Veterans Memorial Medical Center Quezon City, National Capital Region, Philippines
Romel John V. Sazon, MD, Ruth Ursula C. Cinco, MD, FPCP, FPSG, FPSDE Veterans Memorial Medical Center, Quezon City, National Capital Region, Philippines
Introduction: Gastrointestinal (GI) melanomas are extremely rare and aggressive tumor of the GI tract. Differentiating between primary and metastatic GI melanoma is challenging if without obvious oculocutaneous primary lesion. Furthermore, there are no available published reports on synchronous GI melanoma to date. In this report, we present a 52-year-old male with synchronous primary malignant melanoma of the esophagus and ileum.
Case Description/Methods: A 52-year-old male admitted due to progressive dysphagia of 3 months, accompanied with hematemesis and weight loss. There were no skin and ocular lesions nor lymphadenopathy. Laboratory examinations only showed anemia.
Upper endoscopy revealed a tubular, necrotic, and friable mass with black-pigmented and vascular surrounding mucosa extending from the gastroesophageal junction to 33 cm from incisors completely obstructing the lumen. A consideration of benign fibrovascular polyp versus esophageal carcinoma was entertained. Screening colonoscopy showed incidental finding of a 0.3 cm patchy blackish discoloration deep-seated in the mucosa of the ileum. A synchronous primary esophageal and small intestinal melanoma was highly considered.
Biopsies of the esophageal mass and black-pigmented ileal mucosa both showed undifferentiated carcinoma. Immunohistochemical stains confirmed a malignant melanoma (p63, cytokeratin, CD45 negative, and HMB45 positive). Contrast-enhanced chest CT scan showed a mid to distal esophageal mass without evidence of local extension and distant metastasis.
After a multidisciplinary case discussion, the patient underwent Mckeown Esophagectomy with end to end cervical anastomosis. Intraoperatively, a 13 x 8 cm wide based, pedunculated, fungating, black-pigmented mass was found on the mid to distal esophagus with enlarged regional lymph nodes. Surgical histopathology reported a malignant melanoma with lymphovascular invasion. Post-operative period was uneventful and adjuvant chemotherapy with Dacarbazine was initiated.
Discussion: Synchronous GI melanoma without oculocutaneous primary lesion is rare and can be an unusual cause of dysphagia and upper GI bleeding. Multidisciplinary approach will entail optimization of patient’s management. The treatment of choice is still surgical resection, whenever possible, as radiotherapy and chemotherapy have not shown overall survival advantage.
Figure: Figure 1. A. Tubular mass with necrotic, friable, and vascular mucosa. B. Black hyperpigmentation at the base of the mass. C. Patchy blackish discoloration deep-seated in the mucosa of the ileum. D. Mid to distal esophageal mass on contrast-enhanced chest CT. E. Wide-based, pedunculated, fungating, black-pigmented mass on mid to distal esophagus.
Disclosures: Romel John Sazon indicated no relevant financial relationships. Ruth Ursula Cinco indicated no relevant financial relationships.
Romel John V. Sazon, MD, Ruth Ursula C. Cinco, MD, FPCP, FPSG, FPSDE. P0341 - A Case Report of a Synchronous Gastrointestinal Melanoma: A Multidisciplinary Approach, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.