Background: Malignant melanoma is a disease with an increasing rate of incidence, currently at 10 cases per 100,000. In most cases, malignant melanoma metastasizes over the lymph vessels to parenchymal organs. Symptomatic metastases are found in the gastrointestinal tract in only about 2% of the patients. Case Report: A 43-year-old patient with a known metastasized malignant melanoma (brain, liver, bones) was admitted to the department of dermatology due to fatigue, headache and unspecified abdominal symptoms. Because of persistent abdominal symptoms, a computed tomography (CT) scan of the abdomen was performed, showing a perforation of the ileum with an abscess on the basis of multiple small-bowel metastases. A segmental small-bowel resection with primary anastomosis was performed. The postoperative course of the patient was complicated by a subcutaneous wound infection and a prolonged period of convalescence (due to multiple brain metastases). Conclusions: Novel therapy concepts and medication in the treatment of patients with malignant melanoma have improved life expectancy. These patients are therefore expected to suffer more frequently from complications of the primary disease. Interdisciplinary management and cooperation is required to adequately diagnose and handle such cases.
We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a coexisting osteolytic lesion in the right major trochanter. FNA of the thoracic mass was suggestive for malignancy yet not diagnostic regarding the tumor type and the site of the primary tumor. A diagnosis of a stage IV lung cancer was favored and he underwent a left exploratory thoracotomy in view to resect the primary tumor. An extrapulmonary mass localized to the pleura not involving the ipsilateral lung was disclosed. Multiple biopsies revealed metastatic clear cell RCC. A 5 x 7 cm left renal tumor was revealed in a postoperative abdominal CT scan. He was treated with combination of interferon A and vinblastin followed by radical nephrectomy. Twenty-four months after the diagnosis he is alive without evidence of local or distant recurrence. Pleural metastases from RCC are mainly presented as malignant pleural effusions. Thoracic metastatic lesions localized to the pleura, forming solitary or multiple mass(es) have been rarely reported. We review the literature regarding this rare clinical manifestation of the disease and we discuss diagnostic and therapeutic options.
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