J Korean Med Sci.  2004 Apr;19(2):297-301. 10.3346/jkms.2004.19.2.297.

Ileal Malignant Melanoma Presenting as a Mass with Aneurysmal Dilatation: A Case Report

• Kim W
• Baek JM
• Suh YJ
• Jeon HM
• Kim JA

• KMID: 1733494
• DOI: http://doi.org/10.3346/jkms.2004.19.2.297

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.

Keyword

Malignant Melanoma; Gastrointestinal Neoplasms

MeSH Terms

Adult
Dilatation, Pathologic
Female
Human
Ileal Neoplasms/*secondary
Ileum/*pathology
Melanoma/*secondary
Neoplasm Recurrence, Local/pathology
Neoplasms, Unknown Primary/*pathology

Figure

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  Fig. 1 Abdominal computerized tomography shows marked dilatation of the distal ileum and no obstructive lesion.

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  Fig. 2 Small bowel series shows submucosal tumor at distal ileum, suggesting a lymphoma with aneurysmal dilatations or gastrointestinal stromal tumor.

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  Fig. 3 There is markedly dilated lumen in the mass in connection with the lumen of afferent loop (arrowhead) and efferent loop with normal ileal mucosa (arrow).

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  Fig. 4 The microscopic findings of the tumor cells are markedly irregular in size and shape, showing large cells with hyperchromatic nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. (H&E stain, ×400).

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

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