Intestinal Melanoma Research Articles

Management of intussusception in patients with melanoma.

Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma.. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

Primary malignant melanoma of the duodenum: a rare case report

Malignant melanoma especially primary melanoma is uncommon in the gastrointestinal (GI) tract. GI melanomas are usually metastatic from skin melanoma. Anorectal region and small bowel are the most common sites of primary and metastatic GI melanoma respectively. Various theories have been put forward to explain the origin of Primary Melanoma of Small intestine. Melanomas of the GI tract can produce range of symptoms based on their location and size. Surgery is the main stay of treatment for localized disease. We reported a case of primary duodenal melanoma which was managed by surgically.

Primary and secondary mucosal melanoma of the small intestine - a clinical, pathological, and genetic nationwide survey of Danish patients between 1980 and 2014.

The aim of this study was to describe the epidemiology, symptomatology, pathology, genetics, and treatment of primary and metastatic small intestine melanoma in a national Danish cohort. All Danish patients diagnosed with small intestinal melanoma during the period 1980-2014 were included. For each patient, clinical data along with available pathology report and tissue was registered. Targeted next-generation sequencing (NGS) of known hotspots in 50 oncogenic genes was performed. Twenty patients with small intestinal melanoma were retrieved. Eight of these were primary melanomas. The median age was 66years for primary melanoma patients and 58years for secondary melanoma patients. The male/female ratio (M/F) was 3:1 for primary melanoma and 1:1 for secondary melanoma. The median time of survival was 3.5months and 9months for primary and secondary melanoma patients, respectively. NGS of primary tumours showed polymorphisms in the HRAS, PI3KCA, and JAK3 genes. Primary mucosal melanoma of the small intestines is a very rare disease, with an incidence of 0.04 cases/million/year in Denmark. Patients aged 59-70years with abdominal symptoms should make the clinician consider a small bowel melanoma as a differential diagnosis. The prognosis ranged from less than a month to 183.6months.

Primary malignant melanoma of the small intestine: a report of 2 cases and a review of the literature

The majority of malignant melanomas in the small intestine are metastases from primary cutaneous lesions, it can also develop as a primary mucosal tumor in the gastrointestinal tract. In this report, we present rare cases of primary small bowel melanoma and review the current literature. A 78-year-old male presented with abdominal pain and CT enterography identified a ileal mass. A 79-year-old female presented with signs and symptoms of partial small bowel obstruction. Abdominopelvic CT and small bowel series revealed a obstructing mass in the distal jejunum. The masses were confirmed on laparotomy and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. A primary small bowel melanoma is an extremely rare neoplasm. A definite diagnosis can only be made after a thorough investigation has been made to exclude the coexistence of a primary lesion. Curative resection of the tumor remains the treatment of choice.

Diagnosis and Treatment of Intestinal Melanoma Metastases in the Era of Effective Systemic Treatment: Retraction.

Diagnosis and Treatment of Intestinal Melanoma Metastases in the Era of Effective Systemic Treatment: Retraction.

Diagnosis and Treatment of Intestinal Melanoma Metastases in the Era of Effective Systemic Treatment

Diagnosis and Treatment of Intestinal Melanoma Metastases in the Era of Effective Systemic Treatment

Retracted: Diagnosis and Treatment of Intestinal Melanoma Metastases in the Era of Effective Systemic Treatment.

The aim of the present study was to describe different presentations, diagnostic tools, and available treatments for melanoma metastasized to the intestines. The intestine is a frequent site of metastases in melanoma patients. In the current era, with long-term survival after systemic treatment, there is a need for a timely diagnosis and optimal treatment of intestinal metastases. Patients diagnosed between 2011 and 2015 with intestinal metastases of melanoma were included. Diagnostic procedures, treatment strategies, and their outcome were analyzed for all patients. A total of 22 patients were included. Twenty patients received systemic therapy for widely disseminated disease. Fourteen of these twenty patients received local treatment for symptomatic intestinal metastases. Median overall survival after detection of intestinal metastasis in patients receiving systemic treatment was 22 months. On the basis of this cohort, a treatment algorithm for treatment of patients with symptomatic intestinal melanoma metastases was constructed. The treatment of intestinal melanoma metastases has changed due to the introduction of novel systemic treatments that can result in long-term survival of patients with widely metastatic melanoma. Surgeons and other clinicians should be aware of these changes in clinical practice as well as the diverse presentation of intestinal melanoma metastases and the diagnostic and therapeutic dilemmas involved.

Abdominal Pain due to Primary Malignant Melanoma of the Small Intestine

ABSTRACT: To describe a patient presented with abdominal pain due to primary malignant melanoma of the small intestine. A 73-yr-old presented with anorexia, weight loss, colicky abdominal pain. Upper GI tract endoscopic and colonoscopic findings were normal. CT scan of the abdomen revealed a solid tumor, possibly originating from the distal jejenal segments as diffuse thickening of the intestinal wall, dilatation of the proximal segments of the intestine and mesenteric lymph node enlargement. Exploration laparotomy revealed a solid tumor, causing invagination, 4x3 cm. in size, approximately 60 cm. from the treitz. Histopathological examination of the resected specimen made the diagnosis of malignant melanoma. The search for the primary site was negative. After the wide excision of the tumor and mesenteric lymph nodes, six months after the operation the patient remains well. Primary malignant melanoma of the small intestine is a rare condition that surgical intervention give the best chance for effective palliation and disease-free survival. KEY WORDS: Primary malignant melanoma, small intestine. OZET: Ince bagirsagin primer malign melanomu nedeniyle karin agrisi tanimlayan bir hasta sunuldu.73 yasinda erkek hasta anoreksi, kilo kaybi ve kolik abdominal agri ile basvurdu. Ust gastrointestinal endoskopisi ve kolonoskopisi normaldi. Abdomen CT’sinde distal jejenal ansi diffuz incelten ve proksimal segmentte dilatasyon yaratan solid kitle goruldu. Eksplorasyon laparatomisinde Treitz ligamanindan yaklasik 60cm mesafede 4x3cm solid tumore ulasildi. Histopatolojik tanisi malign melanom olarak konuldu. Primer tumor aramasi negatifti. Tumor ve lenf nodlari genis eksize edildi ve operasyondan 6 ay sonra hasta halen iyiydi. Ince bagirsaklarda primer malign melanom nadir bir durumdur ve efektif palyasyon ve hastaliksiz sag kalim icin cerrahi hastaya verilen en iyi sanstir. ANAHTAR KELIMELER: Primer malign melanom, ince bagirsak.

Primary Melanoma of the Small Intestine with a Metastatic Lymph Mass in the Inguinal Canal: A Case Report

Objectives : We report a case of primary melanoma of the small intestine. Primary intestinal melanoma (PIM) is an extremely rare neoplasm for which the cause is unknown. Materials and methods : A 67-year-old man was admitted to our department due to abdominal pain, constipation, a large, hard inguinal mass and severe anaemia. Results : After laboratory data, imaging techniques and histopathological examination, the diagnosis was confirmed. A surgical resection of the intestinal neoplasm, treatment with BRAF inhibitors and radiation therapy to the inguinal mass were performed. Conclusion : PIM is rare and it is usually difficult to establish its exact origin.

A Rare Case of Gastrointestinal Bleeding Due to Primary Intestinal Melanoma

Introduction: We present a rare case of primary small intestine melanoma. Case Report: A 69-year-old male with a history of colon polyps presents with dark stool and fatigue. His hemoglobin dropped from 16 to 11. EGD showed possible Barrett’s esophagus. Biopsy was negative for metaplasia. He had a nodule of the second portion of the duodenum. Biopsy showed normal mucosa. Colonoscopy showed hemorrhoids, diverticulosis, and normal terminal ileum. A 3-mm tubular adenoma was removed from the colon. Small bowel (SB) capsule showed a moderate-sized semi-circumferential mass in the jejunum with areas of ulceration and bleeding. A CT abdomen showed small bowel mass in the distal jejunum. Adjacent enlarged lymph nodes (LN) are suspicious for metastatic disease. The patient underwent exploratory laparotomy and partial SB resection. Pathology reveals malignant melanoma. LN was negative for metastasis. Skin evaluation by dermatology did not find any lesions that were concerning for dysplastic nevi. Ophthalmology evaluation was normal. MRI of the brain revealed no metastatic process. PET-CT revealed intense hypermetabolism in the small bowel at the area of the surgical site without any evidence of metastatic disease. He followed up with oncology and his repeat PET scan and capsule endoscopy remained negative for recurrence of cancer. Discussion: Intestinal melanomas can be primary tumors or metastases of cutaneous, ocular, or anal melanomas. Primary intestinal melanoma is extremely rare. Most cases of SB melanoma are metastases from cutaneous melanoma. Metastases to the gastrointestinal tract are found at autopsy in 60% of patients who die with malignant melanoma. The clinical picture of SB melanoma is similar to the clinical presentation of other tumors involving the SB. Thus, patients with a history of cutaneous melanoma who have intermittent abdominal pain or anemia should be investigated to rule out intestinal metastases. Diagnosis can be made by ultrasound, barium studies, endoscopy, CT, or PET. A combination of imaging techniques is recommended to improve the sensitivity and specificity of radiological imaging. No standard therapy exists for the treatment of intestinal melanoma, although surgical removal is the treatment of choice in all patients with resectable melanoma. Accurate preoperative diagnosis and assessment of the extent of intestinal metastases is essential when selecting patients for surgery. Systemic chemotherapy regimens show no benefit to overall survival. The prognosis is poor, with an overall median survival of 6-9 months and a 5-year survival rate of less than 10%. Conclusion: Primary intestinal melanoma is very rare condition with poor prognosis. Early detection and surgical resection are vital to disease survival.

Primary malignant achromic melanoma of the lung.

Currently, less than thirty cases of primary malignant melanoma of the lung have been reported in the literature. Thus, strict criteria for diagnosis have been published and include: malignant melanoma associated with bronchial epithelial changes; a solitary lung tumor; no prior history of skin, mucous membrane, intestinal or ocular melanoma; and absence of any other detectable tumor at the time of diagnosis. In this article we present a case of melanoma of the lung without evidence of extra-pulmonary disease.

Intestinal obstruction due to primary intestinal melanoma in a patient with a history of rectal cancer resectioning: A case report

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.

A patient presenting with acute abdomen due to metastatic small bowel melanoma: a case report

IntroductionMalignant tumors of the small bowel are rare. Melanoma of the small intestine is in most cases metastatic from a primary skin lesion. Perforation of small bowel melanoma is an extremely rare entity. To the best of our knowledge this is the fifth case published to date.Case presentationWe report a rare case of acute abdomen due to perforated metastatic small bowel melanoma in a 38-year-old Caucasian man.ConclusionsIn the majority of cases small bowel melanoma represents metastasis from cutaneous sites. Although rare, the possibility of abdominal metastatic melanoma presenting with the clinical picture of acute abdomen must be always considered by the operating surgeon in patients with a history of primary cutaneous malignant lesion.

Primary amelanotic malignant melanoma of the small intestine diagnosed by esophagogastroduodenoscopy before surgical resection

A 67-year-old man, presenting with anemia and suspected gastric cancer, was referred to our hospital, where he underwent esophagogastroduodenoscopy (EGD). Biopsy revealed densely populated semi-circular cells with abundant cytoplasm that were positive for S-100 protein, melanoma antigen, and HMB-45, resulting in a diagnosis of malignant melanoma. A gastrointestinal barium study for further exploration demonstrated a filling defect 6 cm in size at the ligament of Treitz. Follow-up EGD of this finding revealed an ulcerated, half-circumferential lesion with a distinct ulcer mound extending from the ascending part of the duodenum to the jejunum, and additional biopsy also indicated malignant melanoma. Computed tomography scans showed wall thickening from the ascending part of duodenum to the proximal jejunum, whereas positron emission tomography revealed accumulation at the upper gastric body, the duodenum to the jejunum, and the left adrenal gland. Systemic exploration of the patient, including the skin, anus, and eyeballs, revealed no other lesions, and primary small intestinal malignant melanoma with metastasis to the stomach and adrenal gland was diagnosed. Partial duodenojejunectomy, partial gastrectomy, and left adrenalectomy were performed, and adjuvant chemotherapy with dacarbazine, nimustine hydrochloride, and vincristine sulfate was administered. No postoperative recurrence has been observed in the past 3 years.

Primary Small Intestinal Melanoma: A Systematic Review

Purpose: Primary small intestinal melanoma is an extremely uncommon pathology. It has been reported only in a handful number of cases. A 69-year-old woman recently presented with metastatic primary small bowel melanoma; this prompted us to systematically review all reported cases in the literature. Methods: We searched for case reports of primary small bowel melanoma in Medline and the Cochrane Central Register of Controlled Trials. The search strategy was limited to human cases without date or language restriction. Cases with metastatic disease or non small-intestinal primary melanoma were excluded. Results: Our search yielded 36 published cases (1975 - 2011). The patients had a mean age of 57 years (range 26-81) and an equal gender distribution. Twenty-six patients (72%) were of European origin, and 10 patients (28%) were reported from the U.S., Japan, Middle East and India. Twelve patients (47%) had primary disease localized to their jejunum and 10 patients (42%) to their ileum. Five (14%) additional patients had disease in both their jejunum and ileum. Twenty-eight patients (78%) presented with abdominal pain; other presenting complaints included weight loss (15/36, 42%), anemia (12/36, 33%) and gastrointestinal (GI) bleeding (8/36, 22%). Eighteen Patients (56%) had subsequent intra-abdominal lymphadenopathy during their clinical course. Twenty-four patients (67%) developed distant metastases of their primary lesion, with the most common site being the brain (5/36, 14%). Hepatic (4/36, 11%) and pulmonary (3/36, 8%) metastases were also seen. Of the 5 patients with cerebral metastases, 3 presented with frank neurological symptoms (hemiparesis & seizures). The most commonly utilized diagnostic modalities were CT scan (20/36, 56%) and small bowel enteroclysis (6/36, 17%). Two patients (6%) were diagnosed after polypoid masses with light gray and black discoloration were seen and biopsied in the jejunum during enteroscopy. The reminder of patients (34/36, 94%) were diagnosed after surgical resection of the affected small bowel. Among the different diagnostic immunochemistry stains, S-100 and HMB-45 were the most commonly used. Eleven (31%) patients received systemic chemotherapy during the course of their disease. Fourteen (39%) patients survived with a mean follow-up of 18 months and 11 patients (31%) died after a mean period of 8 months; mortality data was not reported for 11 (36%) patients. Conclusion: Primary small bowel malignant melanoma is a rare entity with only 36 cases reported in the literature. It remains a difficult diagnosis to make-most often diagnosed surgically and rarely endoscopically. Surgical resection has been the mainstay of therapy but survival and overall prognosis for this rare entity is quite poor.

Presumed melanoma-associated retinopathy (MAR): a presenting sign of primary small intestinal melanoma?

Melanoma-associated retinopathy is a paraneoplastic retinopathy associated mostly with cutaneous melanoma. In most cases it presents months to years after diagnosis of primary cutaneous melanoma was made or after recurrence. We describe a 55-year-old male patient who presented with symptoms of decreased vision and photopsia. Diagnosis of melanoma-associated retinopathy was made, but no primary cutaneous melanoma was found. 3 months later he developed intestinal perforation due to small intestinal melanoma.

Melanoma of Unknown Primary as a Cause of Intestinal Obstruction - a Case Description

Melanoma of unknown primary applies to 1-8% of all diagnosed melanomas, whereas primary melanoma of the small intestine is a extremely rare case. One of the melanoma characteristics is its capability of forming metastases in the small intestine which very often are diagnosed during autopsy.We present a case report of diagnosed melanoma of unknown primary, whose first symptom was intestinal obstruction. Before admission to the hospital cause of intestinal obstruction, the patient didn't present any signs and symptoms. All typical localizations of primary melanoma were excluded during diagnostic procedure. Palliative right hemicolectomy and segmental small intestine resection were performed. There were no complications in the postoperative course. On the ninth day the patient was discharged from hospital.Quick identification and radical resection of melanoma metastases in the alimentary tract may improve the survival rate in this group of patients. Resection, even if it is palliative by assumption, is not only the best method of elimination of persistent symptoms but it also gives hope for longer survival.

Inhibitory effect of dendritic cells combined with cytokine-induced killer cells on the growth and liver metastasis of human primary malignant melanoma of the small intestine

Objective To investigate the inhibitory effect of dendritic cells (DCs) and homologous cytokine-induced killer cells (CIKs) on the growth and liver metastasis of human primary malignant melanoma of the small intestine. Methods A histologically intact liver metastasis fragment derived from a surgical specimen of patients with primary malignant melanoma of the small intestine was implanted in the mucous layer of small intestine in nude mice to construct the liver metastasis model of the malignant melanoma. Peripheral blood mononuclear cells from healthy donors and patients with malignant melanoma of the small intestine were isolated. DCs and CIKs were separately produced according to corresponding culture method, and the DC-CIKs were harvested after coculorthotopically implanted in 56 nude mice, and 72 hours later, all the mice were equally divided into normal saline group (0.3 ml), mitomycin treatment group (400 μg/0.3 ml), healthy donor CIK group (6 × 107/0.3 ml),healthy donor DC-CIK group (3 × 107/0.3 ml), autologous CIK treatment group (6 × 107/0.3 ml), autologous DC-CIK group (6 × 107/0. 3 ml) and DC-CIK (6 × 107/0.3 ml) + mitomycin (400 μg/0. 3 ml) treatment group. Mice in the experimental groups were administered the agents once daily by vena caudalis injection for 28 days. Mice were sacrificed 72 hours after treatment, and the orthotopic xenografts were removed for weighing,and the liver metastases were simultaneously evaluated by macroscopy and microscopy. All data were analyzed using the analysis of variance, LSD test and chi-square test. Results A liver metastatic model of human primary malignant melanoma of the small intestine ( HSIM-0603 ) was established. Of the control group, healthy donor CIK group, healthy donor DC-CIK group, autologous CIK treatment group, autologous DC-CIK group and DC-CIK +mitomycin group, the tumor weights were ( 1.18 ± 0. 17), (0.71 ± 0.06), (0.68 ± 0. 15 ), (0. 43 ± 0.08 ),(0.67 ± 0.07 ), (0.37 ± 0.08 ) and (0.20 ± 0.05 ) g, respectively; the tumor inhibition rates were 0, 39.82%,42.37%, 65.56%, 43.22%, 68.64% and 83.05%, respectively; liver metastases were detected in 8, 8, 5,4, 4, 3, 2 rats, respectively, in the above mentioned groups. There were significant differences in the tumor weight, tumor inhibition rate and liver metastasis rate among the seven groups (F = 152. 300, x2= 200. 538,94. 325, P ＜ 0.05 ). Conclusions The liver metastatic model could be applied to the studies on the pathogenesis,invasion, metastasis and treatment of human primary malignant melanoma of the small intestine. DC-CIK has the potential in inhibiting the growth and liver metastasis of the malignant melanoma of the small intestine. Key words: Neoplasms of small intestine; Malignant melanoma; Liver metastasis; Animal model; Dendritic cells; Killer cells; Immunotherapy

Intestinal malignant melanoma presenting with small bowel invagination: A case report

Gastrointestinal tract metastasis of any malignancy is rare. Cutaneous or ocular malignant melanomas are the most common tumors that metastasize to the gastrointestinal tract. Major symptoms of these metastatic lesions are bleeding and obstruction of the gastrointestinal tract. However, malignant melanoma arising in intestinal mucosa causing intestinal obstruction is a rare clinical entity. Herein, we present a case of primary gastrointestinal tract malignant melanoma who presented initially with iron deficiency anemia, which consequently triggered an invagination of jejunal and ileal segments causing obstruction symptoms, three months later.

Intestinal Melanoma Diagnosed by Capsule Endoscopy

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.