原发性直肠恶性黑色素瘤伴肝转移一例并文献复习  

Primary Rectal Malignant Melanoma Associated by Liver Metastasis: A Case Report and Literature Review

作　　者：杨海燕[1] 陈安海[1] 周本刚[2] 程其娇 YANG Hai-yan CHEN An-hai ZHOU Ben-gang CHENG Qi-jiao(Department of Digestive System Diseases, Affilia- ted Hospital of Zunyi Medical College, Zunyi, Guizhou 563000, China Department of Digestive System Diseases, Huang- shi Central Hospital, Huangshi, Hubei 435000, China)

机构地区：[1]遵义医学院附属医院消化内科,贵州遵义563000 [2]黄石市中心医院消化内科,湖北黄石435000

出　　处：《临床误诊误治》2017年第3期9-11,共3页Clinical Misdiagnosis & Mistherapy

基　　金：贵州省科技厅社会发展攻关项目(黔科合SY字(2011)3056号)

摘　　要：目的探讨原发性直肠恶性黑色素瘤(malignant melanoma,MM)伴肝转移的临床特点及预后。方法对收治的原发性直肠MM伴肝转移1例的临床资料进行回顾性分析,并复习相关文献。结果本例因发现肝多发占位性病变1个月入院。查便隐血阳性。腹部B超示:肝内多发占位性病变。腹部CT示:原发性肝癌或肝转移瘤。后经肠镜及免疫组织化学染色诊断为直肠MM伴肝转移,建议行经皮肝穿刺活组织病理检查,家属拒绝,要求转上级医院。后电话随访,患者放弃治疗,3个月后死亡。结论原发性直肠MM临床表现不典型,早期易误漏诊,多数患者在确诊时已存在局部或远处转移,故早期诊断及治疗至关重要。Objective To investigate clinical features and prognosis of primary rectal malignant melanoma （MM） associated by liver metastasis. Methods Clinical data of 1 patient with primary rectal MM associated by liver metastasis was retrospectively analyzed, and related literature was reviewed. Results The patient was admitted for multiple occupying le- sions more than 1 month. Positive occult blood was found by excreta test, and abdominal ultrasound showed multiple occup- ying lesions in liver. Abdominal CT showed primary liver cancer or liver metastases. Rectal MM associated by liver metastasis was confirmed after enteroscopy and immunohistochemical examination, and percutaneous liver biopsy was suggested, but the family refused and required to transfer to high-level hospital. The patient gave up treatment and died 3 months later by tele- phone follow-up. Conclusion Primary rectal malignant melanoma is atypical in clinical manifestations, and early misdiag- nosed or missed diagnosis. Many patients have local or distant metastases at the time of confirming diagnosis, and therefore early diagnosis and treatment are very important.

关 键 词：黑色素瘤 直肠肿瘤 肿瘤转移 误诊 肝肿瘤 

分 类 号：R735.37[医药卫生—肿瘤]