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Sinha R, Osama MA, Rabab S, Jaiswal CP. A nuanced exploration delving into malignant melanomas occurring in unexpected and less common anatomical locations. J Family Med Prim Care 2024; 13:800-803. [PMID: 38605775 PMCID: PMC11006043 DOI: 10.4103/jfmpc.jfmpc_1778_23] [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: 11/04/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 04/13/2024] Open
Abstract
Malignant melanoma originates from melanoma cells, which derive from the neuroectoderm of the ectodermal mucosa. The chameleonic presentation of malignant melanoma, its often asymptomatic nature, the rarity of the lesion, the grim prognosis, and the imperative for highly specialized treatment are critical factors that merit careful consideration. Herein, we report a compilation of five cases of malignant melanomas occurring at unusual anatomical locations, which were initially misdiagnosed, which on careful analysis with the use of immuno-histochemical stains were correctly diagnosed as malignant melanoma.
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Affiliation(s)
- Reena Sinha
- Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India
| | - Md Ali Osama
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Shadan Rabab
- Department of Pathology, Narayan Medical College and Hospital, Sasaram, Bihar, India
| | - CP Jaiswal
- Department of Pathology, Nalanda Medical College and Hospital, Patna, Bihar, India
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Marak JR, Raj G, Dwivedi S, Zaidi A. Primary anorectal amelanotic melanoma with liver, lungs and lymph nodal metastases. BMJ Case Rep 2023; 16:e257510. [PMID: 37977845 PMCID: PMC10660163 DOI: 10.1136/bcr-2023-257510] [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: 11/19/2023] Open
Abstract
Anorectal melanoma (ARM) is an exceedingly rare and very aggressive malignancy. It originates from the melanocytic cells in the anorectal mucosa, which produces melanin. Other mucosal melanomas commonly found in the mucosa of the oral cavity, vulvovaginal, pharynx and urinary tract. Patients usually present with bleeding per rectum, perianal pain and difficulty in defaecation. Distinction of primary anorectal melanoma from other tumours of this region is difficult because of the lack of common imaging features. MRI is the modality of choice for its better tissue characterisation and resolution. There is no standard treatment protocol available mainly due to scarcity of data. Surgery is the mainstay therapy. Herein we present a case of a male patient in his 30s who presented with rectal bleeding and perianal pain. Haematological analysis revealed normocytic normochromic anaemia. MRI detected a mass lesion in the anorectal region. Contrast enhanced CT revealed multiple metastases in the liver, lungs, periportal, mesorectal and inguinal lymph nodes. The diagnosis of the ulcerated anorectal melanoma was established on histopathological examination. The patient underwent abdominoperineal resection (APR) followed by chemotherapy. Afterward the patient presented to the emergency room with respiratory distress for which he was on ventilator support. Sadly, the patient died after four days.
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Affiliation(s)
- James R Marak
- Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Gaurav Raj
- Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Shivam Dwivedi
- Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Ariba Zaidi
- Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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Primary malignant melanoma of rectum: A rare case report. Int J Surg Case Rep 2023; 104:107942. [PMID: 36801769 PMCID: PMC9957745 DOI: 10.1016/j.ijscr.2023.107942] [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: 02/07/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Malignant melanoma of the gastrointestinal tract is an extremely rare event of which 50 % occurs in anorectal region. The lesion can easily be misdiagnosed as rectal-carcinoma, which comprises >90 % of rectal tumors and has a different treatment. The behavior of the anorectal melanoma is very aggressive and has very poor prognosis with fatal outcome. PRESENTATION OF CASE A 48-year-old man presented complaining of rectal bleeding of two months' duration, without any other significant history. Colonoscopy showed a polypoidal mass in the rectum that was in favor of adenocarcinoma. The microscope examination of biopsy tissue showed sheets of poorly differentiated malignant neoplasm. Immuno-histochemical (IHC) staining showed negativity of pan Cytokeratin and CD31. IHC for HMB45 showed diffuse and strong positivity in neoplastic cells, confirming the diagnosis of malignant melanoma. CLINICAL DISCUSSION According to a report by the National Cancer Database of the United States, primary rectal melanoma is very rare. Mucosal surface of the body is third most common site for primary melanoma after skin and eye. The first case of anorectal melanoma was reported in 1857. Histopathological examinations are gold standard for diagnosis, but histopathology examination without immunohistochemistry will misdiagnose some cases as poorly differentiated adenocarcinoma which has completely different treatment. Surgical resection has been reported as the most useful treatment option. CONCLUSION Malignant melanoma of the rectum is extremely rare and difficult to diagnose in low resources settings. Histopathologic examination with IHC stains can differentiate poorly differentiated adenocarcinoma from melanoma and other rare tumors of anorectal region.
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Apostu RC, Stefanescu E, Scurtu RR, Kacso G, Drasovean R. Difficulties in diagnosing anorectal melanoma: A case report and review of the literature. World J Clin Cases 2021; 9:11369-11381. [PMID: 35071568 PMCID: PMC8717525 DOI: 10.12998/wjcc.v9.i36.11369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/15/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anorectal melanoma is a tumour that is difficult to identify due to its rarity and variability of presentation. Insufficient data published in the literature do not allow for diagnostic and treatment guidelines to be established. Anorectal melanoma has the worst prognosis among mucosal melanomas and is frequently misdiagnosed by standard identification methods.
CASE SUMMARY A 66-year-old woman presented with intermittent anal bleeding, pain, and tenesmus in the past month, with no associated weight loss. Colonoscopy revealed a cauliflower-like tumour with a diameter of 1.5 cm, with exulcerated areas and an adherent clot but without obstruction. Biopsy results identified an inflammatory rectal polyp with nonspecific chronic rectitis. Tumour markers CA 19-9 and CEA were within the normal range. After 6 mo, due to the persistence of symptoms, a pelvic magnetic resonance imaging scan was performed. A lesion measuring 2.8 cm × 2.7 cm × 2.1 cm was identified at the anorectal junction, along with two adjacent lymphadenopathies. No distant metastases were detected. Immunohistochemistry was performed on the second set of biopsies, and a diagnosis of anorectal melanoma was established. Surgical treatment by abdominoperineal resection was performed. Evolution was marked by the appearance of lung metastases at 1 mo postoperatively, detected on a positron emission tomography-computer tomography scan, and perineal recurrence after 5 mo. After molecular testing, the patient was included in an immunotherapy trial.
CONCLUSION This case highlights the difficulty of establishing a definitive early diagnosis of anorectal melanoma, the importance of performing histological analysis on a well-represented biopsy specimen, and the poor prognosis, even with radical surgery.
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Affiliation(s)
- Raluca Cristina Apostu
- Department of Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Elena Stefanescu
- Department of Anesthesia and Intensive Care, Emergency County Clinical Hospital, Cluj-Napoca 400006, Romania
| | - Radu Razvan Scurtu
- Department of Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj Napoca 400006, Romania
| | - Gabriel Kacso
- Department of Medical Oncology and Radiotherapy, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Radu Drasovean
- Department of Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
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Nguyen MT, Nguyen VM, Tran VH, Pham AV. A case report of anorectal malignant melanoma in the transitional zone. Int J Surg Case Rep 2020; 75:264-268. [PMID: 32979823 PMCID: PMC7519280 DOI: 10.1016/j.ijscr.2020.09.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Anorectal malignant melanoma is an uncommon and highly malignant disease with a greater incidence in females. Many patients were misdiagnosed as hemorrhoids, benign polyps, and rectal cancer. They were often diagnosed in an advanced stage. Wide local excision and abdominoperineal resection are the main treatments of rectal melanoma. PRESENTATION OF CASE A case report is a 77-year-old man who has blood in the stool for 4 months without clinical examination. He admitted to the emergency room with sudden syndromes that related to bowel perforation. Rectal examination detected a large anorectal polyp. Computer tomography showed free air and fluid in the peritoneal cavity. He was received laparoscopic surgery and found the fishbone penetrated the sigmoid colon without polyp resection. The polyp was treated by local excision a few days later. The histology examination was a primary malignant melanoma. Due to the pigmented lesion that remained from the resected polyp's root, the abdominoperineal resection was performed as a radical treatment. DISCUSSION Diagnosis of anorectal malignant melanoma is difficult because of atypical signs, that are confused with bleeding hemorrhoids especially an amelanotic melanoma. Treatment is controversial, including surgery, radiotherapy, chemotherapy, and target therapy. A present case is an option in radical surgery. CONCLUSION Anorectal melanoma is a rare disease with poor results and prognosis. A lack of large-data leads to a missing evidence-based guideline in this disease. Early-staging diagnosis and surgical treatment help patients improve their overall survival.
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Affiliation(s)
- Minh Thao Nguyen
- Digestive Surgery Department, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy, Hue University, 49126, Hue City, Viet Nam.
| | - Van Mao Nguyen
- Pathology Department, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy, Hue University, 49126, Hue City, Viet Nam.
| | - Van Huy Tran
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, 49126, Hue City, Viet Nam.
| | - Anh Vu Pham
- Digestive Surgery Department, Hue University of Medicine and Pharmacy Hospital, Hue University of Medicine and Pharmacy, Hue University, 49126, Hue City, Viet Nam.
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Lian J, Xu A, Chu Y, Chen T, Xu M. Early primary anorectal malignant melanoma treated with endoscopic submucosal dissection: a case report. Int J Colorectal Dis 2020; 35:959-961. [PMID: 32124048 DOI: 10.1007/s00384-020-03546-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anorectal malignant melanoma (ARMM) is a rare disease accounting for less than 1% of primary anorectal malignancies. Here we first present a case of early primary anorectal malignant melanoma completely resected by endoscopic submucosal dissection (ESD). METHODS AND RESULTS A 43-year-old woman visited our hospital because of suspected anal melanoma found by routine colonoscopy in her local hospital. Following series of tests including CT, MRI, and whole-body PET-CT did not show any evidence of metastasis. The lesion was removed by the method of ESD in en bloc and no delayed bleeding or perforation occurred. The result of histopathologic examinations confirmed to be malignant melanoma. No recurrence or distant metastases were found during follow-up time (the latest follow-up was 2 years after ESD). CONCLUSION The present case showed endoscopic submucosal dissection that can be an effective and safe alternative treating early primary anorectal malignant melanoma.
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Affiliation(s)
- Jingjing Lian
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Aiping Xu
- Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Yuan Chu
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Tao Chen
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Meidong Xu
- Endoscopy Center, Shanghai East Hospital, Tongji University, Shanghai, China.
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Yi NH, Lee SH, Lee SH, Kim JH, Jee SR, Seol SY. Primary malignant melanoma without melanosis of the colon. Intest Res 2019; 17:561-564. [PMID: 31302994 PMCID: PMC6821945 DOI: 10.5217/ir.2019.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/14/2019] [Indexed: 11/22/2022] Open
Abstract
Primary malignant melanoma (PMM) of the gastrointestinal tract is rare. Reported cases of PMM of the lower gastrointestinal tract typically describe anal and rectal involvement rather than colonic lesions. This report describes a rare case of a 50-year-old woman with PMM originating in the colon. The patient presented to Inje University Busan Paik Hospital with a 3-day history of blood-tinged stools. She underwent colonoscopy for a diagnosis of hematochezia. The colonoscopic examination revealed a large-sized semi-pedunculated sigmoid colon polyp with a reddish-colored mucosal surface. Endoscopic mucosal resection was performed, and the final histopathological findings were consistent with a diagnosis of malignant melanoma. Systemic work-up was performed for assessment of metastasis and to identify the primary tumor considering the high metastatic rate of gastrointestinal malignant melanoma; however, no other malignant lesion was detected. Thus, she was diagnosed with colonic PMM. She underwent laparoscopic low anterior resection and lymph node dissection and has been recurrence-free for > 2 years.
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Manabe S, Boku Y, Takeda M, Usui F, Hirata I, Takahashi S. Endoscopic submucosal dissection as excisional biopsy for anorectal malignant melanoma: A case report. World J Clin Cases 2019; 7:1652-1659. [PMID: 31367624 PMCID: PMC6658369 DOI: 10.12998/wjcc.v7.i13.1652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anorectal malignant melanoma (AMM) is a rare disorder with an extremely poor prognosis. Although there is currently no consensus on the treatment methods for AMM, surgical procedures have been the most common treatment methods used until now. We recently encountered a case of AMM that we diagnosed using endoscopic submucosal dissection (ESD). To our knowledge, this is the first case of ESD for AMM, suggesting that ESD can potentially be a diagnostic and treatment method for AMM.
CASE SUMMARY A 77-year-old woman visited our hospital with a chief complaint of anal bleeding and a palpable rectal mass. Colonoscopy revealed a 20-mm protruded lesion in the lower rectum. After obtaining biopsy specimens from the lesion, although a malignant rectal tumor was suspected, a definitive diagnosis was not made. Endoscopic ultrasonography revealed tumor invasion into the submucosal layer but not the muscular layer. Therefore, we performed an excisional biopsy using ESD. Immunohistochemical examination of the ESD-resected specimen revealed tumor cells positive for Human Melanin Black-45, Melan-A, and S-100. Moreover, the tumor cells lacked melanin pigment; thus, a diagnosis of amelanotic AMM was made. Although the AMM had massively invaded the submucosal layer and both lymphatic and venous invasion were present, we closely monitored the patient without any additional therapy on the basis of her request. Six months after ESD, local recurrence was detected, and the patient consented to wide local excision.
CONCLUSION It is suggested that ESD is a potential diagnostic and treatment method for AMM.
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Affiliation(s)
- Shigeo Manabe
- Department of Gastroenterology, Kouseikai Takeda Hospital, Kyoto 600-8558, Japan
| | - Yoshio Boku
- Fujita Clinic, 67, Gokiya-cho, Oomiya-dori Shichijo-kudaru, Shimogyo-ku, Kyoto 600-8267, Japan
| | - Michiyo Takeda
- Department of Gastroenterology, Kouseikai Takeda Hospital, Kyoto 600-8558, Japan
| | - Fumitaka Usui
- Department of Gastroenterology, Kouseikai Takeda Hospital, Kyoto 600-8558, Japan
| | - Ikuhiro Hirata
- Department of Gastroenterology, Kouseikai Takeda Hospital, Kyoto 600-8558, Japan
| | - Shuji Takahashi
- Department of Gastroenterology, Kouseikai Takeda Hospital, Kyoto 600-8558, Japan
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Tchelebi L, Guirguis A, Ashamalla H. Rectal melanoma: epidemiology, prognosis, and role of adjuvant radiation therapy. J Cancer Res Clin Oncol 2016; 142:2569-2575. [PMID: 27620741 DOI: 10.1007/s00432-016-2245-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Rectal melanoma (RM) is a lethal malignancy which is not well understood. While cases are rising, data concerning effective management are limited. The present paper sought to elucidate the epidemiology and prognosis of RM, while also analyzing the role of adjuvant radiation therapy (RT). METHODS We used the surveillance, epidemiology, and end results program to find all cases of RM diagnosed between 2004 and 2011. Patients 18 or older with non-metastatic disease who had undergone surgery were included. Data regarding the age, race, sex, marital status, stage, and radiation sequence with surgery were extracted from the database and analyzed. Disease-free (DFS) and overall survival (OS) was studied for the group overall and between subgroups. RESULTS Median age at diagnosis was 69 years. RM is significantly more common in whites compared to nonwhites and occurs equally in males and females. Most patients are diagnosed at an early stage. Prognosis is poor with a median DFS of 27 months and median OS of 22 months. There were no differences in outcomes based on age, sex, marital status, or stage; however, OS was improved in nonwhites as compared to whites (P = 0.04). RT did not improve DFS (27 vs 28 months for surgery vs surgery and radiation, P = 0.82) or OS (19 vs 22 months for surgery vs surgery and radiation P=0.80) regardless of stage. CONCLUSIONS RM is an aggressive disease primarily affecting older, white patients. RT does not improve survival, regardless of stage. Optimal management of this lethal disease remains to be elucidated.
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Affiliation(s)
- Leila Tchelebi
- Department of Radiation Oncology, Weill Cornell Medical College, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
| | - Adel Guirguis
- Department of Radiation Oncology, Weill Cornell Medical College, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Hani Ashamalla
- Department of Radiation Oncology, Weill Cornell Medical College, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
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