Primary giant aggressive amelanotic duodenal melanoma

Primary malignant melanoma of the gastrointestinal tract is extremely rare. A 35-year-old man presented with complaints of abdominal pain and weight loss. Contrast enhanced computed tomography showed a large mass involving the duodenum and the superior mesenteric vessels. Upper gastrointestinal endo...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2017-05, Vol.99 (5), p.e131-e134
Main Authors: Kilambi, R, Singh, A N, Dash, N R, Madhusudhan, K S, Das, P
Format: Article
Language:English
Subjects:
Abdomen
Adult
Catheter Ablation
Duodenal Neoplasms - diagnostic imaging
Duodenal Neoplasms - pathology
Duodenal Neoplasms - surgery
Endoscopy
Humans
Male
Melanoma
Melanoma, Amelanotic - diagnostic imaging
Melanoma, Amelanotic - pathology
Melanoma, Amelanotic - surgery
Metastasis
Online Case Report
Pain
Pancreaticoduodenectomy
Patients
Skin cancer
Small intestine
Surgery
Tumors
Ultrasonic imaging
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Summary:Primary malignant melanoma of the gastrointestinal tract is extremely rare. A 35-year-old man presented with complaints of abdominal pain and weight loss. Contrast enhanced computed tomography showed a large mass involving the duodenum and the superior mesenteric vessels. Upper gastrointestinal endoscopy demonstrated a large, friable mass along the duodenal wall and biopsy was suggestive of malignant melanoma. A detailed physical examination and whole body imaging (positron emission tomography and computed tomography) did not reveal any other lesion. The patient underwent a pancreaticoduodenectomy with segmental resection and anastomosis of the superior mesenteric vein as well as a segmental colectomy. His postoperative recovery was uneventful. The histopathology of the operative specimen showed a malignant amelanotic melanoma arising from the duodenum with lymph nodal involvement. He received oral temozolomide. However, he developed liver metastasis at six months and again at ten months, which was managed with radiofrequency ablation both times. He is doing well at 32 months of follow-up review. Multimodality treatment including surgery, adjuvant chemotherapy and salvage therapy appears to be a promising tool for achieving long-term survival in such patients.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2016.0323