Intestinal Melanoma Diagnosed by Capsule Endoscopy

Abstract

Purpose: To present a rare case report of melanoma in the intestine. Methods: 72 year old female presented with past medical history significant for hypertension, status post cardiovascular accident, and status post cheek melanoma Clark IV resected in 2005. She presented with gastrointestinal bleeding that required two hospitalizations for blood transfusions, one time she required four units of blood. Upper endoscopy and colonoscopy were normal except for diverticulosis without evidence of bleeding; she underwent a small bowel series that showed multiple small bowel diverticulae. Results: The patient underwent capsule endoscopy that revealed two masses. Both were believed to be in the jejunum. The first mass was seen at 35 minutes of recording, the second one was at two hours and ten minutes and it was ulcerated with active bleeding. The differential diagnosis includes adenocarcenoma, lymphoma, sarcoma or metastasis from melanoma or other tumors. The patient underwent laparoscopy with removal of the tumors. The pathology revealed metastatic melanoma. Conclusion: Malignant melanoma has the propensity to metastasize widely. Despite the frequent autopsy findings of gastrointestinal (GI) tract involvement by melanoma, the antemortem diagnosis is rarely made. While most GI metastases from melanoma remain undetected, those that become symptomatic can cause life threatening problems, including intestinal haemorrhage, obstruction and perforation. The most common form of presentation is that of multiple submucosal implants which may grow intraluminally to cause intestinal obstruction. Although patients with gastrointestinal tract metastases from melanoma carry a poor prognosis, almost all patients with melanoma and GI tract metastases can have palliation of symptoms by surgical resection with minimal morbidity and mortality. Here, the diagnosis of metastasis in small bowel was not suspected, it was established only after capsule endoscopy and histological examination of the resected specimen. In patients with a history of melanoma, intestinal metastases should be the foremost differential diagnosis if anemia or abdominal pain is present. Furthermore, in patients with small bowel lesions, which colonoscopy and upper endoscopy failed to reveal the source of bleeding, capsule endoscopy should be considered.Figure: Masses on capsule endoscopy.