Patient: Male, 55Final Diagnosis: MelanomaSymptoms: Worsening constipation • tenesmus • weight lossMedication: —Clinical Procedure: Chemoradiation therapySpecialty: OncologyObjective:Challenging differential diagnosisBackground:Malignant melanoma is usually readily diagnosed by the presence of melanin granules. Although amelanotic melanoma contains a few melanin granules, it is often difficult to differentiate from non-epithelial malignant tumors. Immunohistochemical staining may be needed to diagnose the condition.Case Report:This report describes a case of amelanotic melanoma of the rectum, which was originally suspected to be an adenocarcinoma, but was subsequently correctly diagnosed by immunohistochemical staining with HMB-45 antibody and by the presence of S-100 protein. A pinkish-red ulceroproliferative growth was located about 7 cm from the anal verge. The patient was treated by laparoscopic low anterior resection.Conclusions:Very few cases of amelanotic melanoma of rectum have been reported in the literature and there is only limited clinical experience with this disease. It appears to be a highly lethal tumor and may need much more aggressive treatment than that used for carcinoma of the rectum.
Vascularised free tissue transfer has revolutionized skull base defect reconstruction. It allows to restores form and functions without compromising the principles of oncoplastic surgery. Anterolateral thigh (ALT) free flap is a workhorse flap in head and neck reconstruction. The versatility of the ALT-free flap makes it unique to reconstruct almost every soft-tissue defect in head and neck reconstruction. Due to the large surface of the anterolateral thigh, a very large flap can be harvested with very little donor site morbidity. Here we have reported a case of 40 years, male patient, with a known case of primary squamous cell carcinoma (SCC) of the left parotid gland. After the surgical extirpation of the tumor, an extensive soft-tissue defect was created in the region of the left lateral skull base defect. For coverage of large defect, we did the ALT free flap size 25×18 cm (450 cm2). The donor site was partially closed primarily and partially skin grafted. The patient was discharged uneventfully on the 7th postoperative day.
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