Gastrointestinal malignant melanoma

摘要: Case 1 A 69-year-old man was referred for investigation of abdominal pain, progressive weight loss, and iron deficiency anaemia. Faecal occult bloods were positive there no medical history note. Physical examination revealed a firm mobile mass in the right iliac fossa. There organomegaly or lymphadenopathy, retinae clear, cutaneous lesions evident. Abdominal ultrasound scan, small bowel enema, colonoscopy all normal, as renal liver function tests. CT showed soft tissue within The patient underwent hemicolectomy large 10 × cm caecal tumor removed which infiltrating surrounding bowel. Histology this to be metastatic malignant melanoma, confirmed by morphologic immunochemical studies, infiltrated submucosa. cells stained positively with S100 protein. Resection complete (Fig. 1a). On close enquiry postoperatively recalled mole on his back that had disappeared spontaneously 20 years previously. Five after surgery he remained good health signs recurrence lesions. Case 2 A 60-year-old 3-month nausea, lower loss. unremarkable. Clinical fossa, but lymphadenopathy organomegaly. Sigmoidoscopy 15 barium enema diverticular disease only. Ultrasound abdomen normal. Gastroscopy polyp body stomach; biopsies melanoma. One week later presented an emergency acute abdomen. At laparotomy intestinal perforation found nodular metastases stomach, duodenum, An amelanotic nodule thigh biopsied at same time, histology these melanoma. stomach extensive infiltration antrum proximal duodenum solid sheets melanocytes, invading throughout full thickness muscularis propria 1b). A Polya gastrectomy performed month later, time developed further deposits Two months discharge readmitted pancreatic spread obstructive jaundice relieved when stent inserted. He transferred local hospice terminal care, died shortly afterwards.