Melanoma gastrointestinal metastases

Case contributed by Dr Bruno Di Muzio

Presentation

Patient presents with abdominal distention and pain.

Patient Data

Age: 45 years
Gender: Male
CT

CT Abdomen and pelvis

There are multiple infiltrative heterogeneously enhancing lesions involving the heart apex, gastric mucosa, duodenum, left adrenal gland and pancreas tail. There is also a sclerotic area on right posterior arch of T10. Small bowel obstruction is likely due to a solid mass involving the proximal ileum. 

Annotated image

Annotated CT images showing the multiple secondary lesions

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

Nuclear medicine

Previous PET-CT scan from some weeks before admission in the emergency department

The PET-CT shows metabolic activity on lesions at gastric and duodenum wall, in the heart apex and pancreatic tail. There is also metabolic activity in muscles on medial right thigh as well on bone lesions on first and second left metatarsal bones, femora and tibiae, 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 with secondary involvement.

Case Discussion

The patient has a known to have cutaneous melanoma relapsed after oncology treatment. 

Gastric and duodenum metastases are rare and have been encountered more often as hematogenous spread from melanoma or breast or lung carcinomas. Gastric metastases have been shown in more than a fifth of those patients who died from melanoma 1

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Case information

rID: 30385
Published: 7th Aug 2014
Last edited: 16th Jul 2018
Inclusion in quiz mode: Excluded

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