Korean J Gastroenterol.  2024 Jan;83(1):33-36. 10.4166/kjg.2023.136.

A Curious Case of Primary Gastric Mucosal Melanoma

• Sohail Z
• Samar MR
• Qureshi NJ
• Arshad S
• Zaki A

• KMID: 2552241
• DOI: http://doi.org/10.4166/kjg.2023.136

Abstract

Malignant melanoma is a neoplasm of melanin-producing cells predominantly of cutaneous origin, which uncommonly develops within gut mucosa. We present the case of a 58-year-old woman with complaints of abdominal pain, loss of appetite and weight. Esophagogastroduodenoscopy revealed a gastric mass and systemic imaging demonstrated widespread nodal and bilateral adrenal gland involvement. Histopathology of the gastric mass confirmed primary malignant mucosal melanoma of the stomach. The patient received three cycles of Nivolumab but did not respond, and thus, was then offered best supportive care. Although infrequent, mucosal melanoma can arise from the gastrointestinal tract, and in contrast to the cutaneous form, advanced disease usually has a dismal prognosis and responds poorly to immune checkpoint inhibitors. Primary gastric melanoma is an aggressive disease that is diagnosed by exclusion after the differential diagnosis of metastasis from a cutaneous or unknown primary site has been conducted. If available, patients with treatment-naïve mucosal melanoma should be considered for enrollment in clinical trials.

Keyword

Gastric neoplasm; Immunotherapy; Esophagogastroduodenoscopy; Malignant melanoma; Gastrointestinal tract

Figure

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  Fig. 1 Endoscopy showing: (A) An ulcerated gastric mass. (B) Three ulcerated masses in the body, one large, one small, at the proximal gastric body along lesser and greater curvature (arrows) respectively with a small mass at distal gastric body.

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  Fig. 2 (A) H&E stain under 20× magnification, showing large tumor cells with pleomorphic nuclei and abundant cytoplasm. (B) Tumor cells under 20x magnification, show diffuse nuclear positivity for immuno-histochemical marker SOX-10. (C) Tumor cells under 20x magnification, show diffuse cytoplasmic positivity for immuno-histochemical marker HMB-45.

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