此,虽然它占肛门直肠病变的 0.05%至 4.6%,但却是继皮肤和眼睛之后第三大最常见的黑色素瘤部位。一般来说,肛门直肠黑色素瘤的诊断比较混乱且较晚,因为需要高度怀疑;症状无特异性,但大多表现为发黑、出血和疼痛的肿块,有时会与痔疮等肛门直肠良性病变相混淆。在我们接诊的两个临床病例中,年龄分别为 78 岁和 59 岁的妇女出现了紫黑色的肛门直肠肿块,第一个病例与痔疮血栓相混淆,另一个病例与内痔出血相混淆,因此在初级医疗中心被当作内痔治疗,平均延误了 3 个月的诊断时间(图 A、B 和 E)。这两个病例临床高度怀疑为恶性病变,后来在专科医院得到确诊,并接受了活组织切片检查和影像学检查。患者接受了手术,随后进行了免疫化疗。第一例进行了腹会阴切除术(图 C)和腹股沟淋巴结切除术(图 E),另一例进行了局部切除术(图 F)。新辅助治疗或辅助治疗以及手术类型至今仍存在争议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anorectal Melanoma: Not All Dark, Bleeding, and Painful Masses are Hemorrhoids
Anorectal Melanoma represents less than 1% of all gastrointestinal tumors. They are infrequent, aggressive and with little therapeutic consensus. The prognosis is usually reserved, with a five-year survival rate of less than 20%. The anorectal canal is the most common place where melanomas of the gastrointestinal mucosa appear. Thus, although it represents 0.05 to 4.6% of anorectal lesions, this constitutes the third most common location of melanoma, after the skin and eyes. Generally, their diagnosis is confusing and late, as they require a high index of suspicion; The symptoms are non-specific but they mostly present as dark, bleeding and painful masses, sometimes being confused with benign anorectal processes such as hemorrhoids. This occurred in two clinical cases that we presented in women aged 78 and 59 years with a purplish-black anorectal mass, the first case confused with hemorrhoidal thrombosis and the other with bleeding internal hemorrhoids; therefore, being treated as such in primary medical care centers and delaying their diagnosis by an average of 3 months (Figure A, B and E). Both cases with high clinical suspicion of a malignant process were later confirmed in a specialized unit, where they underwent biopsies and imaging studies. The patients underwent surgery, with subsequent chemo-immunotherapy. The first with abdomino-perineal resection (Figure C) plus inguinal lymphadenectomy (Figure E) and the other with local excision (Figure F). Both neo or adjuvant treatment and type of surgery remain controversial today.
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