Gastrointestinal metastases from malignant melanoma

Case contributed by Dr Bruno Di Muzio

Presentation

Patient presents with abdominal distention and pain.

Patient Data

Age: 45
Gender: Male
CT

CT Abdomen and pelvis

There is a small bowel obstruction due to a solid mass involving proximal ileum. On the arterial phase solid, enhancing lesions involving the heart apex, gastric mucosa, duodenum, left adrenal and pancreas tail are better identified. There is also a sclerotic area on right posterior arch of T10.

Annotated image

Annotated CT images showing the multiple secondary lesions

Annotations showing the solid enhanced lesions on heart apex, gastric mucosa, duodenum, left adrenal and pancreas tail. Proximal ileum mass that is probable cause of small bowel obstruction. 

Nuclear medicine

The patient had a previous PET-CT scan from some weeks before his gone to the emergency department

The PET-CT shows metabolic activity on lesions at gastric and duodenum wall, on the heart apex and pancreatic tail (lymph nodes?). There are also metabolic activity in muscles on medial right thigh as well on bone lesions on first and second left metatarsal bones, femurs and tibias, and in the posterior aspect of 7th left rib and on T10 vertebral arch. Small pulmonary nodules and subcutaneous lesions are also identified and compatible to secondary involvement.

Case Discussion

The patient has a know history of cutaneous melanoma relapsed after oncology treatment. 

Gastric and duodenum metastases are rare and, in this case, represent an advanced disease. Metastases to the stomach and duodenum have been encountered more frequently as hematogenous spread from malignant melanoma or carcinoma of the breast or lung. Necropsy studies found gastric metastases in less than 2% of patients who die of a carcinoma 2, but a series of necropsies in individuals with melanoma revealed gastric metastases rates of more than 22% 1

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Case information

rID: 30385
Case created: 6th Aug 2014
Last edited: 25th Sep 2016
Inclusion in quiz mode: Included

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