28538413 Visualization

A 63 Age - year Age - old Age male Sex patient without History smoking Activity or History drinking Activity history History was admitted Clinical_event on Date June Date 11, Date 2014 Date .
His major complaints were gradually aggravated dysphagia Sign_symptom and fatigue Sign_symptom , on suspicion of obstructive Disease_disorder disease Disease_disorder in upper Biological_structure digestive Biological_structure tract Biological_structure .
He had Occupation been Occupation an Occupation athlete Occupation before, and then retired History in History good History physical History status History before admission.
His History family History and History social History history History indicated History nothing History abnormal History .
Thorough physical Diagnostic_procedure examination Diagnostic_procedure of his skin Biological_structure , oral Biological_structure mucosa Biological_structure , eyes Biological_structure , and genital Biological_structure areas Biological_structure failed to identify any superficial lesions Sign_symptom .
Additionally, laboratory Diagnostic_procedure tests Diagnostic_procedure including hepatic Diagnostic_procedure function Diagnostic_procedure , renal Diagnostic_procedure function Diagnostic_procedure , and serum Diagnostic_procedure tumor Diagnostic_procedure markers Diagnostic_procedure such as carcinoembryonic Diagnostic_procedure antigen Diagnostic_procedure , cytokeratin Diagnostic_procedure 19 Diagnostic_procedure fragment Diagnostic_procedure , squamous Diagnostic_procedure cell Diagnostic_procedure carcinoma Diagnostic_procedure , neuron Diagnostic_procedure - specific Diagnostic_procedure enolase Diagnostic_procedure , and carbohydrate Diagnostic_procedure antigen Diagnostic_procedure 125 Diagnostic_procedure were all in Lab_value normal Lab_value range Lab_value .
Therefore, further endoscopic Detailed_description and radiological Detailed_description examinations Diagnostic_procedure were carried out for accurate diagnosis.
Endoscopic Diagnostic_procedure examination Diagnostic_procedure revealed a slightly Color pigmented Color , irregular Detailed_description mass Sign_symptom , which was located in lower Biological_structure esophagus Biological_structure , measuring 5.0 Area   cm Area   × Area   3.0 Area   cm Area in size.
Fine Detailed_description needle Detailed_description biopsy Diagnostic_procedure of the lesion Coreference revealed esophageal Biological_structure melanoma Disease_disorder , which was confirmed by histopathology Diagnostic_procedure .
Besides chest Biological_structure and abdomen Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ), enhanced Detailed_description cranial Biological_structure magnetic Diagnostic_procedure resonance Diagnostic_procedure image Diagnostic_procedure ( MRI Diagnostic_procedure ) and bone Biological_structure emission Diagnostic_procedure computed Diagnostic_procedure tomography Diagnostic_procedure ( ECT Diagnostic_procedure ) showed enlarged Sign_symptom mediastinal Biological_structure , nd also celiac Biological_structure lymph Biological_structure nodes Biological_structure (Fig.1A), without obvious involvement Sign_symptom of supraclavicular Biological_structure lymph Biological_structure nodes Biological_structure .
Concurrently, the CT Diagnostic_procedure showed an isolated Detailed_description , irregular Detailed_description pulmonary Biological_structure tumor Sign_symptom (Fig.1B).
Positron Diagnostic_procedure emission Diagnostic_procedure tomography Diagnostic_procedure was not carried out, because it was not covered by health insurance of this patient.
Therefore, this patient was clinically Diagnostic_procedure staged Diagnostic_procedure as cT3NxM1 Lab_value according to the 7th Detailed_description edition Detailed_description of Detailed_description American Detailed_description Joint Detailed_description Committee Detailed_description on Detailed_description Cancer Detailed_description TNM Detailed_description staging Detailed_description system Detailed_description for esophageal Disease_disorder cancer Disease_disorder .
CT Detailed_description - guided Detailed_description percutaneous Detailed_description pulmonary Biological_structure biopsy Diagnostic_procedure was avoided, with the aim to diminish the risk of tumor dissemination.
Single Detailed_description - stage Detailed_description resection Therapeutic_procedure of the esophageal Biological_structure and pulmonary Biological_structure lesions Sign_symptom was assumed to be reasonable after multidisciplinary consultation Clinical_event , which was approved by Ethical Committee of Xuzhou Central Hospital.
Because the prognosis of this patient probably was extremely poor without targeted Therapeutic_procedure antibodies Therapeutic_procedure , which he could not afford for financial reasons.
After his informed consent, simultaneous Detailed_description Ivor Detailed_description - Lewis Detailed_description esophagectomy Therapeutic_procedure and right Detailed_description upper Detailed_description lobectomy Therapeutic_procedure were performed successfully, under general Medication anesthesia Medication , after double Detailed_description - lumen Detailed_description endotracheal Detailed_description intubation Therapeutic_procedure , followed by systemic Detailed_description dissection Therapeutic_procedure of lymph Biological_structure nodes Biological_structure located in mediastinum Biological_structure and abdomen Biological_structure , in accordance with the principles of oncological surgery.
The operation time was 290 Duration minutes Duration , without obvious bleeding Sign_symptom during the surgery.
Postoperative pathological Diagnostic_procedure staining Diagnostic_procedure of the specimen revealed pleomorphic Sign_symptom cells Sign_symptom and abundant melanin Sign_symptom granules Sign_symptom (Fig.1C), whereas immunohistochemical Diagnostic_procedure tests Diagnostic_procedure demonstrated positive Lab_value expression Lab_value of human Diagnostic_procedure melanoma Diagnostic_procedure black Diagnostic_procedure 45 Diagnostic_procedure ( HMB45 Diagnostic_procedure ), microtubule Diagnostic_procedure - associated Diagnostic_procedure protein Diagnostic_procedure tau Diagnostic_procedure 1 Diagnostic_procedure ( MAPT1 Diagnostic_procedure ), melan Diagnostic_procedure A Diagnostic_procedure and S100 Diagnostic_procedure , and negative Lab_value expression Lab_value of desmin Diagnostic_procedure , synaptophysin Diagnostic_procedure , and epithelial Diagnostic_procedure membrane Diagnostic_procedure antigen Diagnostic_procedure ( EMA Diagnostic_procedure ), which was consistent with melanoma Disease_disorder .
The resection Biological_structure margin Biological_structure and dissected Biological_structure lymph Biological_structure nodes Biological_structure were pathologically tumor Sign_symptom -negative.
In addition, molecular Diagnostic_procedure study Diagnostic_procedure of the patient indicated mutation Sign_symptom of Sign_symptom V Sign_symptom - raf Sign_symptom murine Sign_symptom sarcoma Sign_symptom viral Sign_symptom oncogene Sign_symptom homolog Sign_symptom B1 Sign_symptom (BRAF) V600E.
Based on these findings, a diagnosis of advanced Severity PMME Disease_disorder was tentatively established as stage Lab_value IV Lab_value ( pT3N0M1 Lab_value ), because there was insufficient evidence to distinguish synchronous primary pulmonary melanoma from metastasis for this patient.
The postoperative Therapeutic_procedure recovery Therapeutic_procedure was mainly Lab_value uneventful Lab_value , and the patient was discharged Clinical_event 14 Date days Date after Date surgery Date .
Subsequently, 4 Dosage cycles Dosage of adjuvant Detailed_description conventional Detailed_description chemotherapy Medication with an Dosage interval Dosage of Dosage 3 Dosage weeks Dosage were completed, with controlled moderate toxic effects including thrombocytopenia Sign_symptom , leukopenia Sign_symptom , nausea Sign_symptom , vomiting Sign_symptom , and diarrhea Sign_symptom .
The detailed chemotherapy regimen is as follows: paclitaxel Medication liposome Medication for injection Administration on day 1 and day 8 (135 mg per square meter of body surface area; Nanjing Luye Sike Pharmaceutical Co., Ltd., Jiangsu, China.), tegafur Medication injection Administration on day 2 to 4 (1000 mg per square meter of body-surface area; Shandong Qilu Pharmaceutical Co., Ltd., Jinan, China.) plus cis Medication - platinum Medication on day 2 to 3 (75 mg per square meter of body-surface area; Shandong Qilu Pharmaceutical Co., Ltd., Jinan, China).
This patient suffered from moderate Severity leukopenia/ myelosuppression Sign_symptom after the second cycle of TPF chemotherapy Medication , and he recovered Sign_symptom quickly after the administration of granulocyte Medication colony Medication - stimulating Medication factor Medication ( G Medication - CSF Medication ).
Concurrently, recombinant human Medication interferon Medication alpha-2b (Harbin pharmaceutical group biological engineering Co., Ltd, Harbin, China) was administrated via hypodermic Administration injection Administration thereafter ( 6000 Dosage units Dosage every Dosage 3 Dosage days Dosage ; Fig.2), lasting for Duration 1 Duration year Duration .
The patient was followed Clinical_event up Clinical_event continuously after the surgery.
Chest Biological_structure and abdomen Biological_structure CT Diagnostic_procedure , cranial Biological_structure MRI Diagnostic_procedure , bone Biological_structure ECT Diagnostic_procedure , and thorough physical Diagnostic_procedure examination Diagnostic_procedure were carried out every Frequency 3 Frequency months Frequency .
Encouragingly, the patient survived Outcome without loco Detailed_description - regional Detailed_description recurrence Sign_symptom or remote Detailed_description metastasis Sign_symptom during the follow Clinical_event - up Clinical_event of two Duration and Duration a Duration half Duration years Duration up to now (Fig.3).