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Marak JR, Kumar T, Dwivedi S, Verma S. Primary malignant melanoma of the small bowel: A case report. Radiol Case Rep 2024; 19:1215-1221. [PMID: 38259709 PMCID: PMC10801144 DOI: 10.1016/j.radcr.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Malignant melanoma comprises 1%-3% of all malignant tumors of the gastrointestinal tract. The small bowel melanoma is an extremely rare malignancy. Very few cases have been reported in the literature. The small intestine is mostly affected by the metastatic tumors of the primary lesions especially cutaneous. This malignancy is diagnosed at the late stages as the patient remains asymptomatic. In this report we present a case of malignant melanoma arising from the small bowel in a 58-year-old male. There was no primary lesion in the eye, skin, anus, rectum or elsewhere in the body. The patient was treated with surgery. Afterward the patient presented to the emergency room with respiratory distress for which he was on ventilator support, sadly the patient died after 10 days. Malignant melanoma is an aggressive tumor and does not respond well to chemotherapy or radiotherapy.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Shivam Dwivedi
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Shashwat Verma
- Department of Nuclear Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
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2
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Galindo L, Traylor C, Check L, Faris M. Primary Left Thigh Melanoma Presenting as an Obstructive Hemorrhagic Melanoma of the Small Bowel. Cureus 2023; 15:e42428. [PMID: 37637677 PMCID: PMC10448777 DOI: 10.7759/cureus.42428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Primary malignant melanoma of the small intestine is rare and infrequent. However, the small bowel is a relatively common metastatic destination for cutaneous melanoma. Given the fact that primary small intestinal melanoma is a controversial and rare diagnosis, we present a case in which the initial finding suggested a primary tumor. However, the patient was later diagnosed with a small left thigh melanoma after the diagnosis of primary malignant melanoma of the small bowel was established. As a result, we emphasize that all primary small intestinal melanoma must be thoroughly investigated for an alternative primary lesion. Additionally, we question if the diagnosis of primary malignant melanoma of the small bowel needs to be re-classified as small bowel melanoma of unknown primary, especially in cases in which the primary lesion is unidentified.
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Affiliation(s)
- Lidice Galindo
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | | | - Larissa Check
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Mohamed Faris
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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3
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Du Y, Chang X, Li X, Xing S. Incidence and survival of patients with primary gastrointestinal melanoma: a population-based study. Int J Colorectal Dis 2023; 38:87. [PMID: 36991139 DOI: 10.1007/s00384-023-04385-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Primary gastrointestinal melanoma (PGIM) has received more attention because of its inferior prognosis. Less is known about the incidence and survival rate of PGIM. METHODS PGIM data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The incidence was estimated by age, sex, race, and primary site. Trends in incidence were described as annual percent change (APC). Cancer-specific survival (CSS) and overall survival (OS) rates were estimated and compared using log-rank tests. Cox regression analyses were performed to identify independent prognostic factors. RESULTS The overall incidence of PGIM was 0.360/1,000,000 with a significant upward trend (APC = 1.77%; 95% CI 0.89%-2.67%, p < 0.001) from 1975 to 2016. Most PGIM occurred in the large intestine (0.127/1,000,000) and anorectum (0.182/1,000,000), and both incidences were almost 10 times higher than those of other sites, including the esophagus, stomach, and small intestine. The median survival time was 16 months (IQR, 7-47 months) for CSS and 15 months (IQR, 6-37 months) for OS, and the 3-year CSS and OS rates were 29.5% and 25.4%, respectively. Older age, advanced stage, absence of surgery, and melanoma in the stomach were the independent risk indicators of survival and associated with worse CSS and OS. CONCLUSION The incidence of PGIM has been increasing over the past decades and the prognosis is poor. Thus, further studies are warranted to improve the survival, and more attention should be paid to the patients that are elderly, patients with advanced stage, and patients with melanoma in the stomach.
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Affiliation(s)
- Yu Du
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaona Chang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangxiang Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shugang Xing
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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4
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Cazzato G, Battista S, Ingravallo G, Castelvetere M, Sassano A, Cassano M, Macciomei MC, Parente P. Gastro-intestinal metastasis from Melanoma: Clinico-pathological clues. Pathol Res Pract 2023; 241:154259. [PMID: 36549043 DOI: 10.1016/j.prp.2022.154259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Metastasis from melanoma in the gastro-intestinal tract is a frequent event but, in the absence of an adequate clinical context and oncological anamnesis, it could be misdiagnosed by the pathologists. Moreover, amelanotic and/or poorly differentiated metastasis from melanoma in the gastro-intestinal tract can be easily underestimated. MATERIALS AND METHODS We describe the histological features of gastro-intestinal metastasis from melanoma in a multi-centric cohort of 49 patients. In 24/49 patients, we were able to compare histological findings such as the growth pattern and the melanotic pigment also in the primary melanoma. RESULTS The epithelioid pattern is the most common growth pattern observed in gastro-intestinal metastasis (57 %), followed by the mixed pattern (41 %) and the spindled pattern (2 %). We documented a discordant growth pattern between metastasis and primary in 9/24 cases and the absence of melanotic pigment in 8/49 cases. DISCUSSION Our experience highlights that pathologists should take into account the possibility of gastro-intestinal metastasis from melanoma also in cases with spindled-cells/amelanotic lesions, without a previous anamnesis of melanoma asportation, and in cases of a discordant growth pattern with the primary. A correct clinical integration and an aware immunohistochemical approach are imperative to best manage the bioptic sample in order to investigate the biological profiling and therefore plan a personalizated therapy.
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Affiliation(s)
- Gerardo Cazzato
- Department of Emergency and Organ Transplantation (DETO) - Pathology Section, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Serena Battista
- Pathology Unit, Azienda Sanitaria Universitaria Friuli Centrale S. Maria della Misericordia Hospital, 33100 Udine, Italy.
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation (DETO) - Pathology Section, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Marina Castelvetere
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy.
| | - Antonio Sassano
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy.
| | - Maurizio Cassano
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy.
| | | | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy.
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5
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Case report of metastatic melanoma presenting as an unusual cause of gastrointestinal hemorrhage in an elderly gentleman. Ann Med Surg (Lond) 2022; 78:103920. [PMID: 35734710 PMCID: PMC9207090 DOI: 10.1016/j.amsu.2022.103920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction and Importance: Melanomas are capable of metastasizing to both regional and distant sites and are notably known to metastasize to the skin, lungs, brain, liver, bone, and gastrointestinal tract. Metastatic melanoma is infrequently diagnosed in vivo, and usually found only on post-mortem evaluation at autopsy. Case Presentation Here we present the case of a 64-year-old male who originally presented with melena, fatigue, exertional dyspnea and one episode of near-syncope. He was found to have a hemoglobin of 5.4 gm/dL on initial presentation with largely unremarkable abdominal examination. CTAP demonstrated an area of circumferential small bowel wall thickening, concerning for malignancy. The patient underwent an EGD that was noted for mild gastric fundal erosions, which failed to explain his presenting symptoms. VCE was later performed following discharge to visualize the small bowel, which revealed two bleeding lesions within the small bowel. This was complicated by the device becoming lodged on the more proximal mass, and he was admitted again for push-enteroscopy and device retrieval. At the time of this admission, he continued to be symptomatic and was profoundly anemic with a hemoglobin of 4.7 gm/dL. Clinical Discussion EGD with push enteroscopy was performed, revealing two small masses in the mid-distal duodenum and jejunum, which were tattooed and biopsied. He underwent robotic-assisted laparoscopic small bowel resection of the affected portions of the small bowel, without complications. Surgical samples were consistent with melanoma, and further dermatologic examination revealed a suspicious lesion located on the patient's posterior right shoulder was biopsied and also consistent with melanoma, confirming the suspicion for metastatic process from primary cutaneous lesion. Conclusions We present this case as a rare diagnostic opportunity to observe metastatic melanoma of the small bowel, including a review of pertinent symptomatology and epidemiological data from previous literature. Our case serves as a reminder to consider metastatic melanoma as a rather uncommon cause of severe blood loss anemia, while also providing an overview of endoscopic modalities available for visualizing the small bowel in the management of suspected small bowel malignancy. Melanoma frequently metastasizes to the small bowel but is rarely detected in vivo. Metastatic melanoma of the bowel is an uncommon cause of gastrointestinal hemorrhage. Video capsule endoscopy and small bowel enteroscopy can facilitate diagnosis. Surgical resection is typically the primary focus of initial management. Surveillance for skin lesions is crucial for suspected small bowel malignancy.
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6
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Reddy KM, Maduke T, Wade F, Hachem C. Primary jejunal amelanotic melanoma: case report and review of literature. Clin J Gastroenterol 2021; 14:1376-1380. [PMID: 34081261 DOI: 10.1007/s12328-021-01446-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
Intussusception more commonly occurs in pediatrics but is a rare cause of bowel obstruction and gastrointestinal bleeding in adults. It typically occurs in adults due to a malignancy, which serves as a pathologic lead point. We present a case of a 64-year-old female with nausea, vomiting, and melena who was found to have intussusception associated with a primary jejunal amelanotic melanoma. Both intussusception and primary small bowel melanomas are rare causes of obstruction and bleeding. Intussusception occurring as a result of a primary small bowel amelanotic melanoma is exceedingly rare with very few reported cases. We provide a case report and review of the literature.
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Affiliation(s)
- Kavya M Reddy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 2780 Skypark Dr., St 125, Los Angeles, CA, 90505, USA.
| | - Tinashe Maduke
- Division of Pulmonary and Critical Care, University of Missouri School of Medicine, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Francis Wade
- Department of Internal Medicine, Saint Louis University School of Medicine, 1008 South Spring Ave, Saint Louis, MO, 63110, USA
| | - Christine Hachem
- Department of Internal Medicine, Saint Louis University School of Medicine, 1008 South Spring Ave, Saint Louis, MO, 63110, USA.,Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, 1008 South Spring Ave, Saint Louis, MO, 63110, USA
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7
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Monti M, Guidoboni M, Oboldi D, Bartolini G, Pieri F, Ruscelli S, Passardi A, Ridolfi L, De Rosa F, Sullo FG, Frassineti GL. Melanoma metastasis mimicking gastric cancer: a challenge that starts from diagnosis. Therap Adv Gastroenterol 2021; 14:1756284821989559. [PMID: 33717209 PMCID: PMC7925946 DOI: 10.1177/1756284821989559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/04/2021] [Indexed: 02/04/2023] Open
Abstract
The gastrointestinal tract is an uncommon site of metastasis in melanoma. However, when the primary melanoma cannot be found, the diagnosis of gastric melanoma by endoscopic biopsy is problematic mainly because some tumors are amelanotic and do not contain melanin granules detectable by microscopy. A 56-year-old Caucasian man with melanoma was referred to us following an initial histopathological diagnosis via gastroscopy of poorly differentiated primary gastric carcinoma. A computerized tomography (CT) scan showed metastatic disease and on the basis of this information we started palliative chemotherapy. However, the atypical presentation of the disease with subcutaneous metastases prompted us to make a more in-depth evaluation. Immunohistochemical evaluation modified the diagnosis to melanoma. After only one cycle of chemotherapy, treatment was changed to dabrafenib + trametinib, which was better tolerated and initially induced a partial response. The patient is currently in good clinical condition 20 months after diagnosis. Our case report highlights the difficulty in diagnosing melanoma of the gastrointestinal tract and indicates the need for pathologists and clinicians to consider such a possibility when they are faced with a diagnosis of poorly differentiated gastric cancer and unusual sites of metastasis.
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Affiliation(s)
| | - Massimo Guidoboni
- Immunotherapy and Cell Therapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Devil Oboldi
- Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Federica Pieri
- Pathology Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Silvia Ruscelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Laura Ridolfi
- Immunotherapy and Cell Therapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesco De Rosa
- Immunotherapy and Cell Therapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesco Giulio Sullo
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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8
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Sinagra E, Sciumè C. Ileal Melanoma, A Rare Cause of Small Bowel Obstruction: Report of a Case, and Short Literature Review. Curr Radiopharm 2019; 13:56-62. [PMID: 31749442 PMCID: PMC7509737 DOI: 10.2174/1874471012666191015101410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/02/2019] [Accepted: 07/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Malignant melanoma frequently spreads to the gastrointestinal tract, with 60% of patients with advanced metastatic disease showing digestive involvement; however, primary MM of the small intestine is a controversial diagnosis. In fact, whether these lesions arise as true small bowel primary neoplasms or represent metastases from unidentified cutaneous melanomas remains debatable. The most common complications are intestinal obstruction, massive gastrointestinal bleeding, and perforation. OBJECTIVE & METHODS We report a case of a 64-year-old patient, with an unremarkable medical history, in which a late diagnosis of primary ileal malignant melanoma in the setting of an emergency laparotomy due to small bowel obstruction, and where PET-scan showed costal metastasis. Therefore, we provide a narrative review of the scientific literature about this topic. RESULTS 36 cases of primary small bowel melanoma, included that in the present study, were found through our search in the scientific literature. CONCLUSION Primary small bowel MM appears to be an extremely rare entity which clinicians should be more aware of, in order to plan better a correct strategy of early diagnosis and appropriate treatment.
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Affiliation(s)
- Emanuele Sinagra
- Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015, Cefalu, Italy.,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Carmelo Sciumè
- DICHIRONS, Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, University of Palermo, Palermo, Italy.,Surgery Unit, Ospedale San Giovanni di Dio, Contrada Consolida, Agrigento, Italy
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9
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Zoumpos A, Ho NAH, Loeschhorn-Becker R, Schuppert F. Haemorrhagic small bowel melanoma metastasis: a clinical rarity. BMJ Case Rep 2019; 12:12/9/e230454. [PMID: 31511264 PMCID: PMC6738747 DOI: 10.1136/bcr-2019-230454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest–abdomen–pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.
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Affiliation(s)
- Alexandros Zoumpos
- Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel GmbH, Kassel, Germany
| | - Ngoc Anh Huy Ho
- Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel GmbH, Kassel, Germany
| | | | - Frank Schuppert
- Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel GmbH, Kassel, Germany
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10
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Sciacca V, Ciorra AA, Di Fonzo C, Rossi R, Pistillucci G, Lugini A, D'Aprile M. Long-term Survival of Metastatic Melanoma to the Ileum with Evidence of Primary Cutaneous Disease after 15 years of follow-up: A Case Report. TUMORI JOURNAL 2018; 96:640-3. [DOI: 10.1177/030089161009600423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The small bowel is the most common site of gastrointestinal metastasis from cutaneous melanoma. Malignant melanoma has a poor prognosis, especially if distant metastases appear. Although rare primary melanoma of the small bowel has been described, more frequently these lesions originate from unknown cutaneous melanoma. Here we report the case of a 58-year-old man with a diagnosis of melanoma of the ileum without evidence of primary cutaneous disease. After 15 years, during the clinical and radiological follow-up, a cutaneous melanoma in the left parietal side of the scalp, probably corresponding to the primary lesion with abdominal node metastasis, was diagnosed. After 6 months of chemotherapy with fotemustine, the patient showed a complete response. At present, he is still alive 18 years after the diagnosis of intestinal metastasis.
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Affiliation(s)
- Venerina Sciacca
- Division of Medical Oncology, “S. Maria Goretti” Hospital, Latina, “San Camillo De Lellis” Hospital, Rieti, Italy
| | - A Alida Ciorra
- Division of Medical Oncology, “S. Maria Goretti” Hospital, Latina, “San Camillo De Lellis” Hospital, Rieti, Italy
| | - Concetta Di Fonzo
- Palliative Care Unit, “Villa Azzurra” Hospice, Terracina (LT), “San Camillo De Lellis” Hospital, Rieti, Italy
| | - Rosalinda Rossi
- Division of Medical Oncology, “S. Maria Goretti” Hospital, Latina, “San Camillo De Lellis” Hospital, Rieti, Italy
| | - Giorgio Pistillucci
- Division of Medical Oncology, “S. Maria Goretti” Hospital, Latina, “San Camillo De Lellis” Hospital, Rieti, Italy
| | - Antonio Lugini
- Division of Medical Oncology, “San Camillo De Lellis” Hospital, Rieti, Italy
| | - Modesto D'Aprile
- Division of Medical Oncology, “S. Maria Goretti” Hospital, Latina, “San Camillo De Lellis” Hospital, Rieti, Italy
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11
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Gastric and Rectal Metastases from Malignant Melanoma Presenting with Hypochromic Anemia and Treated with Immunotherapy. Case Rep Oncol Med 2017; 2017:2079068. [PMID: 29158932 PMCID: PMC5660775 DOI: 10.1155/2017/2079068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 09/12/2017] [Indexed: 01/24/2023] Open
Abstract
The authors present a case of an 80-year-old Caucasian male with multiple gastric and rectal metastases from malignant melanoma presenting with hypochromic anemia as the sole symptom of disease without evidence of cutaneous and ocular tumor localization. The patient had a medical history positive for malignant lentigo melanoma of the occipital region of the scalp and early stage laryngeal squamous cell carcinoma and prostatic carcinoma treated with radiation therapy. The authors make some considerations on intestinal involvement by metastatic melanoma and discuss the choice of not treating with endoscopic procedures the gastric metastatic lesions most likely responsible for the clinical sign present at diagnosis. The patient was referred to clinical oncologists and received immunotherapy with ipilimumab and pembrolizumab.
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12
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Vrable A, Chang R. Malignant melanoma of the small bowel presenting with intussusception in a woman: a case report. Melanoma Manag 2017; 4:99-104. [PMID: 30190912 DOI: 10.2217/mmt-2016-0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/10/2016] [Indexed: 11/21/2022] Open
Abstract
Primary malignant melanoma originating in the small bowel is very rare. We report the case of primary malignant melanoma of the small bowel with secondary intussusception in a 51-year-old female with no prior history of cutaneous melanoma. The patient was admitted to the hospital for clinical bowel obstruction after 6 months of varying symptoms of antecedent syncopal events secondary to profound anemia due to iron deficiency followed later by vomiting, abdominal pain and weight loss. A CT scan showed intussusception and she underwent a small bowel resection. Diagnosis of malignant melanoma was confirmed post-operatively following immunohistochemistry. The patient history and postoperative investigation excluded the existence of a primary lesion elsewhere. Our case represents an aggressive primary small bowel melanoma presenting as intussusception.
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Affiliation(s)
- Abby Vrable
- OhioHealth O'Bleness Hospital, 55 Hospital Drive, Athens, OH 45701, USA.,OhioHealth O'Bleness Hospital, 55 Hospital Drive, Athens, OH 45701, USA
| | - Richard Chang
- Department of Medicine Hematology-Oncology, University Hospitals Seidman Cancer Center, 25200 Center Ridge Road, Suite 2100, Westlake, OH 44145, USA.,Department of Medicine Hematology-Oncology, University Hospitals Seidman Cancer Center, 25200 Center Ridge Road, Suite 2100, Westlake, OH 44145, USA
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13
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Kilambi R, Singh AN, Dash NR, Madhusudhan KS, Das P. Primary giant aggressive amelanotic duodenal melanoma. Ann R Coll Surg Engl 2017; 99:e131-e134. [PMID: 28462646 DOI: 10.1308/rcsann.2016.0323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Primary malignant melanoma of the gastrointestinal tract is extremely rare. A 35-year-old man presented with complaints of abdominal pain and weight loss. Contrast enhanced computed tomography showed a large mass involving the duodenum and the superior mesenteric vessels. Upper gastrointestinal endoscopy demonstrated a large, friable mass along the duodenal wall and biopsy was suggestive of malignant melanoma. A detailed physical examination and whole body imaging (positron emission tomography and computed tomography) did not reveal any other lesion. The patient underwent a pancreaticoduodenectomy with segmental resection and anastomosis of the superior mesenteric vein as well as a segmental colectomy. His postoperative recovery was uneventful. The histopathology of the operative specimen showed a malignant amelanotic melanoma arising from the duodenum with lymph nodal involvement. He received oral temozolomide. However, he developed liver metastasis at six months and again at ten months, which was managed with radiofrequency ablation both times. He is doing well at 32 months of follow-up review. Multimodality treatment including surgery, adjuvant chemotherapy and salvage therapy appears to be a promising tool for achieving long-term survival in such patients.
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Affiliation(s)
- R Kilambi
- All India Institute of Medical Sciences , New Delhi , India
| | - A N Singh
- All India Institute of Medical Sciences , New Delhi , India
| | - N R Dash
- All India Institute of Medical Sciences , New Delhi , India
| | | | - P Das
- All India Institute of Medical Sciences , New Delhi , India
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14
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Ait Idir B, Riany A, Jahid A, Chad B. Primary melanoma of the small bowel revealed by gastrointestinal bleeding: a case report. J Med Case Rep 2016; 10:335. [PMID: 27906109 PMCID: PMC5134275 DOI: 10.1186/s13256-016-1119-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/24/2016] [Indexed: 01/09/2023] Open
Abstract
Background Primary melanoma of the small bowel is extremely rare. Only a limited number of cases have been described in the literature. Mostly, the small intestine is affected by metastatic tumors of other primary lesions, especially cutaneous. Case presentation We report the case of a 75-year-old North African woman with a small bowel melanoma. The diagnosis was made by histological examination and immunohistochemical profile matching after a segmental small bowel resection. Postoperative investigations looking for cutaneous, gastrointestinal or ocular primary lesions found no abnormalities. Conclusions The diagnosis of primary small bowel melanoma can be retained although it remains difficult to exclude the possibility of metastatic melanoma.
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Affiliation(s)
- B Ait Idir
- Surgery Unit B, Ibn Sina University Hospital, Rabat, Morocco.
| | - A Riany
- Surgery Unit B, Ibn Sina University Hospital, Rabat, Morocco
| | - A Jahid
- Pathology Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - B Chad
- Surgery Unit B, Ibn Sina University Hospital, Rabat, Morocco
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15
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Mikkelsen LH, Larsen AC, von Buchwald C, Drzewiecki KT, Prause JU, Heegaard S. Mucosal malignant melanoma - a clinical, oncological, pathological and genetic survey. APMIS 2016; 124:475-86. [DOI: 10.1111/apm.12529] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 01/31/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Lauge H. Mikkelsen
- Department of Pathology; Rigshospitalet; Copenhagen Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Copenhagen Denmark
| | - Ann-Cathrine Larsen
- Department of Pathology; Rigshospitalet; Copenhagen Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology; Rigshospitalet; Copenhagen Denmark
| | | | - Jan U. Prause
- Department of Neuroscience and Pharmacology; University of Copenhagen; Copenhagen Denmark
| | - Steffen Heegaard
- Department of Pathology; Rigshospitalet; Copenhagen Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Copenhagen Denmark
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16
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"Unsteady gait": an uncommon presentation and course of malignant melanoma in terminal ileum-a case report and review of literature. Case Rep Gastrointest Med 2013; 2013:958041. [PMID: 24369513 PMCID: PMC3863512 DOI: 10.1155/2013/958041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/20/2013] [Indexed: 11/18/2022] Open
Abstract
Malignant melanoma within the gastrointestinal tract is an uncommon neoplasm that is usually metastatic in origin, with primary melanomas being relatively uncommon. Embryologically melanocytes normally exist in the esophagus, stomach, small bowel, and anorectum and this theory supports the primary melanoma of the gastrointestinal tract that has been confirmed for lesions occurring through several published reports. However, most patients with brain metastases from malignant melanoma are diagnosed after treatment for known extracranial metastases and have poor outcomes. Our case is unique in that we discuss an unusual case of 69-year-old female patient presented with unsteady gait as the first symptom of disease and where the presumed primary lesion later was found in the terminal ileum on colonoscopy. Treatment consisted of surgical removal of the terminal ileal lesion with chemotherapy, whole-brain radiotherapy, and cyberknife radiosurgical procedure. Patient was in remission for more than 14 months and later succumbed to disease. Despite the advances in therapeutic options, prognosis for patients with melanoma brain metastases remains poor with a median survival time of six months after diagnosis.
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17
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Li H, Fan Q, Wang Z, Xu H, Li X, Zhang W, Zhang Z. Primary malignant melanoma of the duodenum without visible melanin pigment: a mimicker of lymphoma or carcinoma. Diagn Pathol 2012; 7:74. [PMID: 22735126 PMCID: PMC3472194 DOI: 10.1186/1746-1596-7-74] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/30/2012] [Indexed: 11/10/2022] Open
Abstract
Primary malignant melanoma of the duodenum is an unusual oncologic entity. Patients usually present the similar clinical symptoms like other common tumors in this site. And there are no specific radiological features either. The cases with only little melanin pigment or without notable melanin pigment are very misleading, especially in small biopsies or frozen sections. Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains. Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere. Herein we report the case of a 60-year-old male patient with primary malignant melanoma of the duodenum, which was misdiagnosed as lymphoma or undifferentiated carcinoma in frozen consultation. The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.
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Affiliation(s)
- Hongxia Li
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China
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18
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Cubas I, Sorser S, Stawick L. Use of double-balloon enteroscopy to diagnose a primary intestinal melanoma. Gastrointest Endosc 2009; 70:1283-4. [PMID: 19647243 DOI: 10.1016/j.gie.2009.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 05/03/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Ivan Cubas
- Providence Hospital and Medical Center, Southfield, Michigan 48322, USA
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19
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Primary malignant melanoma of the duodenum: aggressive management and long-term survival of an unusual oncologic entity. South Med J 2008; 101:836-9. [PMID: 18622334 DOI: 10.1097/smj.0b013e31817dfd75] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary malignant melanoma originating in the small bowel is extremely rare. We report the case of a 55-year-old man who presented with a preoperative bleeding duodenal tumor. A standard pancreaticoduodenectomy was performed. Histopathological examination ascertained the diagnosis of a duodenal malignant melanoma with locoregional lymphatic spread. A thorough postoperative investigation did not reveal any primary melanotic lesions. Thus, the diagnosis of a primary melanoma originating from the duodenum was suggested. Fourteen months after surgery, the patient had no evidence of recurrence. Primary malignant melanoma of the duodenum is an existing, though unusual, oncologic entity. Aggressive surgery remains the treatment of choice offering both symptom palliation and long-term survival.
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20
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von Rosenvinge EC, Koh C, Rotman Y, Lim RM. Electronic clinical challenges and images in GI. Gastrointestinal malignant melanoma. Gastroenterology 2008; 135:e5-6. [PMID: 18555019 PMCID: PMC6436620 DOI: 10.1053/j.gastro.2008.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Erik C von Rosenvinge
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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21
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Cheung MC, Perez EA, Molina MA, Jin X, Gutierrez JC, Franceschi D, Livingstone AS, Koniaris LG. Defining the role of surgery for primary gastrointestinal tract melanoma. J Gastrointest Surg 2008; 12:731-8. [PMID: 18058185 DOI: 10.1007/s11605-007-0417-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 10/31/2007] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The objective of the study was to determine the outcomes for primary gastrointestinal melanomas (PGIM). MATERIAL AND METHODS The Surveillance, Epidemiology, and End Results database (1973-2004) was queried. RESULTS Overall, 659 cases of PGIM were identified. The annual incidence of PGIM was approximately 0.47 cases per million in 2000. Overall median survival time was 17 months. Tumors were identified in the oral-nasopharynx (32.8%), anal canal (31.4%), rectum (22.2%), esophagus (5.9%), stomach (2.7%), small bowel (2.3%), gallbladder (1.4%), and large bowel (0.9%). Univariate analysis demonstrated age, tumor location, stage, surgery, and lymph node status were significant predictors of improved survival. MST has not been reached for tumors located in the large bowel, while tumors located in the stomach demonstrated the shortest median survival (5 months). Improvement in MST was observed for those patients undergoing surgical resection. The presence of lymph node involvement conferred a poorer prognosis. Multivariate analysis of the cohort identified that location, advanced tumor stage, failure to undertake surgical resection, positive lymph node status, and age were all independent predictors of poorer outcome. CONCLUSION PGIM occurs most often in the oral-nasopharynx and anal canal. Surgical extirpation is the only identifiable treatment modality that significantly improves survival.
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Affiliation(s)
- Michael C Cheung
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Abstract
BACKGROUND Although small bowel (SB) involvement is found at postmortem in 50-60% of melanoma patients, diagnosis is only made during life in 10% of cases. This study reports the findings of capsule endoscopy (CE) in melanoma patients referred for investigation of suspected SB involvement. METHODS AND SUBJECTS Eight men and five women with known or previous melanoma were referred for CE between December 2003 and September 2006. The indications were gastrointestinal bleeding (three), anemia (six), positive fecal occult blood test (one), abnormal imaging (two), and abdominal pain (one). RESULTS CE showed SB metastases in five patients and excluded SB involvement in eight. All patients had previous investigations with either endoscopy, push enteroscopy, SB follow-through, CT scan, and/or PET scan. CE showed new lesions not detected by other investigation modalities. CE also ruled out SB metastases when other tests were nondiagnostic. All five patients with SB metastases detected underwent surgical resection. At follow-up after CE of a mean 8.4 months (1-23 months) and 4.9 months (0.25-10 months) after surgery, five patients had died, including three of those who had undergone resection of SB metastases. Seven patients were still alive, including two who had SB surgery. One patient was lost to follow-up. CONCLUSIONS CE may detect the presence and extent of SB metastases in patients with melanoma more reliably than conventional investigations. It should be considered in the workup of melanoma patients with suspected SB disease.
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Affiliation(s)
- Emilia Prakoso
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Department of Medicine, University of Sydney, Australia
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23
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Gardner TB, Bensen SP, Toor A, Anderson PB. Video capsule endoscopy to diagnose metastatic melanoma. Dig Dis Sci 2007; 52:1036-7. [PMID: 17342395 DOI: 10.1007/s10620-006-9372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 04/01/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Timothy B Gardner
- Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
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Primary tumors of jejunum and ileum as a cause of intestinal obstruction: a case control study. Int J Surg 2006; 5:183-91. [PMID: 17509501 DOI: 10.1016/j.ijsu.2006.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 05/08/2006] [Accepted: 05/10/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Small-bowel tumors are rare and account for 1-2% of all gastrointestinal neoplasms. Most of these tumors are found at surgery indicated for other diagnosis or intestinal obstruction. The rarity, unclear presentation and diagnostic difficulty of these tumors stimulated our interest to review our experience with emergency surgery for intestinal obstruction secondary to jejunoileal tumors. METHODS We reviewed 17 patients operated on for intestinal obstruction secondary to benign and malignant primary tumors of jejunum and ileum at our institution the last 10 years. RESULTS The series comprised 8 male and 9 female patients, most of them younger than 49 years of age. The most frequent tumors found were GIST (36%) followed by lymphomas (24%) and adenocarcinomas (18%). Most tumors (65%) were located in the ileum. Mean survival for patients with malignant tumors was 19.5+/-13 months, and for patients with benign tumors 72+/-20 months (p<0.05). CONCLUSION Jejunoileal tumors present frequently in patients younger than 49 years of age. Ileal tumors are more likely to develop intestinal obstruction than jejunal tumors. Emergency surgery for these patients precludes a complete and negative margin resection and constitutes a risk factor for residual disease and short-term survival.
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