食管原发性恶性黑色素瘤影像学表现及临床病理回顾性分析  

Evaluating the Imaging Findings and the Clinicopathological Features of Primary Malignant Melanoma of the Esophagus

作　　者：郑德春[1] 赖国静[2] 许淑桂[1] 鲍道亮[1] 郑子清 陈英[1] 陈韵彬[1] ZHENG De-chun;LAI Guo-jing;XU Shu-gui;BAO Dao-liang;ZHENG Zi-qing;CHEN Ying;CHEN Yun-bin(Department of Radiology,Fujian Cancer Hospital&Fujian Medical University Cancer Hospital,Fuzhou 350014,Fujian Province,China;Department of Endoscopy,Fujian Cancer Hospital&Fujian Medical University Cancer Hospital,Fuzhou 350014,Fujian Province,China)

机构地区：[1]福建省肿瘤医院,福建医科大学附属肿瘤医院放诊科,福建福州350014 [2]福建省肿瘤医院,福建医科大学附属肿瘤医院放疗科,福建福州350014

出　　处：《中国CT和MRI杂志》2021年第1期63-65,共3页Chinese Journal of CT and MRI

基　　金：福建省科技厅自然科学基金项目(2017J01180)。

摘　　要：目的提高食管原发性恶性黑色素瘤的影像诊断和临床病理特征的认识。方法回顾性分析我院收治的5例经病理证实的食管原发性恶性黑色素瘤的临床特征、X线钡透检查、CT表现、胃镜进行总结分析。结果5例患者平均年龄为55岁,病程1~4个月。5例进行增强CT检查及4例进行X线钡透检查,3例进行胃镜检查。肿瘤为单发,病灶中心均位于食管中下段,影像表现表明肿瘤具有向腔内生长的特点,钡透上呈息肉状或结节状充盈缺损,食管腔狭窄梗阻不明显。食管CT检查发现,在5例原发性食管恶性黑色素瘤中4例患者食管原发灶未侵及食管全周长,食管周围脂肪间隙清晰;4例出现纵隔、腹腔及腹膜后淋巴结肿大,其中1例同时合并胃大弯侧、肾动脉水平以下腹膜后淋巴结转移,1例多发骨转移。结论原发性食管恶性黑色素影像表现缺乏特异性,当食管中下段发现肿瘤不伴有食管梗阻或存在不符合食管鳞状细胞癌的淋巴转移规律的淋巴结转移时,应考虑食管原发性恶性黑色素的可能。Objective To improve the image diagnosis of primary malignant melanoma of the esophagus and its clinicopathological features.Methods The clinical features,X-ray barium examination,CT findings,and gastroscopy of 5 patients pathological proved with primary malignant esophageal melanoma were included and analyzed retrospectively.Results The mean age of these five subjects was 55 years old,and the course of clinical symptoms ranged from 1 to 4 months.five patients underwent contrastenhanced CT examination in these cohorts,four received X-ray barium esophageal examination and three took gastroscopy.The tumors were all solo,and the center of the five tumors were all located in the middle and/or inferior segment of the esophagus.The image findings suggest that the tumors were a character with an endogenous growth pattern.The barium examination showed that polypoid or nodular filling defects,and esophageal stenosis and obstruction were not obvious.CT showed that four out of five primary esophageal melanoma subjects did not invade the full circumference of the esophagus,the fat space around the esophagus was apparent in all five patients,and the enlarged lymph nodes in the mediastinum and abdominal and retroperitoneal space were detected in 4 patients;moreover,one subject presented lymph nodes metastasis in the large curved side of the stomach,as well as retroperitoneal space below the level of the renal artery and multiple bone metastases,were reported in the other subject.Conclusion There lacks specificity imaging manifestation for the primary malignant melanoma in the esophagus.The possibility of primary malignant melanin in the esophagus should be considered if the tumors are found in the middle and lower esophagus,while no obvious obstruction accompanies occur or lymph nodes metastases are not consistent with esophageal squamous cell carcinoma and bone metastasis.

关 键 词：食管原发性恶性黑色素瘤 计算机断层成像 X线钡透检查 胃镜检查 影像诊断 

分 类 号：R445.3[医药卫生—影像医学与核医学] R445.4[医药卫生—诊断学]