Intest Res.  2015 Apr;13(2):170-174. 10.5217/ir.2015.13.2.170.

Primary Anorectal Malignant Melanoma Treated With Endoscopic Mucosal Resection

• Park JH
• Lee JR
• Yoon HS
• Jung TY
• Lee EJ
• Lim JG
• Ko SY
• Wang JH
• Lee JD
• Kim HY

• KMID: 2284885
• DOI: http://doi.org/10.5217/ir.2015.13.2.170

Abstract

Anorectal melanoma is a rare neoplasm that accounts for less than 1-4% of anorectal malignant tumors. The main therapeutic modality for anorectal melanoma is surgical treatment, with abdominoperineal resection or wide local excision being the most common approaches. A 77-year-old male with a history of cerebral infarction and hypertension presented with anal bleeding. Here, we report a case of anorectal melanoma treated by endoscopic mucosal resection with adjuvant interferon therapy rather than surgical resection. The patient has been disease-free for 5 years after endoscopic treatment.

Keyword

Anorectal melanoma; Endoscopic mucosal resection; Interferon-alpha; Abdominoperineal resection; Wide local excision

MeSH Terms

Aged
Cerebral Infarction
Hemorrhage
Humans
Hypertension
Interferon-alpha
Interferons
Male
Melanoma*
Interferon-alpha
Interferons

Figure

• 

  Fig. 1 Serial colonoscopic findings. (A) Colonoscopic view demonstrates a dark polypoid lesion with oozing hemorrhage about 1.5 cm in size adjacent to the anal verge. (B) After polypectomy, oozing hemorrhage is stopped.

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  Fig. 2 Pathologic findings. (A) A gross view of the resected specimen, measuring 15×12 mm, shows a dark, black-pigmented solid tumor with a short stalk. (B) Microscopic findings show diffuse infiltration of round or spindle-shaped tumor cells with lymphocytes (H&E, ×40). (C) Immunohistochemically, tumor cells are positive for Human Melanin Black-45 (HMB-45 staining, ×400).

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  Fig. 3 Fluorine-18-fluorodeoxyglucose PET/CT findings. (A) After polypectomy, a PET/CT scan of abdomen reveals a mild hypermetabolic lesion at the anorectal junction (Maximum standardized uptake values, 2.3; white arrow). (B) There is neither lymph node nor systemic metastases. Hypermetabolic lesion at the anorectal junction is observed (arrow head). (C) Five years after initial therapy, PET/CT scan does not demonstrate the hypermetabolic lesion.

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  Fig. 4 Sigmoidoscopic findings. (A) Additional endoscopic mucosal resection (EMR) is performed with three pieces at the site of previous polypectomy. (B) Sigmoidoscopic view reveals scar change at previous EMR site 5 years after initial therapy.

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