粘膜浸潤を伴った直腸肛門部悪性黒色腫の1例  [in Japanese] A Case of Anorectal Malignant Melanoma With Rectal Mucosal Invasion  [in Japanese]

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Abstract

直腸肛門部に発生し周辺粘膜に浸潤をきたした悪性黒色腫(以下,本症)の手術例を経験したので報告する.症例は,67歳の男性,主訴は血便.精査にて肛門縁から1.5cmの直腸肛門部に,腫瘤の一部と周辺粘膜に黒色を呈するIsp型ポリープを認め,本症を疑い同部より生検を行った.生検で本症と確定診断し,腹会陰式直腸切断術を行った.切除標本のポリープ部は深達度sm3,周辺粘膜部は深達度mであり,リンパ節転移は認めなかった.術後3カ月を経た現在,再発の兆候を認めず,経過観察中である.本症は稀な疾患で,早期にリンパ行性,血行性に転移をきたすため予後が極めて不良である.予後の改善には,早期診断と適切な外科的治療の確立が必要である.

A case of malignant melanoma of the anorectal region with circumferential mucosal invasion is reported. A 67-year-old male visited our hospital with bloody stools. An I sp-type polyp was found in the anorectal region, 1.5 cm from the dental line, by a colonoscopic examination. Because both the head of the polyp and the circumferential mucosa presented black color, malignant melanoma was suspected, and biopsy was performed from both areas. Pathological examination diagnosed these lesions correctly as malignant melanoma, and the Mile's operation, with lymph node resection (level D2), was performed. The depth of invasion was to the submucosal layer (sm3) in the polyp, and to the mucosal layer (m) in the circumferential mucosa, with no lymph node metastasis. At present, three months after the operation, no findings suggesting recurrence have been observed.<BR>Primary malignant melanoma of the anorectal region is a relatively rare entity, and the prognosis is very poor. To improve the prognosis, early diagnosis and the establishment of the standard surgical therapy are necessary.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 55(3), 145-150, 2002-03

    The Japan Society of Coloproctology

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