Malignant melanoma of the stomach presenting in a woman: a case report

Malignant melanoma in the stomach treated with endoscopic submucosal dissection: a case report

The initial appearance of malignant melanoma localized in the stomach has never been reported previously. We encountered a patient with gastric melanoma in the stomach, which was histologically confirmed to be confined to the mucosa.

Case Presentation

The patient, when in her 40s, had undergone surgery for malignant melanoma of the left heel. However, there were no detailed records of pathological findings. The patient had a 4-mm black elevated lesion in her stomach observed on esophagogastroduodenoscopy after the eradication of Helicobacter pylori. A year later, esophagogastroduodenoscopy showed that the lesion had increased to 8 mm. A biopsy was performed, but no malignancy was found; the patient continued to be followed up. Esophagogastroduodenoscopy performed at the 2-year follow-up revealed that the melanotic lesion had increased to 15 mm, and biopsy was performed and revealed a malignant melanoma.

Clinical Discussion

Endoscopic submucosal dissection was performed for gastric malignant melanoma. The margin of the resected malignant melanoma was negative; vascular and lymphatic invasions were not observed, and the lesion was confined to the mucosa.

Conclusion

We suggest that even if the first biopsy of a melanotic lesion shows no evidence of malignancy, the lesion should be closely monitored. This is the first reported case of endoscopic submucosal dissection of localized gastric malignant melanoma confined to the mucosa.

Malignant Melanoma of the Stomach

Malignant melanoma with metastasis to the stomach is rare and seldom diagnosed before death. The most common gastrointestinal (GI) metastatic site is the small intestine, followed by the colon, rectum and stomach. We present the case of a 55-year-old woman with a history of melanoma who presented with melena and syncope, and was found to have metastatic gastric melanoma.

LEARNING POINTS

It is important to consider gastric metastasis in patients with a history of melanoma who present with non-specific abdominal symptoms such as abdominal pain, nausea, vomiting, melena/haematochezia, weight loss and anaemia.It is crucial to keep gastric melanoma metastasis as a differential diagnosis in a patient with melanoma due to its aggressive nature and poor prognosis if diagnosis is delayed.Appearances can vary greatly at endoscopy, and so immunohistochemistry is vital at histological work-up for the identification of gastric melanoma.

Metastatic multifocal melanoma of multiple organ systems: A case report

BACKGROUND

Malignant melanoma is becoming more common among middle-aged individuals all over the world. Melanoma metastasis can be found in various organs, although metastases to the spleen and stomach are rare. Herein we present a rare metastatic multifocal melanoma, clinically and histologically mimicking lymphoma, with metastases of multiple organs.

CASE SUMMARY

A 46-year-old Caucasian male with a history of nodular cutaneous malignant melanoma was presented with nausea, general weakness, shortness of breath, abdominal enlargement, and night sweating. The abdominal ultrasound revealed enlarged liver and spleen with multiple lesions. Computed tomography demonstrated multiple lesions in the lungs, liver, spleen, subcutaneous tissue, bones and a pathological lymphadenopathy of the neck. Trephine biopsy and the biopsy from the enlarged lymph node were taken. Tumor cells showed diffuse or partial positivity for melanocytic markers, such as microphthalmia - associated transcription factor, S100, HMB45 and Melan-A. The tumor harbored BRAF V600E mutation, demonstrated by immunohistochemical labelling for BRAF V600E and detected by real-time polymerase chain reaction test. Having combined all the findings, a diagnosis was made of a metastatic multifocal melanoma of the stomach, duodenum, liver, spleen, lungs, lymph nodes and bones. The patient refused treatment and died a week later.

CONCLUSION

This case report highlights the clinical relevance of rare metastatic multifocal melanoma of multiple organ systems.

A Case Series of Gastric Metastatic Growths

Gastric cancer is one of the gastrointestinal malignancies that can be quite devastating with high morbidity and mortality. Unfortunately, it is a malignancy that is encountered all across the world and is often brought into suspicion based on symptoms of the patient. The presentation differs based on the symptomatology and can be quite variable in each and every case. Malignant lesions in the stomach discovered endoscopically can represent as primary gastric growths or can be secondary as a consequence of metastatic spread from a distant primary site. It is important to recognize the different patterns of presentation of metastatic disease and to be aware of the primary tumor sites. The treatment and ultimately the prognosis changes drastically when dealing with a metastatic disease as opposed to a primary localized source with limited spread. The aim of our study is to present a mini series of cases that manifest as metastatic gastric growths. Their clinical, endoscopic and histological appearance is depicted to provide an understanding of each case. The primary sites of origin for our patients were the lungs, skin, lymphoid tissue and kidneys. Their overall clinical course is presented including the approach to the management in each case as well as their outcomes.

Endoscopic diagnosis of gastric metastases from malignant melanoma: systematic review

Background/Aims

Metastases of malignant melanoma (MM) are rare and associated with poor prognosis. The objective of this study was to analyze the clinical and endoscopic characteristics of gastric metastases of MM by systematically reviewing cases and case series involving patients diagnosed using upper gastrointestinal endoscopy.

Methods

The PubMed and LILACS databases were searched. Reports containing individual patient data were included. Outcomes such as clinical data, endoscopic findings, treatments, and survival were analyzed.

Results

A total of 88 studies with individual data from 113 patients with gastric metastases of MM were included. The primary sites of MM were the skin (62%), eyes (10%), and mucous membranes (6%). Most patients (56%) had multiple metastases in the stomach, located predominantly in the gastric body (approximately 80%). The overall survival rate at 2 years was 4%. There was a significant reduction in the survival of patients with multiple gastric metastases compared to that of patients with single metastasis (hazard ratio, 0.459; 95% confidence interval, 0.235−0.895; p=0.022).

Conclusions

Gastric metastases of MM have a poor prognosis, especially in patients with multiple implants in the stomach. Additional studies are needed to verify whether ocular and mucosal melanomas are associated with a higher risk of gastric metastases than that of cutaneous melanomas.

Amelanotic metastatic gastric malignant melanoma: a case report

Melanoma is a malignant form of cutaneous cancer with an increasing incidence since 1970s, accounting for nearly 75% of the death related to skin cancer especially in western countries. Highest recurrence and mortality were observed for the subtype with distal metastasis, demonstrating poor outcomes. However, high incidence of gastrointestinal metastasis of malignant melanoma is frequently misdiagnosed due to lack of specific clinical manifestations, especially for the rare observed cases presented amelanotic appearance, accounting for about 2% of all metastatic cases. In the present study, we reported a 36-year-old male patient, who was firstly diagnosed as gastric cancer, and then was confirmed as amelanotic melanoma metastasis by pathological examination, demonstrating positive for melanoma markers including Melan A, S-100, Hmb45 and CD79a. In conclusion, for the amelanotic neoplasm observed during gastroscopy in patients with melanoma history, pathological examination should be carried out to confirm the possibility of melanoma metastasis, providing evidences for the following treatment.

A Case of Treated Penile Melanoma with Gastric Recurrence

Melanoma is a very aggressive skin cancer that could metastasize to any organ in the body. The treatment of melanomas includes surgical resection, chemotherapy, and immunotherapy. After resections, melanomas could recur at the previous site or present as a distant metastatic lesion. The symptoms of melanoma are vague and primarily occur because of the local disruption of the tissue architecture. Presented here is a case of gastric melanoma that presented with abdominal discomfort and melena in a patient with a history of penile melanoma that was completely resected 3 years earlier. This case illustrates the importance of having metastatic lesions to the intestinal tract as a differential for a patient with gastrointestinal hemorrhage.

Primary gastric melanoma: A case report with imaging findings and 5-year follow-up

BACKGROUND

Most melanomas identified in the stomach are metastatic; primary gastric melanoma (PGM) is extremely rare, and the relevant studies are relatively scarce. PGM may be incorrectly diagnosed as other gastric malignant tumor types.

CASE SUMMARY

We describe a rare case of PGM confirmed through long-term clinical observation and pathological diagnosis. A 67-year-old woman presented to our hospital with recurrent chest tightness and chest pain. Digital gastrointestinal radiography revealed a circular shadow in the gastric cardia. Computed tomography (CT) revealed a heterogeneous tumor with uneven enhancement. Enlarged lymph nodes were noted in the lesser curvature of the stomach. On magnetic resonance imaging (MRI), T1- and T2-weighted imaging revealed hyperintensity in and hypointensity in the tumor, respectively, both of which increased substantially after uneven enhancement. Near total gastrectomy was performed, and the tumor was pathologically confirmed to be a gastric melanoma. Because no other possible primary site of malignant melanoma was suspected, a clinical diagnosis of PGM was made. The patient was followed for nearly 5 years, during which she received CT reexamination, but no recurrence or metastasis was observed.

CONCLUSION

Certain imaging characteristics could be revealed in PGM. Imaging examination can be of great value in preoperative diagnosis, differential diagnosis, and follow-up of patients with PGM.

Gastroduodenal malignant melanoma: A rare case and literature review

Gastroduodenal melanoma is an uncommon entity with high malignancy and early hematogenous metastasis. Patients with advanced gastroduodenal melanoma often have a poor prognosis because of untimely diagnosis and treatment due to its atypical symptoms. Here, we report an 81-year-old man who presented with poor appetite and weight loss and was diagnosed with malignant gastroduodenal melanoma by endoscopy and confirmed by histopathological and immunohistochemical staining. The epidemiology, diagnosis, therapy, and prognosis of gastroduodenal melanoma are also reviewed and discussed in this paper.

Melanoma with gastric metastases

An 81-year-old woman with a history of malignant melanoma who presented with dyspnea and fatigue was found to have metastases to the stomach detected on endoscopy. Primary cutaneous malignant melanoma with gastric metastases is a rare occurrence, and it is often not detected until autopsy because of its non-specific manifestations.

Epidemiological and clinical characteristics of malignant melanoma in Southeast Anatolia in Turkey

INTRODUCTION

The present study aimed to establish the epidemiological and clinical characteristics of patients who were histopathologically diagnosed with malignant melanoma (MM).

METHODS

The present study retrospectively analyzed the data of 78 patients who were histopathologically diagnosed with MM in Dicle University Medical Faculty, Dermatology and Medical Oncology departments between 2005 and 2014.

RESULTS

The study included 78 patients in total with 44 (56.4%) male and 34 (43.6%) female. Median age of the patients was 62.50 years (range: 27 - 84 years). Of the patients, 78.2% (n = 61) had cutaneous melanoma, 8.9% had solid organ melanoma, and 2.5% had ocular and mucosal melanoma. The most common tumor localization among the patients was the lower extremities with 29.4% (n = 23). The most common histopathological type was nodular malignant melanoma with 35.8% (n = 28). Based on TNM, Clark and Breslow classifications, 26.9% (n = 21) of the patients were stage 4, 26.9% (n = 21) were Clark stage 4, and 37.1% (n = 29) were Breslow stage 4. Median overall survival in all patients was 14.9 months (95% CI 10.9 - 18.8 months). In the multivariate Cox analysis, only stage statistically significantly affecting survival [odds ratio (OR): 0.54; (95% CI 0.16-1.82, p = 0.02)].

CONCLUSION

Malignant melanoma data are also important for the optimal utilization of effective methods and healthcare resources to prevent the disease. In order to minimize MM mortality and morbidity, not only the society but also physicians from primary and secondary care hospitals should become familiar with melanoma.

Gastric Metastasis of Malignant Melanoma: Report of a Case and Review of Available Literature

Background

Malignant melanoma is a tumor with common lymphogenic or hematogenic metastasis. Metastasis to the gastric mucosa is uncommon.

Case Report

We present the case of a 43-year-old female patient with metastases of a malignant melanoma to the lesser curvature of the stomach. The primary malignant melanoma of the right breast was resected 2 years previously.

Conclusion

Metastases to the gastric mucosa are rarely seen. Esophagogastroduodenoscopy should be performed in symptomatic patients to rule out metastatic disease. When R0 resection can be achieved, it should be undertaken in order to increase the overall prognosis of the patient.

Primary gastric melanoma: case report of a rare malignancy

We report the case of a 64-year-old white male who presented to his primary care physician with complaints of fatigue. Physical exam was unremarkable and laboratory studies revealed profound anemia, for which the patient received a transfusion. Esophagogastroduodenoscopy revealed a bleeding mass in the proximal stomach that was histologically determined to be malignant melanoma, with immunohistochemical staining demonstrating positivity for SOX10, S100, MART-1, and HMG-45. After an extensive dermatological exam no other primary lesion was identified. Whole body positron emission tomography (18-FDG-PET/CT) demonstrated pathologic uptake only in the area of the proximal stomach. For this reason, primary gastric melanoma was suspected in this patient. The patient underwent subtotal gastrectomy with mass excision followed by Roux-en-Y reconstruction. Very few cases of primary gastric melanoma have been reported. We report this case and present diagnostic criteria for primary non-cutaneous melanoma and discuss potential non-surgical therapies.

Primary gastric malignant melanoma mimicking adenocarcinoma

We report a case of primary gastric malignant melanoma that was diagnosed after curative resection but initially misdiagnosed as adenocarcinoma. A 68-year-old woman was referred to our department for surgery for gastric adenocarcinoma presenting as a polypoid lesion with central ulceration located in the upper body of the stomach. The preoperative diagnosis was confirmed by endoscopic biopsy. We performed laparoscopic total gastrectomy, and the final pathologic evaluation led to the diagnosis of primary gastric malignant melanoma without a primary lesion detected in the body. To the best of our knowledge, primary gastric malignant melanoma is extremely rare, and this is the first case reported in our country. According to the literature, it has aggressive biologic activity compared with adenocarcinoma, and curative resection is the only promising treatment strategy. In our case, the patient received an early diagnosis and underwent curative gastrectomy with radical lymphadenectomy, and no recurrence was noted for about two years.

Palliative radiation therapy for primary gastric melanoma

INTRODUCTION

Primary gastric melanoma is an exceedingly rare cause of upper gastrointestinal bleeding (GI bleeding). Prior reports of primary gastric melanoma have mostly been treated with surgery with utilization of radiation therapy being unreported. Radiation therapy has been used to palliate bleeding of other cancers including lung, bladder, cervix, and more recently primary gastric cancers.

CASE PRESENTATION

This case documents an 87-year-old male who presented with fatigue and melena, and was found to have severe anemia. Endoscopy with biopsy revealed an isolated focus of melanoma. After discharge, he presented two days later and was found to have continued bleeding. Because he was deemed a poor surgical candidate he elected to undergo palliative radiation therapy for bleeding control.

DISCUSSION

The diagnosis of primary verses metastatic melanoma is a topic of debate. Case reports of patients with no known extra-gastric primary have undergone surgical treatment with varying outcomes. Patients with metastatic gastric melanoma have relied on chemotherapy and radiation in addition to surgery, with radiation being used in the palliative setting. The use of radiation to control bleeding in other cancers including primary gastric adenocarcinoma has been previously studied. This case documents the utilization of radiation therapy in bleeding due to primary gastric melanoma.

CONCLUSIONS

Radiation therapy can provide adequate bleeding palliation in patients with primary gastric melanoma.