Malignant melanoma of the stomach presenting in a woman: a case report

Abstract

IntroductionMalignant melanoma is reported to metastasize to all organs of the human body. Although it is common for it to metastasize to the gastrointestinal tract, a melanoma located primarily in the gastric mucosa is an uncommon tumor. Gastrointestinal metastases are rarely diagnosed before death with radiological and endoscopic techniques.Case presentationIn this case report the clinical course and treatment of a woman with melanoma of the stomach, without any other detectable primary lesion, is presented and discussed. A 55-year-old Turkish woman presented to our clinic with complaints of muscle pain and bone pain in the left side of her chest. During an upper gastrointestinal system endoscopy, dark cherry-colored, light elevated, round-shaped lesions were taken from her gastric fundus and from the first part of her duodenum. Biopsies from these samples were determined to be malignant melanoma by the pathologist.ConclusionMetastatic malignant melanoma cases should be examined through endoscopy for gastrointestinal metastases.

Mide Metastazı Yapan Malign Melanom

“…Malign melanom vücuttaki her organa metastaz yapabilen bir tümördür (3). Gastrointestinal sistem metastazı sık saptanırken mide tutulumu oldukça nadirdir (3,4). Metastatik tümörler ilk tanı olabileceği gibi yıllar sonra nüks belirtisi olarak da karşımıza çıkabilmektedir (5).…”

“…Metastatik MM lezyonları yalnız makroskobik olarak değil, mikroskobik olarak da çok değişken morfolojiler göstermektedir. Bu lezyonların ayırıcı tanısında immünohistokimyasal (İHK) belirteçler oldukça değerlidir (2,3 Yapılan araştırma sonucunda, iki yıl önce dış merkezde geçirdiği enükleasyona ait materyale dair patoloji raporuna ulaşılan hastanın, sağ bulbus okuli posteriyor yerleşimli, evre pT1a olarak değerlendirilmiş, "epitelioid morfolojide MM" tanısı almış olduğu görüldü. Ayrıca sistemik taramalarda karaciğerde metastatik lezyonlar saptandı.…”

Melanoma with gastric metastases

“…The classic appearance is multiple, small nodules that may be pigmented at endoscopy or may ulcerate to produce a bull's-eye or ‘target-like’ appearance (3, 5). The majority of gastric metastases occur in the body and fundus, most often at the greater curvature (6). Confirmation of melanoma is made if the biopsies immunostain positively with S-100 protein and the premelanosome glycoprotein monoclonal antibody HMB-45 (7).…”

Acute upper gastrointestinal bleeding in a patient with malignant melanoma

“…Up to 60% of patients with melanoma have evidence of gastric metastases on autopsy; however, the majority are asymptomatic, with only 4.4% diagnosed prior to death 1 2. This patient presented with melena, which is the most common sign of gastric melanoma 3. These lesions are often asymptomatic.…”

“…Endoscopically, melanoma metastases to the stomach are classified into three types: ulcerated melanotic nodules on normal rugae, ulcerated submucosal masses and pigmented mass lesions with necrosis 1 3. Typical endoscopic finding of gastric melanoma is that of multiple nodules located in the gastric fundus and body with ulcerations giving them a ‘bull’s eye’ appearance 3. The ‘bull’s eye’ appearance can be appreciated in the images presented (figure 2).…”