直腸肛門部悪性黒色腫の2例

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　直腸肛門部悪性黒色腫は頻度が少なく,特異的症状に乏しく早期診断が困難であり,診断時にはすでに遠隔転移を認めることも多い,きわめて予後不良の疾患である｡我々は経肛門的腫瘍全摘生検施行にて診断,腹会陰式直腸切断術施行,術後化学療法にて長期生存を得ている症例,及び多臓器に遠隔転移を生じたが化学療法にて消化管病変を抑え,QOLを維持できた症例を経験した｡症例1: 69歳,女性｡2004年6月,前医外科にて歯状線部口側の黒色分葉状腫瘤を全摘生検し,病理組織検査にて悪性黒色腫と診断され,後療法の目的で2004年8月に当科を紹介され受診した｡腹会陰式直腸切断術,左側方リンパ節郭清術を行い,術後補助化学療法としてDAV療法を5コース施行した｡術後3年5ヵ月の現在も再発はしていない｡症例2 :74歳,男性｡2001年5月,近医外科にて肛門管右側の黒色腫瘤を切除し,病理組織検査にて悪性黒色腫と診断された｡2002年7月に同部位に再発を認め,同外科にて腹会陰式直腸切断術,人工肛門造設術を施行された｡術後2ヵ月後の同年9月,胃壁,直腸壁,右副腎,腹腔･骨盤腔内リンパ節に転移があり,当科を紹介され受診した｡DAC-Tam療法5コース,約9ヵ月間で胃病変PR,直腸病変SD｡この間,経口摂取及び消化管出血コントロール可能であった｡その後,背部･四肢皮膚に多発転移あり,CDV療法に変更して2コース追加したが脳転移が出現し永眠した｡化学療法開始から16ヵ月,全経過33ヵ月であった｡　　Case 1. The patient was a 69-year-old female, who had a black nodule at the dental line. An excisional biopsy specimen from the lesion revealed malignant melanoma. She underwent an abdominoperineal resection and postoperatively received 5 courses of DAV (DTIC, ACNU,and VCR) therapy. The patient has been disease-free for 3 years and 5 months after the operation without any signs of recurrence. Case 2. The patient was a 74-year-old male. who had previously undergone local resection of an anorectal tumor with anal bleeding, and was diagnosed with anorectal malignant melanoma at another hospital before admission into our institution. One year and two months after the first resection. local recurrence was detected at the rectum, and he underwent an abdominoperineal resection in the same hospital. Two months later, he presented with multiple metastatic lesions (stomach. rectum and celiac and pelvic lymph nodes) and was admitted to our hospital. Here, the patient received DAC-Tam (DTIC. ACNU, CDDP and Tamoxifen) therapy. During 5 courses of the chemotherapy, the gastric lesion was significantly reduced in size and the rectal lesion became stable. Thus, although he was able to intake orally. the chemotherapy was useful from the viewpoint of QOL. Subsequently, multiple skin metastases developed and CDV (CDDP, DTIC and VDS) combined chemotherapy was initiated. After the second chemotherapy course. brain metastasis appeared and the patient died of melanoma 16 months after the start of chemotherapy and 33 months after the initial diagnosis of anorectal malignant melanoma.
日本皮膚科学会西部支部の論文
2009-06-01

直腸肛門部悪性黒色腫の2例

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