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Abstract
BackgroundAnorectal malignant melanomas (ARMM) are rare tumors, characterized by an early lymphatic spread and distant metastasis, resulting in an extremely poor overall survival. The objective of this study was to determine the pattern of regional lymph node metastasis (LNM) by computed tomography (CT) and 18F-FDG-PET/CT in patients undergoing abdominoperineal resection (APR) and its impact on oncologic outcome.MethodsA retrospective analysis of six consecutive patients who underwent APR due to primary ARMM was performed. Patients were staged by CT and PET/CT.ResultsFour out of six patients had preoperative LNM involvement (two patients inguinal and perirectal, one iliacal, one perirectal), with two of them presenting with distant metastases additionally. Inguinal/iliacal LNM in two patients as well as liver metastasis in one patient was seen in PET/CT and missed by CT. The three patients with initial inguinal/iliacal LNM died during the observation period (overall survival: 10 (6–18) months). The three patients without inguinal/iliacal LNM involvement are currently alive, one patient showing a slowly progressive disease since 5 years, and two patients are tumor-free since 8.5 and 1.5 years (the patients had initial perirectal LNM).ConclusionsIn ARMM, PET/CT is superior to CT in detection of LNM and distant metastasis. APR is possibly a curative approach if the PET/CT shows exclusively perirectal LNM despite locally advanced tumor growth.
Highlights
Anorectal malignant melanomas (ARMM) are rare tumors, characterized by an early lymphatic spread and distant metastasis, resulting in an extremely poor overall survival
It is published that lymph node metastasis (LNM) in ARMM are associated with a poor overall survival, little is known about lymphatic spread to the inguinal/iliac lymph nodes or to the perirectal lymph nodes or to both regions, and if surgery should be adapted
All ARMM were localized to the dentate line, and tumor diameter varied between 0.4 and 11 cm at the time of diagnosis
Summary
Anorectal malignant melanomas (ARMM) are rare tumors, characterized by an early lymphatic spread and distant metastasis, resulting in an extremely poor overall survival. LNM is reported to be associated with a near to 0–5-year disease-specific survival [8] This can be attributed to the fact that lymphatic spread in ARMM results in distant metastasis to the lung and liver in up to 90 % of cases [8, 12]. It is published that LNM in ARMM are associated with a poor overall survival, little is known about lymphatic spread to the inguinal/iliac lymph nodes or to the perirectal lymph nodes or to both regions, and if surgery should be adapted. More than 10 different lymphatic pathways were described in the anal area [18], and a simultaneous presence of perirectal and inguinal LNM seems to be rare [19]. 18F-FDG-PET/CT scan
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