1年4ヵ月間にわたって経過を観察した転移性胃悪性黒色腫の1例

Metastatic Malignant Melanoma of the Stomach Followed up over One Year and Four Months

　悪性黒色腫は稀な疾患であるが，短期間に広汎な全身への転移を起し極めて予後の悪い腫瘍である．胃への転移も少なくない¹⁾²⁾．転移性胃悪性黒色腫について，従来は剖検や手術により確認された報告が多かったが，最近では消化管診断技術の向上もあって臨床的にも診断されるようになってきた²⁾³⁾⁴⁾．今回われわれは転移性胃悪性黒色腫を臨床的に診断し，そしてその経過を1年4カ月間にわたって観察することができたので報告する．

　The patient, a 35-year-old woman was hospitalized on account of malignant melanoma of the left retina. Because of complaints referrable to the stomach she was examined by X-ray, but no abnormality was detected then in the stomach. When she was re-examined six months later, a metastatic lesion was found in the stomach, and it proved to be malignant melanoma of the stomach confirmed histologically as such by direct vision biopsy. She was then placed on follow-up for the subsequent ten months by both X-ray and endoscopy.

　Roentgenograms showed several radiolucencies in the corpus. Their margins were well-defined with barium flecks in the center of each radiolucency, presenting the so-called “bull's eye” picture. Some were accompanied with bridging folds, suggesting submucosal origin of the lesions. In the course of follow-up protrusions increased in size, and some neighboring elevations fused into one. The size of the central depressions was also found to change.

　Gastroscopy revealed multiple, gently-sloping elevations, with depressions all in the center of them. White coat tinged with blackish gray adhered to the depression. No pigment deposit was noted in the mucosa other than the elevated regions. Biopsy specimens were taken out of the depressions and a diagnosis of malignant melanoma producing melanin pigment was arrived at.

　Subsequently the patient died of symptoms resembling cerebral hemorrhage. Gross specimens of the stomach at necrospy showed quite a number of protrusions centering on the corpus, varying in size from a rice corn to as big as the tip of the thumb. In the center were seen blackish depressions. The cut surface of the elevations showed nodular tumors, of blackish brown color and centering on the submucosal layer.