Malignant Melanoma of the Small Intestine

Abstract

Uniformly as fatal as melanomas occurring elsewhere in the body, malignant melanomas of the small intestine are extremely rare. To date only about 33 of these tumors involving the gastrointestinal tract have been reported in the literature. Of these, 22 were definitely metastatic lesions, while the exact nature of some of the others remains in doubt (1). A case apparently primary in the intestine is reported here. Case Report A 39-year-old white male was first seen after being under treatment elsewhere for eight months for chronic gastrointestinal bleeding, supposedly of duodenal ulcer origin. During the three months preceding admission he had lost 15 to 20 lb. of weight, had suffered from a pronounced anemia with a hemoglobin as low as 6 gm., and had received several transfusions. Occasionally he had experienced some abdominal cramps, usually mild but sometimes severe. Tarry but well formed stools had been an almost daily occurrence since the onset of illness, and it was this sign that had brought the patient originally to his family doctor. He was the father of six children and had always enjoyed good health. The family history revealed no striking disease predilection. On admission the patient was extremely pale but appeared well developed and “husky.” No physical abnormalities were noted. Laboratory studies disclosed the following: hemoglobin 9.0 gm.; red blood cell count 3,660,000; hematocrit 28.5 per cent; white cell count 10,000, with 84 per cent polymorphonuclears, 14 per cent lymphocytes, 2 per cent mononuclears. Bleeding, coagulation, and prothrombin times were normal. The results of urinalysis were normal, as were the Kahn test, blood urea nitrogen, and fasting blood sugar. On gastric analysis some slight increase in free acid was noted. Sigmoidoscopy revealed no lesion in the lower bowel. A chest film was negative. Gastro-duodenal x-ray studies were then undertaken, but no evidence of peptic ulcer could be found. However, a deformity of the descending limb of the duodenum was observed, along with similar deformities throughout the jejunum and proximal ileum. These were described as mucosal irregularities strongly suggesting multiple polyps of the small intestine (Figs. 1 and 2). An exploratory laparotomy was done and the preoperative diagnosis was confirmed. Throughout the entire small bowel, beginning at the junction of the first and second parts of the duodenum and extending all the way to the cecum, were countless polyps varying widely in size and shape. The other viscera, including the stomach and large bowel, showed no evidence of disease. Since no curative surgical procedure could be performed, a 20-cm. portion of jejunum was resected for diagnosis and a side-to-side anastomosis was carried out to close the bowel. The post-operative course was surprisingly smooth. The resected segment of bowel was truly remarkable.