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Primary malignant melanoma of the duodenum without visible melanin pigment: a mimicker of lymphoma or carcinoma.

Li H, Fan Q, Wang Z, Xu H, Li X, Zhang W, Zhang Z - Diagn Pathol (2012)

Bottom Line: Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains.Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere.The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China.

ABSTRACT
Primary malignant melanoma of the duodenum is an unusual oncologic entity. Patients usually present the similar clinical symptoms like other common tumors in this site. And there are no specific radiological features either. The cases with only little melanin pigment or without notable melanin pigment are very misleading, especially in small biopsies or frozen sections. Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains. Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere. Herein we report the case of a 60-year-old male patient with primary malignant melanoma of the duodenum, which was misdiagnosed as lymphoma or undifferentiated carcinoma in frozen consultation. The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

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Computed tomography scan of the abdomen reveals a space-occupying lesion originating from the descending part of the duodenum (red arrow).
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Figure 1: Computed tomography scan of the abdomen reveals a space-occupying lesion originating from the descending part of the duodenum (red arrow).

Mentions: A 60-year-old Chinese male patient suffering from durative right abdominal pain and dark stools for one month, a recent episode of nausea and vomiting, was admitted to hospital in May 27, 2008. No history of fever, anorexia, hematemesis, radiating pain or weight loss was reported. Upper GI endoscopy revealed a malignant tumor at the descending part of the duodenum and the biopsy suspected poorly differentiated carcinoma. But there were no enough tumor cells for further immunohistochemical stain. In physical examination, there was no any obvious black nevus or nodule, nor swelled superficial lymph node. Routine hematological and biochemical studies showed no abnormalities. Serum detection showed tumor markers such as alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 50 (CA-50), carbohydrate antigen 19–9 (CA-19-9) were all in the normal range. FOB (Fecal Occult Blood) Testing was positive. GI tract barium meal revealed a filling defect in the descendant duodenum, without obvious mucosal destruction and barium passed smoothly. Computed tomography scan of the abdomen disclosed the presence of a space-occupying lesion originating from the descending part of the duodenum with stenotic lumens (Figure 1). An exploratory laparotomy was performed through a midline incision in Jun 2, 2008 and confirmed the presence of a solid tumor arising from the lateral part of the descendant duodenum, which invading the duodenal serosa. Enlarged mesentery lymph node and peripancreatic lymph node were identified. Because the surgeons suspected the tumor as lymphoma, so only a palliative operation (tumor resection) was done.


Primary malignant melanoma of the duodenum without visible melanin pigment: a mimicker of lymphoma or carcinoma.

Li H, Fan Q, Wang Z, Xu H, Li X, Zhang W, Zhang Z - Diagn Pathol (2012)

Computed tomography scan of the abdomen reveals a space-occupying lesion originating from the descending part of the duodenum (red arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472194&req=5

Figure 1: Computed tomography scan of the abdomen reveals a space-occupying lesion originating from the descending part of the duodenum (red arrow).
Mentions: A 60-year-old Chinese male patient suffering from durative right abdominal pain and dark stools for one month, a recent episode of nausea and vomiting, was admitted to hospital in May 27, 2008. No history of fever, anorexia, hematemesis, radiating pain or weight loss was reported. Upper GI endoscopy revealed a malignant tumor at the descending part of the duodenum and the biopsy suspected poorly differentiated carcinoma. But there were no enough tumor cells for further immunohistochemical stain. In physical examination, there was no any obvious black nevus or nodule, nor swelled superficial lymph node. Routine hematological and biochemical studies showed no abnormalities. Serum detection showed tumor markers such as alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 50 (CA-50), carbohydrate antigen 19–9 (CA-19-9) were all in the normal range. FOB (Fecal Occult Blood) Testing was positive. GI tract barium meal revealed a filling defect in the descendant duodenum, without obvious mucosal destruction and barium passed smoothly. Computed tomography scan of the abdomen disclosed the presence of a space-occupying lesion originating from the descending part of the duodenum with stenotic lumens (Figure 1). An exploratory laparotomy was performed through a midline incision in Jun 2, 2008 and confirmed the presence of a solid tumor arising from the lateral part of the descendant duodenum, which invading the duodenal serosa. Enlarged mesentery lymph node and peripancreatic lymph node were identified. Because the surgeons suspected the tumor as lymphoma, so only a palliative operation (tumor resection) was done.

Bottom Line: Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains.Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere.The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China.

ABSTRACT
Primary malignant melanoma of the duodenum is an unusual oncologic entity. Patients usually present the similar clinical symptoms like other common tumors in this site. And there are no specific radiological features either. The cases with only little melanin pigment or without notable melanin pigment are very misleading, especially in small biopsies or frozen sections. Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains. Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere. Herein we report the case of a 60-year-old male patient with primary malignant melanoma of the duodenum, which was misdiagnosed as lymphoma or undifferentiated carcinoma in frozen consultation. The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

Show MeSH
Related in: MedlinePlus