1
|
Abu-Heija U, Darweesh M, Kusmic D, Young M. Primary Gastric Mucosal Melanoma: A Rare Etiology of Iron Deficiency Anemia. Cureus 2023; 15:e38668. [PMID: 37288180 PMCID: PMC10243225 DOI: 10.7759/cureus.38668] [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: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Iron deficiency anemia is a concerning finding, particularly in males and post-menopausal females, and can have numerous underlying causes. When evaluating potential sources of gastrointestinal blood loss, bidirectional endoscopy is often necessary. We report the case of an 89-year-old female with multiple comorbidities, including atrial fibrillation treated with apixaban, who presented with symptomatic iron deficiency anemia. Extensive dermatological and radiological assessments ruled out a primary source, and subsequent endoscopy identified a rare etiology: primary gastric mucosal melanoma. This case highlights the importance of thorough evaluation in identifying uncommon causes of iron deficiency anemia such as unsuspected malignancies, hereditary conditions, and different autoimmune conditions amongst other etiologies.
Collapse
Affiliation(s)
- Usama Abu-Heija
- Internal Medicine, East Tennessee State University, Johnson City, USA
- Medical Education, Jordan University of Science and Technology, Ar Ramtha, JOR
| | - Mohammad Darweesh
- Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Damir Kusmic
- Gastroenterology, East Tennessee State University, Johnson City, USA
| | - Mark Young
- Gastroenterology, East Tennessee State University, Johnson City, USA
| |
Collapse
|
2
|
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] [Accepted: 06/30/2022] [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.
Collapse
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
| |
Collapse
|
3
|
Primary Gastric Malignant Melanoma in a 68-Year-Old Woman: A Case Report and Review of the Literature. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:128-134. [PMID: 35911930 PMCID: PMC9289592 DOI: 10.12865/chsj.48.01.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
Abstract
Non-cutaneous melanoma is a very rare clinical entity. Gastric melanoma can be primary or secondary, but determining their nature is in most cases very challenging. To date, very few cases of primary gastric melanoma have been described in the literature. We report the first case of primary gastric melanoma documented in a Romanian patient, confirmed through clinical, imagistic, and pathological diagnosis. A 68-year-old female patient presented to our hospital with complaints of dyspepsia, abdominal pain, and weight loss. Esophagogastroduodenoscopy revealed two large sessile masses in the gastric fundus, which was histologically compatible with melanoma; immunohistochemistry staining was positive for vimentin, S100 protein, HMB45 antibody and Melan A/MART1, and negative for pan-CKAE1/AE3, leukocyte common antigen and DOG1. Extensive dermatological and ophthalmological examinations did not identify a primary lesion. The patient was therefore diagnosed with primary melanoma of the stomach. At the time of the diagnosis, multiple bone and pulmonary metastases were detected and considering the poor general status of the patient, surgery was not recommended. She died three months following diagnosis. A review of the literature identified only 32 other reported cases of primary gastric melanoma, all in individuals ≥50 years of age and most of them in male patients. Partial or total gastrectomy was the usual treatment of choice, but prognosis was overall poor. Awareness of this rare condition must be increased among healthcare providers, as early detection can improve survival chances.
Collapse
|
4
|
D'Orazio B, Bonventre S, Cudia B, Di Vita G, Geraci G. Early diagnosis of primary melanoma of caecum. Case report and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021112. [PMID: 34747384 PMCID: PMC10523045 DOI: 10.23750/abm.v92is1.11201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 11/23/2022]
Abstract
Malignant gastrointestinal melanoma is usually a metastatic lesion. We report the case of a 79-year-old female asymptomatic patient. Colonoscopy revealed one plane 15 mm pigmented lesion in the caecum. Neither CT scan of the abdomen nor right hemicolectomy revealed no metastatic disease. Histopathological examination of the surgical specimen was indicative of malignant melanoma.A set of additional enquires such as laboratory and imaging tests did not point out any suspicious lesions in the skin, eye, leptomeninges or other sites. Therefore, we made the diagnosis of primary colonic melanoma.The diagnosis of this disease is still a challange and often demanding for a multidisciplinary approach, involving the surgeon, onclogist and even immunotherapy or radiotherapy.
Collapse
Affiliation(s)
- Beatrice D'Orazio
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo; Postgraduate Medical School in General Surgery, University of Palermo, Palermo.
| | - Sebastiano Bonventre
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo.
| | - Bianca Cudia
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo.
| | - Gaetano Di Vita
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo.
| | - Girolamo Geraci
- General Surgery Unit - Department of Surgical, Oncological and Stomatological Sciences, University of Palermo.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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] [Received: 05/19/2020] [Accepted: 08/18/2020] [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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Khosla D, Zaheer S, Periasamy K, Rana S, Madan R, Gude G, Vasishta R, Kapoor R. Primary malignant melanoma of the stomach: A rare neoplasm. CLINICAL CANCER INVESTIGATION JOURNAL 2020. [DOI: 10.4103/ccij.ccij_77_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
10
|
Primary Mucosal Melanoma of the Stomach. Case Rep Gastrointest Med 2018; 2018:6040693. [PMID: 30159179 PMCID: PMC6109490 DOI: 10.1155/2018/6040693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/17/2018] [Accepted: 07/16/2018] [Indexed: 12/12/2022] Open
Abstract
Considered to be rare, mucosal melanomas are rare type of melanoma that are found on mucosal surfaces and are primary or metastatic in origin. We report a case of a 66-year-old Hispanic female who presented with vague abdominal pain and upon further endoscopic work-up revealed 2 gastric lesions. Endoscopic biopsy results revealed gastric melanoma in the distal lesion. A PET/CT scan indicated it to be suspicious for the primary site of metastasis but was ultimately diagnosed as a benign nevus on biopsy. An extensive clinical exam showed no other probable sites of origin. The patient underwent a subtotal Billroth II gastrectomy and enterostomy tube placement for temporary feeding. Primary melanoma of the stomach is an exceptionally rare occurrence with limited cases that can be accounted for in literature; thus we report this case for review.
Collapse
|
11
|
Raja J, Hegde R, Srodon M, Katoch A, Kurtzman S, Zhang Z. A Case of Primary Melanoma of the Transverse Colon. Cureus 2017; 9:e1803. [PMID: 29308331 PMCID: PMC5749940 DOI: 10.7759/cureus.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Melanoma is among the most prevalent neoplasms diagnosed annually with the vast majority arising from a cutaneous origin. Though there are described metastases to the gastrointestinal tract, there are only rare descriptions of primary gastrointestinal melanoma. Both diagnosis and management of this unique population can be challenging given the infrequency with which it occurs. To follow is the third reported case of transverse colon primary melanoma with a description of multimodality treatment with surgery, chemotherapy, and immunotherapy.
Collapse
Affiliation(s)
- Junaid Raja
- Internal Medicine and Radiology, Yale University School of Medicine
| | - Rakesh Hegde
- General and Colorectal Surgery, Waterbury Hospital
| | | | | | | | | |
Collapse
|
12
|
Hatano Y, Haruma K, Ayaki M, Kamada T, Ohtani H, Murao T, Manabe N, Mori H, Masaki T, Shiotani A. Black Spot, a Novel Gastric Finding Potentially Induced by Proton Pump Inhibitors. Intern Med 2016; 55:3079-3084. [PMID: 27803398 PMCID: PMC5140853 DOI: 10.2169/internalmedicine.55.6974] [Citation(s) in RCA: 10] [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] [Indexed: 12/17/2022] Open
Abstract
Objective We have recently discovered new gastric lesions with black spots. There have been no reports about black spots and their clinicopathological features. We therefore report the clinicopathological features of black spots and assess their causes and mechanisms. Methods Sixty-four patients with black spots among 26,620 Japanese patients that underwent endoscopy between May 2012 and October 2014 were enrolled. Endoscopic findings of black spots were defined as black pigmentations in the gastric mucosa by conventional endoscopy. We investigated the clinicopathological characteristics, including gender, age, underlying diseases and medications, endoscopic and pathologic findings of patients with black spots. Results The prevalence of patients with black spots was 0.24%. Of sixty-four cases, 44 (68.8%) were taking proton pump inhibitors (PPIs). Eight (12.5%) were taking corticosteroids. There were 10 cases (15.6%) with decreased renal function. All black spots were identified only in the fundic gland region. Forty-one (64.1%) patients had multiple (more than ten) black spots. There were two different types: black spots on the flat mucosa and black spots on fundic gland polyps. Pathologically, parietal cell protrusions, fundic gland cysts and brownish pigmentation in fundic gland cysts were seen in 26 (76.5%), 23 (67.6%) and 6 (17.6%) patients, respectively. Conclusion We herein describe gastric black spots as a new gastric mucosal finding that arises only in the fundic gland region. The black spots are pathologically brownish pigmentations in fundic gland cysts. Adverse events of PPIs and parietal cell protrusion caused by PPI use are strongly considered to be one of the etiologies of black spots.
Collapse
Affiliation(s)
- Yu Hatano
- Department of Internal Medicine, Mitsugi General Hospital, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Augustyn A, de Leon ED, Yopp AC. Primary gastric melanoma: case report of a rare malignancy. Rare Tumors 2015; 7:5683. [PMID: 25918612 PMCID: PMC4387358 DOI: 10.4081/rt.2015.5683] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/25/2015] [Accepted: 01/30/2015] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Alexander Augustyn
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Emma Diaz de Leon
- Department of Pathology, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Adam C Yopp
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas, TX, USA ; Division of Surgical Oncology, University of Texas Southwestern Medical Center , Dallas, TX, USA
| |
Collapse
|
14
|
Cho JM, Lee CM, Jang YJ, Park SS, Park SH, Kim SJ, Mok YJ, Kim CS, Lee JH, Kim JH. Primary gastric malignant melanoma mimicking adenocarcinoma. J Gastric Cancer 2015; 14:279-83. [PMID: 25580362 PMCID: PMC4286909 DOI: 10.5230/jgc.2014.14.4.279] [Citation(s) in RCA: 6] [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] [Indexed: 11/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jun-Min Cho
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - You-Jin Jang
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sung-Soo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seong-Heum Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung-Joo Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young-Jae Mok
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Chong-Suk Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ju-Han Lee
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
| | - Jong-Han Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Kottschade LA, Grotz TE, Dronca RS, Salomao DR, Pulido JS, Wasif N, Jakub JW, Bagaria SP, Kumar R, Kaur JS, Morita SY, Moran SL, Nguyen JT, Nguyen EC, Hand JL, Erickson LA, Brewer JD, Baum CL, Miller RC, Swanson DL, Lowe V, Markovic SN. Rare presentations of primary melanoma and special populations: a systematic review. Am J Clin Oncol 2014; 37:635-41. [PMID: 23563206 PMCID: PMC4349521 DOI: 10.1097/coc.0b013e3182868e82] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A subset of patients with melanoma present in rare and unique clinical circumstances requiring specific considerations with respect to diagnostic and therapeutic interventions. Herein, we present our review of patients with: (1) primary mucosal melanoma of the head and neck, gastrointestinal, and genitourinary tracts; (2) primary melanoma of the eye; (3) desmoplastic melanoma; (4) subungual melanoma; (5) melanoma in special populations: children, nonwhites, as well as a discussion of familial melanoma.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Riten Kumar
- Department of Pediatric Hematology/Oncology-Hospital for Sick Children, Toronto
| | | | - Shane Y. Morita
- The Queen’s Medical Center/Queen’s Cancer Center-University of Hawaii/John A Burns School of Medicine
| | | | | | | | - Jennifer L. Hand
- Department of Dermatology-Mayo Clinic
- Department of Pediatrics-Mayo Clinic
- Department of Medical Genetics-Mayo Clinic
| | | | | | | | | | | | - Val Lowe
- Department of Radiology-Mayo Clinic
| | - Svetomir N. Markovic
- Department of Oncology- Mayo Clinic
- Department of Hematology-Mayo Clinic
- Department of Immunology-Mayo Clinic
| |
Collapse
|
16
|
Slater JM, Ling TC, Slater JD, Yang GY. Palliative radiation therapy for primary gastric melanoma. J Gastrointest Oncol 2014; 5:E22-6. [PMID: 24490048 DOI: 10.3978/j.issn.2078-6891.2013.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/20/2013] [Indexed: 01/16/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Jason M Slater
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Ted C Ling
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Jerry D Slater
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Gary Y Yang
- Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| |
Collapse
|
17
|
Li G, Tang X, He J, Ren H. Intestinal obstruction due to primary intestinal melanoma in a patient with a history of rectal cancer resectioning: A case report. Mol Clin Oncol 2013; 2:233-236. [PMID: 24649338 DOI: 10.3892/mco.2013.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/09/2013] [Indexed: 01/01/2023] Open
Abstract
The vast majority of the cases of intestinal melanomas are metastatic lesions, originating from an occult primary cutaneous or ocular lesion, whereas primary small intestinal melanomas are extremely rare. This is a rare case of primary small intestinal malignant melanoma with intestinal obstruction in a patient with a prior history of rectal cancer resection. The patient was admitted for abdominal pain and obstipation. Following an overall inspection, the patient was subjected to surgical treatment and a small intestinal tumor was removed. The histopathological examination of the lesion revealed a diffuse neoplastic infiltration involving the entire thickness of the intestinal mucosa. The neoplastic cells exhibited marked atypia, pleomorphism and immunoreactivity to S-100, anti-melanoma antibody (HMB-45) and melanocyte/melanoma tumor antigen (Melan-A). The diagnosis of primary small intestinal melanoma was confirmed. The patient underwent an uneventful postoperative recovery and was administered adjuvant therapy. At the 3-month, 6-month and 1-year follow-up, the patient remained alive, with no signs of tumor metastasis and/or recurrence. In this case, the patient was repetitively assessed by abdominal computed tomography (CT) and plain film, confirming that the obstruction was caused by small intestinal melanoma. There was no association between the rectal cancer history and the melanoma. A definitive diagnosis requires detailed clinical, histopathological and immunohistochemical analyses.
Collapse
Affiliation(s)
- Gang Li
- Department of Surgical Oncology, The First Affiliated Hospital of School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaojiang Tang
- Department of Surgical Oncology, The First Affiliated Hospital of School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jianjun He
- Department of Surgical Oncology, The First Affiliated Hospital of School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Hong Ren
- Department of Surgical Oncology, The First Affiliated Hospital of School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
18
|
Aggarwal R, Dhawan S, Chopra P. Primary Gastric Melanoma: a Diagnostic Challenge. J Gastrointest Cancer 2013; 45 Suppl 1:33-5. [DOI: 10.1007/s12029-013-9530-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
19
|
Yamamura K, Kondo K, Moritani S. Primary malignant melanoma of the stomach: report of a case. Surg Today 2011; 42:195-9. [PMID: 22167480 PMCID: PMC3264870 DOI: 10.1007/s00595-011-0077-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 02/15/2011] [Indexed: 02/07/2023]
Abstract
We report a case of primary malignant melanoma (MM) of the stomach. The patient, a 73-year-old man, was referred to our hospital for investigation of an elevated lesion in the stomach, detected by gastroscopy. On admission, physical examinations and laboratory data were unremarkable. Gastroscopy revealed a pigmented, elevated tumor, approximately 2 cm in diameter, in the posterior wall of the stomach. A biopsy was taken, which resulted in a diagnosis of MM, based on the presence of melanin in tumor cells. F-18 fluorodeoxyglucose positron emission tomography showed no accumulation of tracer except for the tumor in the stomach, indicating that it was a primary MM of the stomach. The patient underwent distal gastrectomy, but died of recurrence 1 year later. Very few cases of primary MM of the stomach have been reported. Thus, we report this case, followed by a review of the literature.
Collapse
Affiliation(s)
- Kazuo Yamamura
- Department of Surgery, Nagoya National Hospital, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
| | | | | |
Collapse
|
20
|
O'Neill J, Khundar R, Knowles L, Scott-Young N, Orlando A. Melanoma with an unknown primary–a case series. J Plast Reconstr Aesthet Surg 2010; 63:2071-80. [DOI: 10.1016/j.bjps.2010.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 01/23/2010] [Accepted: 02/20/2010] [Indexed: 12/19/2022]
|
21
|
Ansidei V, Covarelli P, Tomassini GM, Messina S, Ciuffetti G, Simonetti S. [Subacute anaemia: An unusual presentation of giant melanoma]. Ann Dermatol Venereol 2010; 137:650-1. [PMID: 20932448 DOI: 10.1016/j.annder.2010.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 01/19/2010] [Accepted: 06/29/2010] [Indexed: 11/28/2022]
|
22
|
Simionescu O, Dumitrescu D, Costache M, Blum A. Dermatoscopy of an invasive melanoma on the upper lip shows possible association with Laugier-Hunziker syndrome. J Am Acad Dermatol 2009; 59:S105-8. [PMID: 19119112 DOI: 10.1016/j.jaad.2008.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 06/12/2008] [Accepted: 07/15/2008] [Indexed: 12/12/2022]
Abstract
We report mucosal melanoma of the upper lip in a patient affected by the Laugier-Hunziker disease. Using dermatoscopy, two distinct parts were identified in the same mucosal area: nodular (malignant) and macular (benign). A complete surgical excision was performed and the patient has been free of disease for 16 months.
Collapse
Affiliation(s)
- Olga Simionescu
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | | | | | | |
Collapse
|
23
|
Ravi A. Primary gastric melanoma: a rare cause of upper gastrointestinal bleeding. Gastroenterol Hepatol (N Y) 2008; 4:795-797. [PMID: 21960901 PMCID: PMC3104388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Anupama Ravi
- Division of Digestive Diseases, Emory University, Atlanta, Georgia
| |
Collapse
|
24
|
Presumed primary malignant melanoma of the liver: a case report. Clin J Gastroenterol 2008; 1:75-79. [PMID: 26193467 DOI: 10.1007/s12328-008-0014-3] [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: 01/29/2008] [Accepted: 04/10/2008] [Indexed: 10/22/2022]
Abstract
A 55-year-old woman was hospitalized with a palpable and painful mass in her upper abdomen. Abdominal computed tomography revealed a 10 × 7-cm tumor extending into the abdominal cavity from the left hepatic lobe and multiple metastatic lesions in the right hepatic lobe. A left hepatic lobectomy was performed for debulking and palliative resection. Histopathological examination of the resected specimen diagnosed the large hepatic tumor in the left hepatic lobe as a malignant melanoma. Physical and radiological examinations were performed on dermatological, ophthalmic, gynecological, and central nervous system areas, and endoscopic examinations were performed on the upper digestive tract and colon. No other lesions were disclosed as possible primary tumors for the disease. This result suggested that the tumor might arise from the left hepatic lobe.
Collapse
|
25
|
Manouras A, Genetzakis M, Lagoudianakis E, Markogiannakis H, Papadima A, Kafiri G, Filis K, Kekis PB, Katergiannakis V. Malignant gastrointestinal melanomas of unknown origin: Should it be considered primary? World J Gastroenterol 2007; 13:4027-9. [PMID: 17663525 PMCID: PMC4171183 DOI: 10.3748/wjg.v13.i29.4027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
26
|
Resta G, Anania G, Messina F, de Tullio D, Ferrocci G, Zanzi F, Pellegrini D, Stano R, Cavallesco G, Azzena G, Occhionorelli S. Jejuno-jejunal invagination due to intestinal melanoma. World J Gastroenterol 2007; 13:310-2. [PMID: 17226915 PMCID: PMC4065964 DOI: 10.3748/wjg.v13.i2.310] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cutaneous melanoma is one of the most studied neoplastic lesions in biology and clinical oncology. It has been well documented that this type of neoplasm presents a high metastatic rate, and is able to involve nearly every tissue. Non-cutaneous melanoma represents an unusual pattern of melanoma, and the small intestine is an uncommon anatomic localization. Herein we report an extremely rare clinical case of a young woman affected by a bleeding jejunal melanoma, whose early clinical presentation was an intestinal invagination.
Collapse
Affiliation(s)
- Giuseppe Resta
- Università degli Studi di Ferrara, Dipartimento di Scienze Chirurgiche Anestesiologiche e Radiologiche, Istituto di Clinica Chirurgica, Arcispedale S. Anna, Corso Giovecca, Ferrara 203-44100, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|