A case of anorectal malignant melanoma who was performed abdomino-perineal resection

直腸肛門部悪性黒色腫は早期に転移を来たすため予後は不良であり,比較的稀な疾患である.今回我々は直腸肛門部悪性黒色腫に対して腹会陰式直腸切断術を施行した一例を経験したため,若干の文献的考察を加え報告する.症例は70歳代の男性,下血と便の狭小化を主訴に近医を受診し,肛門縁より2cmの肛門管～下部直腸に黒色調で半周性の2型の腫瘤を認めた.生検でGroupV,悪性黒色腫と診断され,当科紹介受診し,腹会陰式直腸切断術+D2郭清を行った.病理組織検査所見で#251へリンパ節転移を認めたため,術後病期をpMP, pN1, sH0sP0pCY0cM0, fStageIIIaと診断した.本人の同意が得られず,術後補助化学療法は行わない方針とし,外来で経過観察としたが術後半年の造影CT検査で再発を認めたため,DAV療法を予定している.　

A 73-year-old man was seen at the medical clinic because of suffering from hematochezia and narrowing of stool. Colonoscopy showed a black tumor occupying almost half round of tract, 2cm from anal verge. Biopsy revealed malignant melanoma. He was treated by abdomino-perineal resection with D2 lymphadenectomy(pMP, pN1, sH0sP0pCY0cM0, fStageIIIa1).He didn’t received adjuvant chemotherapy, but contrast enhanced CT half a year after the operation showed sign of recurrence. The DAV chemotherapy was scheduled.

悪性黒色腫

直腸肛門部悪性黒色腫

腹会陰式直腸切断術

直腸肛門部

直腸切断術