A Case of a Metastatic Small Bowel Tumor Resected during Chemotherapy for Reccurent Malignat Melanoma of the Nasal Cavity

Abstract

The patient was a 66-year-old man who underwent resection of malignant melanoma of the nasal cavityattheDepartmentofOtolaryngologyinourhospitalinJune2018.Afterthat,hehadbeenfollowed upbytheDepartmentofOtolaryngologyandHeadandNeckSurgeryintheneighboringuniversityhospital.HehadlocalrecurrenceintheposteriornaresinFebruary2019andunderwentendoscopicsinussurgery.Thenhewastreatedwithimmunotherapy,atotalof18coursesofnivolumabaspostoperativeadjuvantchemotherapy.Again,recurrenceofretropharyngeallymphnodeswasconfirmedinNovember2019 and he was converted to another immunotherapy with pembrolizumab, a total of 2 courses, followed by proton beam therapy.Then, he was referred to the Department of Gastroenterology in our hospital in June2020fortheexaminationofabdominalpainandprogressiveanemiawhichoccurredamonthearlier. Furtherexaminationrevealedanilealtumorabout100cmproximaltotheterminalileum,whichcouldnot bereachedbythepreoperativeendoscope.Hewasdiagnosedpreoperativelyashavingamalignanttumor of the small intestine, and laparoscopic partial ileal resection plus lymph node dissection was per-formedinJuly.Postoperativepathologicaldiagnosiswasmetastaticsmallboweltumorofmalignantmelanoma.Thepostoperativecoursewasuneventful.Immunotherapywithpembrolizumabwasresumedand isstillsustainedinanoutpatientsetting.