Unexpected post-operative diagnosis of primary rectal melanoma. A case report

Anorectal melanoma (ARM) is a very uncommon and highly lethal malignancy. Due to its rarity and non-specific symptoms, preoperative diagnosis may be often erroneous and subsequent treatment inappropriate. We report a case of primary rectal melanoma and discuss the current diagnostic and therapeutic...

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Bibliographic Details
Published in:Il Giornale di chirurgia 2014-05, Vol.35 (5-6), p.137-139
Main Authors: Erdas, E, Calò, P G, Licheri, S, Pomata, M
Format: Article
Language:English
Subjects:
Aged, 80 and over
Anus Neoplasms - diagnosis
Clinical Practice
Colectomy - methods
Diagnosis, Differential
Fatal Outcome
Humans
Male
Melanoma - diagnosis
Melanoma - pathology
Melanoma - surgery
Neoplasm Recurrence, Local - diagnosis
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - surgery
Rectal Neoplasms - diagnosis
Rectal Neoplasms - pathology
Rectal Neoplasms - surgery
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Description
Summary:Anorectal melanoma (ARM) is a very uncommon and highly lethal malignancy. Due to its rarity and non-specific symptoms, preoperative diagnosis may be often erroneous and subsequent treatment inappropriate. We report a case of primary rectal melanoma and discuss the current diagnostic and therapeutic challenges. An 87-year-old man was admitted to our surgical unit with a history of progressive constipation, tenesmus, rectal bleeding and transanal mucous discharge. Preoperative investigations, including CT scan and colonoscopy with biopsy, were suggestive for locally advanced low rectal sarcoma and therefore the patient underwent abdominoperineal resection (APR). However, histopathological examination and immunohistochemistry resulted in a postoperative diagnosis of primary rectal melanoma. The patient died 6 months later due to local and systemic recurrence. ARM should always be considered when unusual anorectal lesions are discovered. Regardless of the pathological stage and the extent of surgery, prognosis of ARM remains poor. Thus, whenever feasible, wide local excision is now the preferred treatment, since it is associated with lower postoperative morbidity and better quality of life compared to APR. In our case, although the initial diagnosis was incorrect, APR was justified by the local invasiveness and large size of the tumor.
ISSN:0391-9005
1971-145X
DOI:10.11138/gchir/2014.35.5.137