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Yan ZH, Huang J, Chiang J, Kwan KWC. Metastatic Gastric Mucosal Melanoma: A Rare Case Presenting With Diffuse Gastric Polyposis. Cureus 2023; 15:e43740. [PMID: 37727165 PMCID: PMC10505986 DOI: 10.7759/cureus.43740] [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: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
We report a 66-year-old Chinese lady who presented with a three-month history of postprandial vomiting, early satiety, anorexia and weight loss, and significant physical findings of hepatomegaly and ascites. Gastroscopy revealed gastric polyposis with both hyperpigmented and unpigmented lesions over the gastric fundus, body, and proximal antrum, biopsies of which yielded malignant melanoma histologically. Cross-sectional imaging with CT also demonstrated extensive hepatic and bony metastases. No cutaneous or ocular primary was detected. She was treated with a combination of ipilimumab and nivolumab but developed interval progression of hepatic metastases after two cycles of immunotherapy. The patient eventually succumbed two months after diagnosis.
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Affiliation(s)
- Zhi Hao Yan
- Department of Gastroenterology and Hepatology, Sengkang General Hospital, Singapore, SGP
| | - Jingxiang Huang
- Department of Pathology, Sengkang General Hospital, Singapore, SGP
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, SGP
| | - Kah Wai Clarence Kwan
- Department of Gastroenterology and Hepatology, Sengkang General Hospital, Singapore, SGP
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Eng JY, Tahkin S, Yaacob H, Yunus NH, Sidek ASWM, Wong MPK. Multiple gastrointestinal melanoma causing small bowel intussusception. Ann Coloproctol 2023; 39:85-88. [PMID: 34284560 PMCID: PMC10009067 DOI: 10.3393/ac.2021.00143.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/21/2021] [Indexed: 10/20/2022] Open
Abstract
A 61-year-old gentleman presented with small bowel intussusception from small bowel melanoma intussusceptum. He complains of intermittent abdominal distension but no history of intestinal obstruction. Apart from this, he was also symptomatic anemia which required repeated transfusion for the past few months. The contrast-enhanced computed tomography of the abdomen shows an omental mass with small bowel intussusception. He then underwent an exploratory laparotomy with segmental resection of the affected segment. Histopathological examination confirmed primary gastrointestinal melanoma. Multiple small bowel malignant melanoma is a rare disease. It remains a controversial diagnosis as it may be a primary or metastasis from an unidentified or regressed primary cutaneous melanoma. Prompt surgical intervention enables us to obtain tissue diagnosis, prevent complete intestinal obstruction and strategize the goals of treatment for the patient.
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Affiliation(s)
- Jian Yang Eng
- Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | - Salehah Tahkin
- Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | - Huzairi Yaacob
- Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | - Nor Hayati Yunus
- Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | | | - Michael Pak-Kai Wong
- School of Medical Sciences, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
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Kheyri Z, Khoozani MS, Ala M. Metastatic melanoma presenting with dyspepsia: a case report. J Int Med Res 2022; 50:3000605221117146. [PMID: 36314792 PMCID: PMC9629552 DOI: 10.1177/03000605221117146] [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] [Indexed: 11/05/2022] Open
Abstract
The gastrointestinal tract is an uncommon site for metastasis. Gastrointestinal metastasis of melanoma is usually asymptomatic, often affects the small intestine (81.1%) and the colon (15.1%), and rarely affects the stomach. Our patient was a 40-year-old man presenting with gradually worsening dyspepsia of a few weeks’ duration. He did not mention other gastrointestinal symptoms, and he was not anemic. He had a history of auricular melanoma, which was resected. A black lesion with a diameter of approximately 20 mm was detected in the body of his stomach during upper gastrointestinal endoscopy. Biopsies were taken, and the diagnosis of metastatic melanoma was confirmed by immunohistochemistry (IHC). A gastrointestinal work-up, computed tomography (CT), and positron-emission tomography (PET) did not reveal additional lesions. The lesion in the stomach was resected, and a new course of chemotherapy was initiated. A lower threshold should be considered for gastrointestinal work-up in patients with melanoma.
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Affiliation(s)
- Zahedin Kheyri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Shiravi Khoozani
- Maysa Pathobiology and Genetics Laboratory, Tehran, Iran,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moein Ala
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,Moein Ala, School of Medicine, Tehran University of Medical Sciences (TUMS), Poursina Street, Enqelab Square, Tehran 1417613151, Iran.
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Mahapatra BR, Muraleedharan A, Das Majumdar SK, Adhya AK. Metastatic primary gastric melanoma: a rare clinical presentation and a review of literature. BMJ Case Rep 2022; 15:e249312. [PMID: 35835487 PMCID: PMC9289026 DOI: 10.1136/bcr-2022-249312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary gastric melanoma is a rare clinical finding. It presents with upper gastrointestinal symptoms like abdominal pain, weight loss and melaena. It is often difficult to differentiate a primary gastric melanoma from primary cutaneous melanoma with gastric metastasis. Upper gastrointestinal endoscopy and biopsy of the lesion for histopathology and immunohistochemistry help to reach a definite diagnosis. We report a case of primary gastric melanoma with metastases to the liver and bone. The patient was treated with palliative radiotherapy, palliative chemotherapy and a bone-stabilising agent.
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Affiliation(s)
- Bikash Ranjan Mahapatra
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anupam Muraleedharan
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Amit Kumar Adhya
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Chu YM, Hung CS, Huang CS. Primary malignant melanoma of the esophagogastric junction: A case report. Medicine (Baltimore) 2021; 100:e26467. [PMID: 34160452 PMCID: PMC8238344 DOI: 10.1097/md.0000000000026467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Most gastrointestinal melanomas are metastatic from an oculocutaneous primary lesion; however, primary gastrointestinal melanomas have been found in all levels of the gastrointestinal tract. We present the case of Primary malignant melanoma of the esophagus and discuss the diagnostic methods, differentiation from metastatic lesions and treatment options. PATIENT CONCERNS A 78-year-old male patient presented with fresh blood vomiting and tarry stools for 1 day. DIAGNOSES Esophagogastroduodenoscopy of this patient revealed a tumor ∼4 cm in size at the cardia side of the esophagogastric junction with dark-red and gray pigmentation. Immunohistochemical stains of the biopsy specimens were positive for S-100 and HMB-45, which are specific markers of melanoma. INTERVENTIONS Laparotomy with proximal gastrectomy was performed by the surgeon. Histological examination of the surgical specimen revealed the tumor arose from the distal esophagus with invasion of the proximal stomach. Primary malignant melanoma of the esophagus was diagnosed after a full skin and ophthalmic examination and positron emission tomography, which revealed no lesions elsewhere in the body. OUTCOMES No tumor recurrence was noted at the 1-year follow-up. LESSONS Primary malignant melanoma of the esophagus is an extremely rare but highly aggressive tumor. The special pattern of pigmentation should be recognized while performing endoscopy. Early detection and radical resection of the tumor are critical to ensure favorable outcomes.
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Affiliation(s)
- Yu-Ming Chu
- Division of Digestive Medicine, Department of Internal Medicine, Cathay General Hospital
| | - Chih-Sheng Hung
- Division of Digestive Medicine, Department of Internal Medicine, Cathay General Hospital
- School of Medicine, Fu-Jen Catholic University, New Taipei City
| | - Ching-Shui Huang
- Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan
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Mellotte GS, Sabu D, O'Reilly M, McDermott R, O'Connor A, Ryan BM. The challenge of primary gastric melanoma: a systematic review. Melanoma Manag 2020; 7:MMT51. [PMID: 33318781 PMCID: PMC7724652 DOI: 10.2217/mmt-2020-0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Primary gastric melanoma is a rare clinical presentation. The purpose of this review was to compare the 1-year survival in patients who underwent surgery with patients who did not receive treatment. Patients & methods: A systematic search of databases for case reports and case series of primary gastric melanoma was conducted. Results: The mean survival of patients was 22 months. One-year survival was 56.5% with surgery, rising to 66% with adjuvant therapy. Mean survival of the surgical group was 21.05 months (±20.2) versus 4.5 months (±3.61) in the nonsurgical group. Conclusion: Primary gastric melanoma has a poor prognosis but early surgical intervention can have a significant impact on patient outcome. We reviewed the biology and clinical diagnosis of gastrointestinal melanoma and the current management options available.
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Affiliation(s)
- Gregory S Mellotte
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland.,Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
| | - Diya Sabu
- Department of Oncology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Mary O'Reilly
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Ray McDermott
- Department of Oncology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Anthony O'Connor
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland.,Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
| | - Barbara M Ryan
- Department of Gastroenterology, Tallaght University Hospital, Dublin, D24 NR04, Ireland.,Department of Clinical Medicine, Trinity College Dublin, D02 PN40, Ireland
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Schizas D, Tomara N, Katsaros I, Sakellariou S, Machairas N, Paspala A, Tsilimigras DI, Papanikolaou IS, Mantas D. Primary gastric melanoma in adult population: a systematic review of the literature. ANZ J Surg 2020; 91:269-275. [PMID: 32687691 DOI: 10.1111/ans.16160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Primary gastric melanoma (PGM) is a rare malignant tumour of the stomach with poor prognosis. The aim of this systematic review was to assess the available literature on this entity and to highlight its biological behaviour and preferred treatment approach. METHODS PubMed and Cochrane bibliographical databases were independently searched (last search: 2 February 2020) by two investigators for articles reporting on PGM in the adult population. RESULTS Twenty-five studies met the inclusion criteria and concerned collectively 25 patients (18 males and seven females) with an age of 63.4 ± 8.97 years (mean ± standard deviation). Main symptoms included abdominal pain (64%), weight loss (48%) and hematemesis or melena (32%). The most frequent tumour location was the body of the stomach (54.2%). All tumours were surgically resected and the majority of the patients had a partial gastrectomy (52%). Median recurrence time was 5 months and 12% of patients reached 5-year survival landmark. CONCLUSION PGM is a rare disease characterized by an aggressive malignant behaviour. Its differential diagnosis from a metastatic lesion is crucial. A prompt diagnosis and therapeutic approach are needed. Further studies are required to elucidate the optimal management of this clinical entity.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nefeli Tomara
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stratigoula Sakellariou
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free London, London, UK
| | - Anna Paspala
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios Mantas
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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