| Gaoyang Lin. Primary malignant melanoma of the esophagus successfully treated with camrelizumab: A case report and literature review. Oncol Transl Med, 2022, 8: 201-208. |
| 一例卡瑞丽珠单抗治疗原发性食管恶性黑色素瘤成功的报告和回顾 |
| Primary malignant melanoma of the esophagus successfully treated with camrelizumab: A case report and literature review |
| Received:January 10, 2022 Revised:August 15, 2022 |
| DOI：10.1007/s10330-022-0549-9 |
| 中文关键词: 原发性食管恶性黑色素瘤，PD-1单抗，卡瑞丽珠单抗，免疫治疗 |
| 英文关键词: primary malignant melanoma of the esophagus; PD-1 mAb; camrelizumab; immunotherapy |
| 基金项目:2020-WJZD036:青岛市2020年度医药科研指导计划 |
| Author Name | Affiliation | E-mail | | Gaoyang Lin* | Department of Thoracic Surgery, The Affiliated Qingdao Hiser Medical Center of Qingdao University Medical College | lingaoyang1988@126.com |
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| 中文摘要: |
| 背景：原发性食管恶性黑色素瘤是一种罕见的侵袭性疾病，往往对化疗反应较差。以往的研究表明，目前对原发性食管恶性黑色素瘤的治疗方法还不够。在这里，我们描述了一例原发性食管恶性黑色素瘤应用免疫检查点抑制剂卡瑞丽珠单抗成功治疗的患者。
病例介绍：一名83岁的中国女性，有3个月的吞咽困难病史。既往病史：高血压、2型糖尿病、眼底出血和白内障。患者既往无皮肤、眼部或其他部位黑色素瘤病史。上消化道造影示：考虑胃炎和十二指肠憩室，建议内镜检查。胸部+上腹部增强CT扫描显示：①食管占位性病变，纵隔淋巴结肿大，考虑食管癌的可能性高，建议进一步内镜检查；②右侧胸腔积液（少量），无明显淋巴结浸润或远处转移。食管镜检查发现距切牙23cm处有隆起肿块，肿块持续至距切牙30cm处，上肿块呈球状，下肿块明显腐烂。食道病理活检部位：距门齿23厘米，距门齿28厘米。食管组织病理活检显示：大的圆形肿瘤细胞和黑色素噬菌细胞增生。病理免疫组化结果：HMB45、MelanA呈阳性，S100、CK7、CK5/6、CAM5.2、LCA、P63、TTF-1、Syn部分呈阴性，Ki-67阳性指数约为60%。根据这些结果，患者诊断为食管恶性黑色素瘤，纵隔淋巴结肿大。患者于2019年10月18日至2020年5月5日给予5个周期的卡瑞丽珠单抗联合化疗。两个疗程卡瑞丽珠单抗联合化疗后的胃镜检查显示：食管距切牙23~25cm，有两个连续隆起的肿块，呈串珠状，每个肿块的长度和直径约1cm，表面光滑呈黑色。管腔周围粘膜黑色素增生，从门齿至贲门40cm，齿状线清晰，贲门无狭窄。患者接受了5个疗程的卡瑞丽珠单抗联合化疗，达部分缓解后维持病情处于稳定状态。未记录与免疫治疗相关的严重不良事件。
结论：本研究提示卡瑞丽珠单抗可能是原发性食管恶性黑色素瘤患者的一种可行的治疗选择。需要从未来的临床试验和研究中获得更多的证据来充分验证这些发现。 |
| 英文摘要: |
| An 83-year-old Chinese woman presented with a 3-month history of dysphagia. She also had a history
of hypertension, type 2 diabetes, fundus hemorrhage, and cataract but no history of cutaneous, ocular,
or other-site melanomas. Upper gastrointestinal tract angiography revealed gastritis and duodenal
diverticulum; thus, an endoscopic review was recommended. Enhanced computed tomography of the
chest and upper abdomen revealed the following: (1) Esophageal space-occupying lesions and mediastinal
lymph node enlargement (considering the high possibility of esophageal cancer, further endoscopy was
recommended) and (2) A small amount of right pleural effusion, with no significant lymph node infiltration
or distant metastasis. Esophagoscopy identified a bulge mass blocking the esophagus from 23 to 30 cm
from the incisors. The upper mass had a spherical clustering, while the lower mass significantly festered.
Pathological biopsy samples were obtained from the esophagus 23 and 28 cm from the incisors. Tissue
biopsy showed proliferation of large round tumor cells and melanocytes. Immunohistochemistry showed
positive findings for HMB45 and MelanA; partially positive findings for S100, CK7, CK5/6, CAM5.2, LCA,
P63, and TTF-1; and negative findings for Syn. The Ki-67 positivity index was approximately 60%. Based on
these findings, the patient was diagnosed with malignant esophageal melanoma with enlarged mediastinal
lymph nodes. She was then treated with five cycles of camrelizumab therapy combined with chemotherapy
from October 18, 2019, to May 5, 2020. Gastroscopy review following two courses of combination therapy
revealed that the esophagus was 23–25 cm away from the incisors, and there were two continuous uplifted
and beaded masses that had a smooth and black surface, with each of them having a length and diameter
of approximately 1 cm. Melanosis of the mucosa around the lumen was observed at 40 cm from the incisors
to the cardia; the dentate margin was clear; and the cardia had no stenosis. The patient then received five
courses of combination therapy and became consistently stable after partial remission. No severe adverse
events related to the immunotherapy were recorded. Camrelizumab may be a viable treatment option for
patients with PMME. Additional evidence from future clinical trials and research is necessary to fully validate
our findings. |
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