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Ileal malignant melanoma presenting as a mass with aneurysmal dilatation: a case report.

Kim W, Baek JM, Suh YJ, Jeon HM, Kim JA - J. Korean Med. Sci. (2004)

Bottom Line: A 36-yr-old woman was found to have a secondary malignant melanoma in the terminal ileum with profuse aneurysmal dilatation, which is not the typical presentation of the malignant melanoma in the small intestine.Radiologic studies revealed a large tumor involving the distal ileum with aneurysmal dilatations having afferent and efferent loops, which needed to be differentiated from malignant lymphoma and other gastrointestinal tumors.She had been free from any evidence of the local or systemic recurrence for one year after the completion of eighteen months of the subcutaneous interferon treatment; postoperatively however, the occurrence of metastatic mass at the right axilla rendered us from complete resection due to severe penetration into the vital nerves and vessels in the axilla.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. kimwook@hfh.cuk.ac.kr

ABSTRACT
Malignant melanoma is the most common metastatic tumor of the gastrointestinal tract and can present with fairly common constitutional symptoms. A 36-yr-old woman was found to have a secondary malignant melanoma in the terminal ileum with profuse aneurysmal dilatation, which is not the typical presentation of the malignant melanoma in the small intestine. Radiologic studies revealed a large tumor involving the distal ileum with aneurysmal dilatations having afferent and efferent loops, which needed to be differentiated from malignant lymphoma and other gastrointestinal tumors. Exploratory laparotomy was done, and we found a huge mass with plentiful aneurysmal dilatations; much the same of the findings from the previous studies. Segmental resection with the surrounding omentum was done followed by end-to-end anastomosis between both ends of the remaining ileum. She had been free from any evidence of the local or systemic recurrence for one year after the completion of eighteen months of the subcutaneous interferon treatment; postoperatively however, the occurrence of metastatic mass at the right axilla rendered us from complete resection due to severe penetration into the vital nerves and vessels in the axilla.

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Result of immunohistochemical staining with HMB-45 is positive (×200).
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Figure 5: Result of immunohistochemical staining with HMB-45 is positive (×200).

Mentions: After treating anemia with repeated transfusion, exploratory laparotomy was done. After evacuating moderate amount of intraabdominal ascites, we could locate a mass at the terminal ileum, which resided in the middle of the lower abdomen and attached firmly to the omentum anteriorly, the sigmoid colon posteriorly, and the urinary bladder inferiorly. The diameter of the mass exceeded 15 centimeters, and the intervening normal segment of the ileum between the mass and the ileocecal valve was 10 centimeters in length. The mass had serpentine aneurysmal dilatations around it, but no lymphadenopathy was found around the mass. The patient underwent segmental resection of the involved ileum along with the mesentery. Unfortunately, we had to sacrifice her right adnexa and some part of the bladder wall due to severe adhesion with the mass. By dividing the mass longitudinally, we could see a necrotic tumor with nodules on the serosal surface of the diseased ileum having normal looking proximal and distal small intestinal loops attatched to it (Fig. 3). Grossly, the specimens were previously opened and continuous segment of terminal ileum, 44 cm long, and cecum and ascending colon, 18 cm long. The lumen of the small intestine was markedly dilated, about 15 cm in diameter, at 26 cm from the proximal margin of resection and showed tan gray dull and nodular serosal surface. It showed diffusely thickened wall, up to 25 cm, and showed tan gray nodular luminal surface. Formalin-fixed and paraffin-embedded sections of the small intestine showed infiltration of the nests of epithelioid tumor cells. The tumor cells showed marked cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures, and abundant cytoplasm (Fig. 4). Melanin pigment was focally present in the cytoplasm. After immunohistochemical staining with HMB-45 and S-100, the diagnosis of the malignant melanoma infiltrating to the ileal mucosa was confirmed (Fig. 5).


Ileal malignant melanoma presenting as a mass with aneurysmal dilatation: a case report.

Kim W, Baek JM, Suh YJ, Jeon HM, Kim JA - J. Korean Med. Sci. (2004)

Result of immunohistochemical staining with HMB-45 is positive (×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822316&req=5

Figure 5: Result of immunohistochemical staining with HMB-45 is positive (×200).
Mentions: After treating anemia with repeated transfusion, exploratory laparotomy was done. After evacuating moderate amount of intraabdominal ascites, we could locate a mass at the terminal ileum, which resided in the middle of the lower abdomen and attached firmly to the omentum anteriorly, the sigmoid colon posteriorly, and the urinary bladder inferiorly. The diameter of the mass exceeded 15 centimeters, and the intervening normal segment of the ileum between the mass and the ileocecal valve was 10 centimeters in length. The mass had serpentine aneurysmal dilatations around it, but no lymphadenopathy was found around the mass. The patient underwent segmental resection of the involved ileum along with the mesentery. Unfortunately, we had to sacrifice her right adnexa and some part of the bladder wall due to severe adhesion with the mass. By dividing the mass longitudinally, we could see a necrotic tumor with nodules on the serosal surface of the diseased ileum having normal looking proximal and distal small intestinal loops attatched to it (Fig. 3). Grossly, the specimens were previously opened and continuous segment of terminal ileum, 44 cm long, and cecum and ascending colon, 18 cm long. The lumen of the small intestine was markedly dilated, about 15 cm in diameter, at 26 cm from the proximal margin of resection and showed tan gray dull and nodular serosal surface. It showed diffusely thickened wall, up to 25 cm, and showed tan gray nodular luminal surface. Formalin-fixed and paraffin-embedded sections of the small intestine showed infiltration of the nests of epithelioid tumor cells. The tumor cells showed marked cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures, and abundant cytoplasm (Fig. 4). Melanin pigment was focally present in the cytoplasm. After immunohistochemical staining with HMB-45 and S-100, the diagnosis of the malignant melanoma infiltrating to the ileal mucosa was confirmed (Fig. 5).

Bottom Line: A 36-yr-old woman was found to have a secondary malignant melanoma in the terminal ileum with profuse aneurysmal dilatation, which is not the typical presentation of the malignant melanoma in the small intestine.Radiologic studies revealed a large tumor involving the distal ileum with aneurysmal dilatations having afferent and efferent loops, which needed to be differentiated from malignant lymphoma and other gastrointestinal tumors.She had been free from any evidence of the local or systemic recurrence for one year after the completion of eighteen months of the subcutaneous interferon treatment; postoperatively however, the occurrence of metastatic mass at the right axilla rendered us from complete resection due to severe penetration into the vital nerves and vessels in the axilla.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. kimwook@hfh.cuk.ac.kr

ABSTRACT
Malignant melanoma is the most common metastatic tumor of the gastrointestinal tract and can present with fairly common constitutional symptoms. A 36-yr-old woman was found to have a secondary malignant melanoma in the terminal ileum with profuse aneurysmal dilatation, which is not the typical presentation of the malignant melanoma in the small intestine. Radiologic studies revealed a large tumor involving the distal ileum with aneurysmal dilatations having afferent and efferent loops, which needed to be differentiated from malignant lymphoma and other gastrointestinal tumors. Exploratory laparotomy was done, and we found a huge mass with plentiful aneurysmal dilatations; much the same of the findings from the previous studies. Segmental resection with the surrounding omentum was done followed by end-to-end anastomosis between both ends of the remaining ileum. She had been free from any evidence of the local or systemic recurrence for one year after the completion of eighteen months of the subcutaneous interferon treatment; postoperatively however, the occurrence of metastatic mass at the right axilla rendered us from complete resection due to severe penetration into the vital nerves and vessels in the axilla.

Show MeSH
Related in: MedlinePlus