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Intraperitoneal metastatic malignant melanoma arising from small bowel…… A case report.


Article Information

Title: Intraperitoneal metastatic malignant melanoma arising from small bowel…… A case report.

Authors: Fariha Ahmed, Naveed Akhtar, Shafiq Ullah Ch, Syed Shams-ul-Hassan

Journal: The Professional Medical Journal (TPMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2022-07-01 2023-06-30
Y 2021-07-01 2022-06-30

Publisher: Independent Medical College, Faisalabad- Pakistan

Country: Pakistan

Year: 2023

Volume: 30

Issue: 4

Language: English

DOI: 10.29309/TPMJ/2023.30.04.6035

Keywords: Primary Malignant MelanomaSmall Bowel Tumors and Gastrointestinal Tumors

Categories

Abstract

Small bowel tumors are very rare. Melanoma in small intestine can be primary or metastatic. Metastatic malignant melanoma in small intestine can arise from skin, eyes, oropharynx, esophagus or ano rectal mucosa. Primary malignant melanomas of small intestine are very rare. In this case report, we are going to present primary malignant melanoma of small intestine, which has already metastasized by the time of presentation. A 60 year old male, presented to us with abdominal pain, vomiting and absolute constipation. On exploration, black colored mass of 5x5cm in distal ileum which was attached to posterior wall of urinary bladder on right side and whole of the gut from stomach to rectum was involved. The patient was thoroughly examined and investigated for cutaneous melanoma, but there was no such tumor present. So it was concluded that this patient had primary malignant melanoma arising from distal ileum.


Research Objective

To present a case report of primary malignant melanoma of the small intestine that had already metastasized by the time of presentation, and to discuss its origin, characteristics, and management.


Methodology

Case report involving a 60-year-old male patient presenting with abdominal pain, vomiting, and absolute constipation. Investigations included physical examination, blood chemistry, and emergency exploratory laparotomy. Histopathology and immunohistochemistry were used for diagnosis. The patient underwent debulking of the mass and omentectomy, followed by chemotherapy.

Methodology Flowchart
                        graph TD;
    A["Patient Presentation Symptoms & Initial Exam"] --> B["Blood Chemistry"];
    B --> C["Emergency Exploratory Laparotomy"];
    C --> D["Identification of Masses & Debulking/Omentectomy"];
    D --> E["Histopathology & Immunohistochemistry"];
    E --> F["Diagnosis: Malignant Melanoma"];
    F --> G["Chemotherapy"];
    G --> H["Follow-up"];                    

Discussion

The paper discusses the rarity of small bowel tumors and melanomas. It explores potential origins of primary melanoma in the small intestine, including neural crest melanoblasts and APUD cells. The aggressive nature and poor prognosis of primary intestinal melanoma compared to cutaneous melanoma are highlighted, along with treatment modalities involving surgical resection and adjuvant chemotherapy.


Key Findings

A 5x5cm black colored mass was found in the distal ileum, attached to the posterior wall of the urinary bladder. The entire gut from stomach to rectum, mesentery, omentum, and anterior surface of the liver were studded with small black colored masses. Histopathology and immunohistochemistry (S100, Melan A, HMB 45 positive) confirmed malignant melanoma. The patient received two cycles of Dacarbazine chemotherapy.


Conclusion

The case presented is concluded to be a primary malignant melanoma arising from the distal ileum, which had already metastasized extensively at the time of presentation. Thorough investigation for cutaneous melanoma was negative.


Fact Check

1. Patient Age: The patient was a 60-year-old male. (Confirmed in Case Presentation)
2. Tumor Size: The primary mass in the distal ileum measured 5x5cm. (Confirmed in Abstract and Case Presentation)
3. Immunohistochemistry Markers: S100, Melan A, and HMB 45 were positive. (Confirmed in Case Presentation)


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