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Navajas Hernández P, Del Pino Bellido P, Aparcero López R, Machuca Aguado J, Caunedo Álvarez Á. A rare gastrointestinal tumor: primary gastric melanoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:278-279. [PMID: 36263830 DOI: 10.17235/reed.2022.8715/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Primary gastric melanoma is an exceptional tumour with less than 20 cases described in the literature, as its origin is not entirely clear as the presence of melanocytes in the stomach has not been demonstrated. Symptomatology is non-specific, which prevents its early detection, and it is diagnosed in late stages. We present the case of a patient who was admitted to our hospital for vomiting in coffee grounds with analytical and haemodynamic repercussions. Urgent gastroscopy revealed a gastric lesion suspicious for malignancy, which was histologically confirmed as gastric melanoma. The therapeutic approach to these tumours is complex and they have a very poor prognosis.
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Bangolo A, Fwelo P, Sagireddy S, Shah H, Trivedi C, Bukasa-Kakamba J, Patel R, Bharane L, Randhawa MK, Nagesh VK, Dey S, Terefe H, Kaur G, Dinko N, Emiroglu FL, Mohamed A, Fallorina MA, Kosoy D, Waqar D, Shenoy A, Ahmed K, Nanavati A, Singh A, Willie A, Gonzalez DMC, Mukherjee D, Sajja J, Proverbs-Singh T, Elias S, Weissman S. Interaction between Age and Primary Site on Survival Outcomes in Primary GI Melanoma over the Past Decade. Med Sci (Basel) 2023; 11:medsci11020032. [PMID: 37218984 DOI: 10.3390/medsci11020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Primary malignant melanomas of the Gastrointestinal mucosa are uncommon. Most cases of gastrointestinal (GI) melanomas are secondary, arising from metastasis at distant sites. The purpose of this study is to assess to what extent the interaction between independent prognostic factors (age and tumor site) of primary GI melanoma influence survival. Furthermore, we also aimed to investigate the clinical characteristics, survival outcomes, and independent prognostic factors of patients with primary GI melanoma in the past decade. METHODS A total of 399 patients diagnosed with primary GI melanoma, between 2008 and 2017, were enrolled in our study by retrieving data from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of primary GI melanoma. Variables with a p value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model (model 1) to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. Furthermore, we analyzed the effect of the interaction between age and primary location on mortality (model 2). RESULTS Multivariate cox proportional hazard regression analyses revealed higher OM in age group 80+ (HR = 5.653, 95% CI 2.212-14.445, p = 0), stomach location of the tumor (HR = 2.821, 95% CI 1.265-6.292, p = 0.011), regional lymph node involvement only (HR = 1.664, 95% CI 1.051-2.635, p < 0.05), regional involvement by both direct extension and lymph node involvement (HR = 1.755, 95% CI 1.047-2.943, p < 0.05) and distant metastases (HR = 4.491, 95% CI 3.115-6.476, p = 0), whereas the lowest OM was observed in patients with small intestine melanoma (HR = 0.383, 95% CI 0.173-0.846, p < 0.05). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups and lower CSM in small intestine and colon melanoma excluding the rectum. For model 2, considering the interaction between age and primary site on mortality, higher OM was found in age group 80+, followed by age group 40-59 then age group 60-79, regional lymph node involvement only, regional involvement by both direct extension and lymph node involvement and distant metastases. The small intestine had a lower OM. The rectum as primary location and the age range 40-59 interacted to lower the OM (HR = 0.14, 95% CI 0.02-0.89, p = 0.038). Age and primary gastric location did not interact to affect the OM. For the CSM, taking into account the interaction between age and the primary location, higher mortality was found in the same groups and the colon location. The primary colon location also interacted with the age group 40-59 to increase the CSM (HR = 1.38 × 109, 95% CI 7.80 × 107-2.45 × 1010, p = 0). CONCLUSIONS In this United States population-based retrospective cohort study using the SEER database, we found that only the age range 40-59 interacted with the rectum and colon to lower and increase mortality respectively. Primary gastric location, which was the single most important location to affect mortality, did not interact with any age range to influence mortality. With those results, we hope to shed some light on this rare pathology with a very dismal prognosis.
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Affiliation(s)
- Ayrton Bangolo
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Pierre Fwelo
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Sowmya Sagireddy
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Harin Shah
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Chinmay Trivedi
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - John Bukasa-Kakamba
- Department of Endocrinology, Kinshasa University Clinics, Kinshasa 190, Democratic Republic of the Congo
| | - Rutvij Patel
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Luke Bharane
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Manraj K Randhawa
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Vignesh K Nagesh
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Shraboni Dey
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Hannah Terefe
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Gagan Kaur
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Nicholas Dinko
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Fatma Lina Emiroglu
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Ahmed Mohamed
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Mark A Fallorina
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - David Kosoy
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Danish Waqar
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Ankita Shenoy
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Kareem Ahmed
- Department of Internal Medicine, University of Washington, Seattle, WA 98195, USA
| | - Anvit Nanavati
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Amritpal Singh
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Anthony Willie
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Diego M C Gonzalez
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Deblina Mukherjee
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Jayadev Sajja
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Tracy Proverbs-Singh
- Department of Gastrointestinal Malignancies, Hackensack Meridian Health/John Theurer Cancer Center, North Bergen, NJ 07047, USA
| | - Sameh Elias
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
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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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Xu YF, Jin SE. Oral malignant melanoma with gastric metastasis and hemorrhage: A case report. Shijie Huaren Xiaohua Zazhi 2022; 30:420-424. [DOI: 10.11569/wcjd.v30.i9.420] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the gastrointestinal tract is a relatively common site of melanoma metastases, reports of digestive tract hemorrhage caused by melanoma are very rare. The metastatic route is still unclear, though it is considered as implant metastasis in oral malignant melanoma.
CASE SUMMARY We report the case of an 88-year-old man who was admitted to our hospital with hematemesis and melena. By endoscopic inspection, he was diagnosed with active hemorrhage caused by primary gastric cancer or gastric stromal tumor. Eventually, he underwent surgical resection treatment and was discharged. At the outpatient review 3 wk postoperatively, it was noted that an oral melanoma which had been overlooked preoperatively had enlarged several times and was eventually considered to be the primary focus of the gastrointestinal melanoma. The patient passed away at home after 1 mo.
CONCLUSION In the present case, an oral cavity mass was found but not further identified, which caused misdiagnosis. The possibility of malignant melanoma should be considered when encountering a gastrointestinal mass, especially when combined with mucocutaneous melanoma. In patients who have pure cutaneous melanoma, attention should also be paid to their gastrointestinal symptoms, with regular gastrointestinal endoscopy or systemic examination performed.
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Affiliation(s)
- Yi-Fan Xu
- Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Shan-En Jin
- General Surgery Department, People's Hospital, Hangzhou 310000, Zhejiang Province, China
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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.
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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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Younes AI, Mohamed A, Rizvi AH, Prenshaw K. Primary malignant melanoma of the gastric antrum: A case report. Clin Case Rep 2021; 9:e04495. [PMID: 34188931 PMCID: PMC8218325 DOI: 10.1002/ccr3.4495] [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: 12/22/2020] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 11/09/2022] Open
Abstract
Primary melanoma of the antrum is a rare and aggressive disease. Diagnosis requires a correlation between the patient's history, tumor histopathology, and immunohistochemistry. Surgery and mutation-targeted treatments may improve overall survival.
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Affiliation(s)
- Ahmed I. Younes
- Department of Pathology and Laboratory MedicineEast Carolina University/Vidant Medical CenterGreenvilleNCUSA
| | - Anas Mohamed
- Department of Pathology and Laboratory MedicineEast Carolina University/Vidant Medical CenterGreenvilleNCUSA
| | - Areeba H. Rizvi
- Department of Pathology and Laboratory MedicineEast Carolina University/Vidant Medical CenterGreenvilleNCUSA
| | - Karyn Prenshaw
- Department of Pathology and Laboratory MedicineEast Carolina University/Vidant Medical CenterGreenvilleNCUSA
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8
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Long GJ, Ou WT, Lin L, Zhou CJ. Primary gastric melanoma in a young woman: A case report. World J Clin Cases 2020; 8:6425-6431. [PMID: 33392326 PMCID: PMC7760428 DOI: 10.12998/wjcc.v8.i24.6425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/10/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Most melanomas identified in the stomach are metastatic. The primary gastric melanoma (PGM) is extremely rare. As such, clinical reports of PGM are scarce in the literature, lending to the challenge of diagnosis and treatment.
CASE SUMMARY A 31-year-old woman presented with a 1-mo history of dysphagia but no symptoms of abdominal pain, abdominal distension, nausea, vomiting, hematemesis, or melena. The patient reported an unintentional weight loss of 6 kg within that time. History-taking revealed no previous medical conditions or surgical events. Abdominal computed tomography at a local hospital had suggested gastric tumor. Endoscopic examination in our hospital found a large, irregular, black mass. Subsequent laparoscopic exploration found the tumor on the side of the stomach fundus penetrating through the serosa, and enlarged lymph nodes (groups 1, 3, 7, and 9) fused into a mass, surrounding the peripheral artery and inseparable. Postoperative immunohistochemistry suggested gastric malignant melanoma. Positron emission tomography-computed tomography confirmed PGM. Treatment with programmed cell death protein 1 antagonist (toripalimab) plus chemotherapy (paclitaxel) was initiated but discontinued upon tumor bleeding. At the last telephone follow-up, the patient reported poor general condition but was alive.
CONCLUSION Although unresolved and ongoing, this rare case of PGM expands the overall knowledge about this rare tumor’s diagnosis and management.
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Affiliation(s)
- Guo-Jie Long
- Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, Guangdong Province, China
| | - Wen-Ting Ou
- Department of Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, Guangdong Province, China
| | - Lin Lin
- Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, , Zhanjiang 524002, Guangdong Province, China
| | - Cai-Jin Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, , Zhanjiang 524002, Guangdong Province, China
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Abstract
Primary gastric malignant melanoma (PGMM) is an extremely rare clinical entity, and few cases have been described in the literature. Here, we report a histologically confirmed PGMM case of a 74-year-old man with a mass in the stomach found by gastroscopy. The patient had no history of melanoma. This rare disease may be misdiagnosed for another gastric malignant tumor type when there is no known primary lesion. Early detection and surgical intervention are critical for long term survival or cure, though the tumor is often advanced at the time of diagnosis and is associated with a dismal outcome.
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Affiliation(s)
- Konstantinos Kosmas
- Cytology Department, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
| | - Ioannis Vamvakaris
- Pathology Department, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
| | - Eleni Psychogiou
- Pathology Department, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
| | - Eirini Klapsinou
- Department of Cytology, Diagnostic and Therapeutic Center of Athens "Hygeia", Athens, GRC
| | - Dimitra Riga
- Pathology Department, General Hospital of Thoracic Diseases of Athens "Sotiria", Athens, GRC
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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] [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.
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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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12
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Wang J, Yang F, Ao WQ, Liu C, Zhang WM, Xu FY. Primary gastric melanoma: A case report with imaging findings and 5-year follow-up. World J Gastroenterol 2019; 25:6571-6578. [PMID: 31802836 PMCID: PMC6886020 DOI: 10.3748/wjg.v25.i44.6571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Fang Yang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Wei-Qun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Chang Liu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Wen-Ming Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Fang-Yi Xu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Intraepithelial Melanoma in the Stomach After Treatment With Immune Checkpoint Blockade Therapy. Am J Dermatopathol 2018; 39:e116-e118. [PMID: 28248716 DOI: 10.1097/dad.0000000000000859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Melanoma is the most common tumor to metastasize to the gastrointestinal tract, commonly affecting the small intestine, colon, and anorectum. Primary mucosal melanoma can arise in any gastrointestinal site, most frequently affecting anorectal mucosa. Melanoma involving the gastric mucosa, specifically, is exceedingly rare and carries a poor prognosis with a median survival of 5 months. The presence of atypical melanocytes exclusively within gastric epithelium has not been previously described. We report a case of a 52-year-old man with widespread BRAFV600E mutant metastatic melanoma who was referred to our institution for immune checkpoint antibody-blockade therapy. The patient had previously been treated with BRAF inhibitors, and despite initial response to therapy, developed resistance leading to disease progression and multiorgan involvement including the liver, spleen, and axial skeleton. Immune checkpoint antibody blockade with ipilimumab and pembrolizumab has been shown to induce significant tumor regression in patients with melanoma by upregulating T-cell activity and removing the natural check on the host immune response. After his first dose of combination therapy, the patient underwent an upper gastrointestinal tract endoscopy for severe nausea and was found to have 2 pigmented lesions within the gastric body, one of which was biopsied. The biopsy showed gastric body-fundic type mucosa with melanophages and scattered atypical intraepithelial melanocytes within the lamina propria, which were strongly positive for S100, HMB45, SOX10, and MITF. A Fontana-Masson silver stain was performed for confirmation. The finding of predominantly atypical intraepithelial melanocytes associated with melanin pigment was interpreted as metastatic melanoma to the stomach with some regression in response to immune checkpoint blockade therapy.
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Bolzacchini E, Marcon I, Bernasconi G, Pinotti G. Primary melanoma of the stomach treated by BRAF inhibitor and immunotherapy. Dig Liver Dis 2016; 48:974. [PMID: 27158123 DOI: 10.1016/j.dld.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Elena Bolzacchini
- U.O. Oncologia Medica, Ospedale di Circolo e Fondazione Macchi, Azienda Socio Sanitaria dei Sette Laghi, Varese, Italy.
| | - Ilaria Marcon
- U.O. Oncologia Medica, Ospedale di Circolo e Fondazione Macchi, Azienda Socio Sanitaria dei Sette Laghi, Varese, Italy
| | - Giordano Bernasconi
- U.O. Medicina ad indirizzo Gastroenterologico, Presidio ospedaliero di Busto Arsizio, Azienda Socio Sanitaria territoriale ASST della Valle Olona, Busto Arsizio, Italy
| | - Graziella Pinotti
- U.O. Oncologia Medica, Ospedale di Circolo e Fondazione Macchi, Azienda Socio Sanitaria dei Sette Laghi, Varese, Italy
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