出血に対して胃切除術を行った鼻腔悪性黒色腫の胃転移例

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  • A Case of Gastric Metastasis Arising from Malignant Melanoma of the Nasal Cavity Underwent Gastrectomy for Bleeding
  • シュッケツ ニ タイシテ イ セツジョジュツ オ オコナッタ ビコウ アクセイ コクショク シュ ノ イ テンイレイ

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<p>The prognosis of metastatic malignant melanoma remains poor and it is sometimes difficult to stop bleeding from a hemorrhagic metastatic lesion. Herein, we report a case of gastrectomy performed for uncontrolled bleeding from a stomach metastasis arising from malignant melanoma of the nasal cavity.</p><p>The patient was a 55-year-old man with malignant melanoma of the nasal cavity. Complete resection of the primary lesion a transnasal approach and postoperative radiation were performed, however, one year after the treatment, the patient was diagnosed as having metastasis to the Rouviere node. Moreover, upper gastrointestinal endoscopy also showed some elevated submucosal lesions in the stomach. Histologic examination showed metastatic malignant melanoma in the stomach, and PET-CT revealed multiple bone metastases and cervical lymph node metastases. Despite treatment with nivolumab, ipilimumab and pembrolizumab, the gastric metastatic lesion only enlarged.</p><p>About 58 months after his first visit to us, the patient was hospitalized because of severe anemia, and upper gastrointestinal endoscopy showed bleeding from the gastric metastatic lesion. As endoscopic hemostasis was difficult to accomplish, we performed proximal gastrectomy as palliative surgery. Following the surgery, the anemia improved and there were no postoperative complications. Pembrolizumab therapy was continued postoperatively, but the patient died 5 months after the surgery.</p><p>Immune checkpoint inhibitors and molecular-targeted agents are known to improve the outcomes of patients with malignant melanoma, however, it is sometimes difficult to control the bleeding metastatic lesions.</p><p>We think that gastrectomy is effective in patients with uncontrollable gastrointestinal hemorrhage, even if it is only with palliative intent.</p>

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