Metastatic MalignantMelanoma of Gastrointestinal Tract with Unknown Primary- A Diagnostic Dilemma?

Title: Metastatic MalignantMelanoma of Gastrointestinal Tract with Unknown Primary- A Diagnostic Dilemma?

Authors: Padhi Sanjukta, Pujari Lincoln, Meher Papuji, Samantray Sagarika, Singh Sivram Prasad

DOI: http://dx.doi.org/10.18535/jmscr/v4i8.87

Abstract

Background: Malignant melanoma with its diverse histological patterns and varied manifestations is a diagnostic enigma. This problem becomes even more complex when it presents as a metastatic lesion with no known primary site. This is referred to as malignant melanoma of unknown primary (MUP). MUP generally accounts for 2-9% of all melanomas ⁽¹⁾. The incidence of malignant melanoma in the gastro-intestinal tract without any evidence of a primary lesion in the skin or any other site is extremely rare ^{(2, 3)}

Case: We present here a case of a 58 yr old man with symptoms such as vomiting,epigastric pain and loss of appetite for two months. General examination revealed a right inguinal lymphadenopathy and hepatomegaly with no abnormality in skin. On endoscopic evaluation we found, multiple melanotic patches on gastric mucosa, .Metastatic melanoma in stomach with unknown primary is a rare entity and we report it here for documentation.

Conclusion: Metastatic malignant melanoma of the gastrointestinal tract without an identifiable source is exceptionally rare. The present case puts light into the extensive search and timely diagnosis to yield a early pre-mortem diagnosis and timely intervention.

Keywords: MUP, Gastric Melanoma, Diagnosis.

References

1. Milton CW, Lane Brown MM, Gilder M, Malignant melanoma with an occult primary lesion, Br J Surg, 1967, 54(7):651–658

2. Sorensen YA, Larsen LB. Malignant melanoma in the small intestine. Ugeskr Laeger 1998; 160(10): 1480-1481.

3. Christova S, Meinhard K, Mihailov I, Alexiev B. Three cases of primary malignant melanomas of the alimentary tract. GenDiagnPathol. 1996; 142(1): 63-7.

4. Kadivar TF, Vanek VW, Krishnan EU. Primary malignant melanoma of the small bowel: a case study. Am Surg1992; 58: 418-422

5. Avital S, Romaguera RL, Sands L, Marchetti F, Hellinger MD. Primary malignant melanoma of the right colon. Am Surg 2004; 70: 649-651

6. Ollila DW, Essner R, Wanek LA, Morton DL. Surgical resection for melanoma metastatic to the gastrointestinal tract.Arch Surg. 1996 Sep;131(9):975-9; 979-80

7. Blecker D., Abraham S., Furth E.E., Koch-man M.L. Melanoma in the gastrointestinal tract. American Journal of Gastroenterology. 1999Dec;94(12):3427–3433.

8. Mishima Y. Melanocytic and nevocytic malignant melanomas: cellular and subcell-ular differentiation. Cancer. 1967;20:632–649

9. Amar A., Jougon J., Edouard A., Laban P., Marry J.P., Hillion G. Primary malignant melanoma of the small intestine. Gastroenterologie Clinique et Biologique. 1992;16:365–367.

10. Giuliano AE, Moseley HS, Morton DL. Clinical aspects of unknown primary melanoma. Ann Surg. 1980;191:98–104.

11. Atmatzidis KS, Pavlidis TE, Papaziogas BT, Papaziogas TB. Primary malignant melanoma of the small intestine: report of a case. Surg Today. 2002;32:831–833

12. Manouras A, Genetzakis M, Lagoudianakis E, Markogiannakis H, Papadima A, Kafiri G, et al. Malignant gastrointestinal melanomas of unknown origin: Should it be considered primary? World J Gastroenterol. 2007;13(29):4027–4029.

13. Avital S, Romaguera RL, Sands L, Marchetti F, Hellinger MD. Primary malignant melanoma of the right colon. Ann Surg. 2004;70:649–51.

14. Anbari KK, Schuchter LM, Bucky LP, Mick R, Synnestvedt M, Guerry D 4th, et al. Melanoma of unknown primary site: Presentation, treatment and progress: A single Institution study. Cancer.1997;79:1816–21.

15. Katz KA, Jonasch E, Hodi FS. Melanoma of unknown primary: Experience at Massachussets general hospital and Dana Farber cancer institute. Melanoma Res. 2005;15:72–82.

16. Dasgupta T, Bowden L, Berg JW: Malignant melanoma of unknown primary origin. Surg Gynecol Obstet 1963, 117: 341-345

17. Schlagenhauff B, Stroebel W, Ellwonger V, et al. Metastatic melanoma of unknown primary origin shows prognostic similarities to regional metastatic melanoma recommendations for initial staging examinations. Cancer. 1997;80(1):60-5.

18. Reintgen D.S., Cox C., Slingluff C.L., Jr., Seigler H.F. Recurrent malignant melanoma: the identification of prognostic factors to predict survival. Annals of Plastic Surgery. 1992;28:45–49

19. Tsilimparis N., Menenakos C., Rogalla P., Braumann C., Hartmann J. Malignant melanoma metastases as a cause of small bowel perforation. Onkologie. 2009;32:356–358

20. Amersi FF, Terando AM, Goto Y, et al: Activation of CCR9/CCL25 in Cutaneous melanoma mediates preferential metastasis to the small intestine. Clin Cancer Res 2008;14:638-645

21. Bender G.N., Maglinte D.D., McLarney J.H., Rex D., Kelvin F.M. Malignant melanoma:patterns of metastasis to the small bowel, reliability of imaging studies, andclinical relevance. American Journal of Gastroenterology. 2001;96:2392–2400.

22. Poggi S.H., Madison J.F., Hwu W.J., Bayar S., Salem R.R. Colonic melanoma, primary or regressed primary. Journal of Clinical Gastroenterology. 2000; 30:441–444.

23. Lens M., Bataille V., Krivokapic Z. Melanoma of the small intestine. Lancet Oncology. 2009;10:516–521

24. Balch CM, Soong SJ, Murad TM, Smith JW, Maddox WA, Durant JR. A multifactorial analysis of melanoma: IV: Prognostic factors in 200 melanoma patients with distant metastases: (Stage III) J ClinOncol. 1983;1:126–134.

Corresponding Author

Dr Sanjukta Padhi

Pithapur, Cuttack, Orissa

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