A rare cause of melena
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CASE REPORT
A rare cause of melena Benjamin L. Elsbernd1 · Daniel R. Nussenzveig1,2 · Anh D. Nguyen3 Received: 21 June 2020 / Accepted: 24 August 2020 © Japanese Society of Gastroenterology 2020
Abstract Melanoma presenting in the gastrointestinal tract is commonly due to metastasis from a primary cutaneous or ocular lesion. There have been a few case reports of primary GI melanoma which is commonly seen in the rectum and anus. We report a case of a 77-year-old man who presented with GI bleeding and was found to have a primary small bowel melanoma. This case highlights how to approach the workup of a melanoma lesion found in the GI tract. Keywords Small bowel · Melanoma · Iron deficiency anemia
Introduction Melanoma is a cancer that arises from melanocytes and has been increasing in incidence worldwide [1]. In the GI tract, melanoma usually presents as metastasis from a primary source, and primary GI melanoma is a rare clinical entity with only ten case reports of primary small bowel melanoma documented in the literature [2, 3]. We report a case of a 77-year-old man who presented with GI bleeding and was found to have a primary small bowel melanoma.
Case report A 77-year-old male presented with generalized weakness and a remote history of melena 1 week prior to admission. Physical exam was unremarkable with no palpable masses or abdominal tenderness. Labs were significant for iron deficiency anemia with a hemoglobin of 8.9 from 13.1 and a ferritin of 14 ng/ml. Patient underwent bidirectional endoscopy which showed no clear source for iron deficiency anemia. A capsule endoscopy was performed, and a mass with * Anh D. Nguyen [email protected] 1
University of Texas Southwestern Medical Center, Dallas, TX, USA
2
North Texas VA Health and Hospital System, Dallas, TX, USA
3
Baylor Scott & White Center for Esophageal Diseases, 3500 Gaston Ave, Suite 711, Dallas, TX, USA
overlying ulcerated mucosa was seen in the small bowel (Fig. 1). Subsequent computed tomographic enterography demonstrated a 3.3 cm soft tissue mass in the jejunum (Fig. 2). As the mass was unable to be reached endoscopically, the patient underwent a laparoscopic small bowel resection with removal of the mass, and pathology was found to be most consistent with malignant melanoma. Histology showed solid nests of epithelioid cells with brisk mitotic activity (Fig. 3), and immunohistochemistry staining was positive for SOX-10 (Fig. 4), a marker of melanocyte differentiation. The dermatology service performed a skin exam showing no evidence of a cutaneous primary melanoma, and a fundoscopic exam by ophthalmology showed no evidence of ocular melanoma. A positron emission tomography scan did not identify an alternative site of primary malignancy or any other sites concerning for metastatic disease (Fig. 5). As the patient had a solitary lesion in the small bowel without evidence of an alternative primary melanoma, the final diagnosis was primary malignant melanoma of the jejunum. At one year follow-up, the patient did not have any recurr
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