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

Abstract

Abstract. 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 melanocyte̸melanoma 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.

Primary small bowel melanoma. A case report and a review of the literature

“…To determine whether the small intestinal malignancy is a primary lesion Sacks et al (14) established three diagnostic criteria : i) single lesion, ii) other organs free of primary lesions and absence of enlargement of draining lymph nodes and iii) survival time over (>) one year after the diagnosis (15).…”

Primary Bowel Malignant Melanoma with Ileo-Ileal Intussusception

“…In order to determine if malignant melanoma of the small bowel is a primary lesion, Sacks et al [13] established three diagnostic criteria: i) single lesion, ii) other organs without primary lesions and absence of lymph ganglion enlargement, and iii) survival time over one year after diagnosis. [14]. In another study, Blecker and et al [15] proposes the following criteria for the diagnosis of primary intestinal melanoma of the small bowel: i) the presence of a solitary mucosal lesion in the intestinal epithelium ii) the absence of melanoma or atypical skin melanocytic lesions and iii) the presence of intramuscular melanoma lesions in the upper or adjacent intestinal epithelium.…”

Primary malignant melanoma of the small bowel: A case report

“…To determine whether the small intestine melanoma is a primary lesion, few diagnostic criteria are postulated. Sacks et al., established the three diagnostic criteria: 1) single lesion, 2) no primary lesions in the other organs with the absence of enlarged lymph nodes, 3) more than 1 year of survival after the diagnosis [13] . In another study, Blecker et al., proposed the diagnostic criteria which is important to strengthen the diagnosis of the true primary small intestine melanomas [14 , 15] .…”