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Primary anorectal malignant melanoma (ARMM) is an extremely rare but aggressive tumor. We assessed the efficacy and safety of transcatheter arterial infusion (TAI) with anti-PD-1 antibody pembrolizumab at a dosage of 100 mg with 0.9% NaCl at a volume of 100 mL administered over a 30-min period every 3 weeks, combined with temozolomide or albumin-bound paclitaxel (nab-paclitaxel) in four patients with ARMM. Temozolomide was administered orally once per day at a dosage of 200 mg/m2/d for five consecutive days about every 4 weeks. Nab-paclitaxel was administered at a dosage of 200mg/m2/d once about every 3 weeks. Among four patients with a median follow-up of 8.9 months, two cases showed Murine Double Minute 2 (MDM2) amplification. Case 1 with Stage II ARMM showed pathological complete response after four cycles of TAI with pembrolizumab combined with nab-paclitaxel. Case 4 was at Stage II and showed stable disease consistently throughout the treatment. Case 2 was at stage II and Case 3 was at stage III, and they showed partial response after four or three cycles, respectively, of TAI with pembrolizumab combined with temozolomide. No Grades 3–4 adverse reactions were observed. Therefore, a combination of TAI with pembrolizumab and temozolomide or with nab-paclitaxel appears to be a promising option for treating ARMM. However, multicenter clinical trials are required to confirm the efficacy and safety of this procedure
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@#Introduction: Primary gastrointestinal melanomas are mucosal malignancies that arise from melanocytes in the oropharynx, rectum, and anus. Anorectal malignant melanoma (ARMM) are exceedingly rare, accounting for less than 1% of all melanomas, 0.1% of all rectal malignancies and 4% of anal malignancies. Diagnosis is frequently delayed as these lesions are often mistaken for haemorrhoids. Histological evaluation with special immunohistochemical stains is often necessary for definitive diagnosis. Due to the aggressive nature, 61% of patients with ARMM would already have lymph node involvement or distant metastases, by the time of diagnosis. Prognosis is usually poor with 5-year survival rate of <20%. We report a case of metastatic ARMM in an elderly lady who presented with symptoms and signs mimicking a haemorrhoid. Case Report: A 69-year-old lady presented with one year history of intermittent rectal bleed and an anorectal mass that was initially treated as haemorrhoid. Colonoscopy showed a hyperpigmented mass in the anorectal region which was confirmed as malignant melanoma on histopathological examination. Imaging with CT and MRI demonstrated locally advanced tumour with distant metastases to the liver and lung. Patient was referred for palliative management. Conclusion: ARMM is a rare malignancy and often presented with non-specific clinical signs. Diagnosis is frequently delayed without high index of suspicion. MRI pelvis is the imaging of choice to assess local extent of disease. Histologic evaluation with special immunohistochemical stains is often necessary for definitive diagnosis. Prognosis is poor despite surgical and chemotherapeutic interventions.
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OBJECTIVE:To investigate the surgical treatment of anorectal malignant melanoma(ARMM) and the prognostic factors that affect patients' overall survival(OS).METHODS:Theclinical and pathological data of 91 patients diagnosed as ARMM, who underwent surgery in the Gastrointestinal Cancer Center of Peking University Cancer Hospital from January 2003 to January 2018 were retrospectively analyzed. The effects of different clinicopathological factors on OS of the patients, and difference surgery, abdominal-perineal resection(APR) and wide local excision(WLE) on patients' survival were compared.RESULTS:Of the 91 patients with ARMM, 35(38.5%) were male, 56(61.5%) were female, and the ratio of male to female was 1:1.6. 12 patients(13.2%) underwent wide local excision and 79 patients underwent abdominal-perineal resection(86.8%); there were 19 cases(20.9%) diagnosed with distant metastasis and 72 cases(79.1%)without distant metastasis. The of 1-, 3-, and 5-year survival rates of ARMM patients in this cohort were 74%, 23% and9%; and the median survival of the patients was 18.7 months. The univariate analysis of the clinicopathological features of the patients demonstrated that the preoperative distant metastases, tumor diameters(>2 cm), tumor invasion depth(>2 mm) and lymph node metastasis were the prognostic factors of OS; multivariate analysis showed that preoperative distant metastasis and lymph node metastasis were independent factors affecting OS.The median survival of the patients admitted APR and WLE were both 21 months. There was no significant difference in survival between the WLE and APR group(P=0.94).CONCLUSION:Preoperative distant metastasis and lymph node metastasis are independent prognostic factors for overall survival of ARMM patients.Comparing with WLE, APR could not bring survival benefits.
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Objective:To analyze the clinicopathological features, diagnosis, and treatment of anorectal malignant melanoma (ARMM), and to explore its prognostic factors and misdiagnosis. Methods:A total of 36 patients with ARMM were enrolled in this study from January 2000 to November 2016 in Nanfang Hospital, Zhujiang Hospital, and Guangdong Provincial Hospital of Traditional Chinese Medicine. Results: The clinical manifestations of ARMM were not specific. The odds of misdiagnosis were as high as 52.8% in this study. The 1-and 3-year survival rates were 75%and 35%, respectively, with median survival time of 24.51 months. Survival rate was correlated with tumor size, invasion depth, clinical stage, and lymph node metastasis (P<0.05), but was not related to patient age and gender. The median survival time of the three groups of patients (surgery alone, surgery-based combination therapy, untreated) were 39.21, 26, and 15 months. The difference was not statistically significant. No difference in survival was found between patients under-going abdominoperineal resection and wide local excision. Conclusion:ARMM has poor prognosis and is easily misdiagnosed as a ma-lignant tumor. The prognostic factors are tumor size, invasion depth, clinical stage, and lymph node metastasis. Surgical treatment can extend survival. To avoid misdiagnosis and prolong survival, early diagnosis and early treatment are recommended.
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Objective To investigate the clinical and pathological features of anorectal malignant melanoma ( AMM) .Methods The clinical pathological and follow-up data of 7 cases of anorectal malignant melanoma were collected.The clinical and histopathological features and immunophenotype were analyzed .Results Among the 7 cases, 5 cases were female, 2 cases were male, aged 50-68 years, the average was 61 years.The tumors located in the lower rectum in 1 cases, 2 cases of teeth near the line , 4 cases of anal anus .The structure and morphology of the cancer cells were diverse .The organizational structures were mainly diffuse , focal and acinar .The cellular morphologies were mainly epithelioid , spindle and lymphocyte like .And the results of IHC showed the expression of the following three markers, vimentin, S-100 and HMB45, were strongly positive in cancer cells.However, the expression of CK , EMA and LCA were negative .And 2 cases of CEA expression were positive , LI Ki-67 was 20%-50%.Conclusions Anorectal malignant melanoma is one kind of rare malignant tumor and its characteristic morphology , immunophenotype could be helpful for diagnosis and differential diagnosis .
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Primary malignant melanoma of the anorectum is rare, representing about 1% of all colorectal carcinoma and less than 1% of all melanomas. The most common symptom of malignant melanoma of the anorectum is anal bleeding and this is often misdiagnosed as hemorrhoids. A 72-year-old female patient was admitted due to intermittent anal bleeding for 6 months. Colonoscopic examination showed a large exophytic mass with an irregularly ulcerated and greenish-brown pigmentation on the anus and the examination also simultaneously showed a submucosal tumor-like lesion in the rectum that was located 5 cm from the anal verge. Light microscopy of the tumor revealed malignant melanocytes and the tumor cells reacted positively for immunohistochemical staining with S-100 protein and HMB-45. Distant metastasis to the brain was detected on brain MRI.
Subject(s)
Aged , Female , Humans , Anal Canal , Brain , Colorectal Neoplasms , Hemorrhage , Hemorrhoids , Light , Melanocytes , Melanoma , Microscopy , Neoplasm Metastasis , Pigmentation , Rectum , S100 Proteins , UlcerABSTRACT
Malignant melanoma of the anorectal region is rare and carries a poor prognosis. The clinical features of pain, bleeding or an external mass are similar to those encountered in many other disorders of the anal canal. We reports a case of anorectal malignant melanoma with regional lymph node involvement who was treated with abdominoperineal resection. Early diagnosis and accurate evaluation is important, as the prognosis was related to tumor size & the thickness. Abdominoperineal resection should be considered in patient without advanced disease.