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NEJM：转移性黑素瘤患者胃肠道出血-病例报道

2020-01-30 xing.T MedSci原创

转移性黑素瘤胃肠道出血
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活检样本的组织学检查结果与转移性黑色素瘤一致。计算机断层扫描显示胃壁增厚，以及脑、肺和肝转移。尽管接受了姑息性放射治疗和派姆单抗治疗，但他在3个月后仍因黑斑病进一步发作以及其他多种并发症而就诊。

患者为一名85岁的男子，因突然失去意识后到急诊就诊。该患者就诊时，已经恢复了意识，并报告有2周的深色大便史。他患有两种癌症：乳腺癌，正在接受戈舍瑞林和来曲唑的治疗；结节性黑素瘤，他的右臂上进行了广泛的局部切除，并在5个月前切除了腋窝淋巴结。

心率是每分钟110次，血压是为115/70mmHg。他面色苍白，并且存在持续的黑斑，没有腹部压痛。实验室检查发现血红蛋白水平为7.6 g/dL（正常范围为11.5至15.5），他输注了1个单位的红细胞。内窥镜检查发现多个息肉样结节伴中心凹陷，但最近无活跃的胃出血迹象。



活检样本的组织学检查结果与转移性黑色素瘤一致。计算机断层扫描显示胃壁增厚，以及脑、肺和肝转移。尽管接受了姑息性放射治疗和派姆单抗治疗，但他在3个月后仍因黑斑病进一步发作以及其他多种并发症而就诊。

该患者被转诊到临终关怀医院，不久后去世。
 
原始出处：

Amanda H.W. Lim,et al.Gastrointestinal Bleeding from Metastatic Melanoma.N Engl J Med 2020;https://www.nejm.org/doi/full/10.1056/NEJMicm1909170

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    2020-02-01 liao1619

    #胃肠道#

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    2020-02-01 1249842em09(暂无昵称)

    #转移性#

    0

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    2020-02-01 124987a0m66(暂无昵称)

    #胃肠道出血#

    0

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    2020-02-01 yuhaisheng_ibp_32061713

    #黑素瘤#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1346307, encodeId=4295134630e61, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386584, encodeId=f0591386584d0, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390979, encodeId=fe3913909e96c, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479431, encodeId=73f814e943179, content=<a href='/topic/show?id=4a571033209b' target=_blank style='color:#2F92EE;'>#黑素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103320, encryptionId=4a571033209b, topicName=黑素瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4d4d7523220, createdName=yuhaisheng_ibp_32061713, createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378712, encodeId=c0953e8712c2, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/11/13/297abc49521542fee373596e497d37fc.jpg, createdBy=db695226500, createdName=1478fa69m73暂无昵称, createdTime=Thu Jan 30 14:26:29 CST 2020, time=2020-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378658, encodeId=9eb53e8658bd, content=少见病，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/11/13/297abc49521542fee373596e497d37fc.jpg, createdBy=db695226500, createdName=1478fa69m73暂无昵称, createdTime=Thu Jan 30 14:08:43 CST 2020, time=2020-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035101, encodeId=dd711035101ab, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 30 13:35:00 CST 2020, time=2020-01-30, status=1, ipAttribution=)]
    2020-01-30 1478fa69m73暂无昵称

    学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1346307, encodeId=4295134630e61, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386584, encodeId=f0591386584d0, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390979, encodeId=fe3913909e96c, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479431, encodeId=73f814e943179, content=<a href='/topic/show?id=4a571033209b' target=_blank style='color:#2F92EE;'>#黑素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103320, encryptionId=4a571033209b, topicName=黑素瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4d4d7523220, createdName=yuhaisheng_ibp_32061713, createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378712, encodeId=c0953e8712c2, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/11/13/297abc49521542fee373596e497d37fc.jpg, createdBy=db695226500, createdName=1478fa69m73暂无昵称, createdTime=Thu Jan 30 14:26:29 CST 2020, time=2020-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378658, encodeId=9eb53e8658bd, content=少见病，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/11/13/297abc49521542fee373596e497d37fc.jpg, createdBy=db695226500, createdName=1478fa69m73暂无昵称, createdTime=Thu Jan 30 14:08:43 CST 2020, time=2020-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035101, encodeId=dd711035101ab, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 30 13:35:00 CST 2020, time=2020-01-30, status=1, ipAttribution=)]
    2020-01-30 1478fa69m73暂无昵称

    少见病，学习了

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1346307, encodeId=4295134630e61, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1386584, encodeId=f0591386584d0, content=<a href='/topic/show?id=f08293399f9' target=_blank style='color:#2F92EE;'>#转移性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93399, encryptionId=f08293399f9, topicName=转移性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390979, encodeId=fe3913909e96c, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479431, encodeId=73f814e943179, content=<a href='/topic/show?id=4a571033209b' target=_blank style='color:#2F92EE;'>#黑素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103320, encryptionId=4a571033209b, topicName=黑素瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4d4d7523220, createdName=yuhaisheng_ibp_32061713, createdTime=Sat Feb 01 01:35:00 CST 2020, time=2020-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378712, encodeId=c0953e8712c2, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/11/13/297abc49521542fee373596e497d37fc.jpg, createdBy=db695226500, createdName=1478fa69m73暂无昵称, createdTime=Thu Jan 30 14:26:29 CST 2020, time=2020-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378658, encodeId=9eb53e8658bd, content=少见病，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/11/13/297abc49521542fee373596e497d37fc.jpg, createdBy=db695226500, createdName=1478fa69m73暂无昵称, createdTime=Thu Jan 30 14:08:43 CST 2020, time=2020-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035101, encodeId=dd711035101ab, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 30 13:35:00 CST 2020, time=2020-01-30, status=1, ipAttribution=)]
    2020-01-30 旺医

    顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息

    0