Korean J Gastroenterol.  2017 Aug;70(2):103-106. 10.4166/kjg.2017.70.2.103.

The Diagnosis of Metastatic Malignant Melanoma Incidentally Found during a National Health Screening Endoscopy: A Case Report

• Lee JS
• Kim SJ
• Kang DH
• Kim HW
• Choi CW
• Park SB
• Yeo CW
• Kim HJ

• KMID: 2391368
• DOI: http://doi.org/10.4166/kjg.2017.70.2.103

Abstract

Malignant melanoma is one of the most common malignant diseases of the gastrointestinal tract. It has been reported that the malignant melanoma metastasizes not only to the small intestine due to the abundant blood supply, but also to the stomach, colon, and esophagus. Gastrointestinal metastasis is usually suspected depending on the clinical symptoms, as well as based on radiological or endoscopic findings. Imunohistochemical stains, such as Melan-A/Melanoma antigen recognized by T cell-1 or human melanoma black-45, are useful for confirming the diagnosis of malignant melanoma. A 44-year-old male received an operation due to a malignant melanoma at the left thumb two years ago. On the national health screening endoscopy, a submucosal tumor with hyperemic change on the top was found. The final diagnosis was a metastatic malignant melanoma in the stomach, pancreas, and pelvic bone. We recommend that endoscopists should consider the potential malignancy of subepithelial tumor with mucosa change, despite the tumor size being less than 1 cm.

Keyword

Melanoma; Stomach; Metastasis; Endoscopy

MeSH Terms

Adult
Colon
Coloring Agents
Diagnosis*
Endoscopy*
Esophagus
Gastrointestinal Tract
Humans
Intestine, Small
Male
Mass Screening*
Melanoma*
Mucous Membrane
Neoplasm Metastasis
Pancreas
Pelvic Bones
Stomach
Thumb
Coloring Agents

Figure

• 

  Fig. 1 Endoscopic finding. Subepithelial tumor-like lesion (8 mm) with hypervascular change on the fundus (arrow).

• 

  Fig. 2 Pathologic finding. (A) Abnormal cell proliferation is observed. The nuclei of the cells are larger than other inflammatory cells (H&E stain, ×100). (B) Strongly positive immunohistochemical stains for HMB-45 protein (HMB-45 stain, ×100). (C) Strongly positive immunohistochemical stains for Melan-A (Melan-A stain, ×100). HMB-45, human melanoma black-45.

• 

  Fig. 3 PET-CT finding. (A) Increased FDG uptake at the right ilium (arrow). (B) Increased FDG uptake at the left hilar area in the mediastinum (arrow). (C) Focal increased FDG uptake at the pancreatic body (arrow). PET, photon emission tomography; CT, computed tomography; FDG, fluorodeoxyglucos.

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