内容紹介
Summary
A 56-year-old woman with complaints of anal bleeding and pain visited our hospital, and an elastic soft mass was detected in the anal canal on digital examination. Colonoscopy showed a black Isp polypoid lesion with a black pit from the anal canal to the lower rectum(P-Rb). She was diagnosed with malignant melanoma based on colonoscopic biopsy. Tumor marker levels(CEA, CA19-9)were not increased. No distant metastasis was detected on abdominal CT. No direct invasion was detected on MRI of the pelvis. The patient underwent laparoscopic abdominoperineal resection and D2 lymph node dissection. Histopathology showed a malignant melanoma(pT4b, N0, M0, pStageⅡC). The patient received interferon therapy as adjuvant therapy. There is no sign of recurrence 2 years and 1 month after the surgery. Anorectal malignant melanoma is relatively rare, so establishment of therapy by the accumulation of cases is desired.
要旨
症例は56歳,女性。下血および肛門痛を主訴に近医を受診した。直腸診で15 mm大の隆起性病変を指摘され,当院に紹介受診となった。下部消化管内視鏡検査により肛門縁から約2 cmの肛門管(P)から下部直腸(Rb)にかけて黒色の色素沈着を伴うIspポリープを認め,生検で悪性黒色腫と診断された。CEA,CA19-9は基準範囲内で,CT,MRIでは他臓器浸潤や遠隔転移は認めなかった。腹腔鏡下腹会陰式直腸切断術(中枢側D2,側方郭清なし)を施行した。病理組織学的所見では,pT1(SM),N0,M0,INF c,ly0,v0,pStageⅠであった。術後補助療法はフェロン局所投与を行い,術後2年1か月経過し無再発生存中である。直腸肛門部悪性黒色腫は症例数が少ないため,今後は症例数の蓄積による治療法の確立が望まれる。
目次
A 56-year-old woman with complaints of anal bleeding and pain visited our hospital, and an elastic soft mass was detected in the anal canal on digital examination. Colonoscopy showed a black Isp polypoid lesion with a black pit from the anal canal to the lower rectum(P-Rb). She was diagnosed with malignant melanoma based on colonoscopic biopsy. Tumor marker levels(CEA, CA19-9)were not increased. No distant metastasis was detected on abdominal CT. No direct invasion was detected on MRI of the pelvis. The patient underwent laparoscopic abdominoperineal resection and D2 lymph node dissection. Histopathology showed a malignant melanoma(pT4b, N0, M0, pStageⅡC). The patient received interferon therapy as adjuvant therapy. There is no sign of recurrence 2 years and 1 month after the surgery. Anorectal malignant melanoma is relatively rare, so establishment of therapy by the accumulation of cases is desired.
要旨
症例は56歳,女性。下血および肛門痛を主訴に近医を受診した。直腸診で15 mm大の隆起性病変を指摘され,当院に紹介受診となった。下部消化管内視鏡検査により肛門縁から約2 cmの肛門管(P)から下部直腸(Rb)にかけて黒色の色素沈着を伴うIspポリープを認め,生検で悪性黒色腫と診断された。CEA,CA19-9は基準範囲内で,CT,MRIでは他臓器浸潤や遠隔転移は認めなかった。腹腔鏡下腹会陰式直腸切断術(中枢側D2,側方郭清なし)を施行した。病理組織学的所見では,pT1(SM),N0,M0,INF c,ly0,v0,pStageⅠであった。術後補助療法はフェロン局所投与を行い,術後2年1か月経過し無再発生存中である。直腸肛門部悪性黒色腫は症例数が少ないため,今後は症例数の蓄積による治療法の確立が望まれる。