Metastases of malignant melanoma in the proximal jejunum

Clinical History

A patient with history of malignant melanoma showed symptoms of chronic gastrointestinal bleeding. Gastroscopy and colonoscopy were normal.

Imaging Findings

A 70-year-old man with history of malignant melanoma resection twelve years before and known metastases of the brain and lung, presented with abdominal pain, loss of weight, chronic anemia, and positive hemoccult test. Gastroscopy and colonoscopy were normal. A small bowel enema was performed. The found lesion had been suspected as an additional metastatic lesion of the known malignant melanoma. Laparotomy was performed to resect the cause ofr hemorrhage and to prevent obstructive ileus. In laparotomy a large tumour was found in the first jejunal loop, nearly filling the lumen. The correct diagnosis of metastases of malignant melanoma has been confirmed histologically.

Discussion

The hollow viscera are an important but less frequent site of hematogenous metastases. Carcinoma of the breast or lung and melanoma are the most common primary tumours [1]. Melanoma is well known for its propensity to metastasize to virtually any organ and for its highly variable clinical course. Melanoma spreads most frequently to nonvisceral sites: skin, subcutaneous tissue, and distant lymph nodes in about 42 to 57 % of cases. Visceral metastases to the lungs, liver, brain, bone and intestines are the next common sites [2]. In autopsy studies metastases of small bowel were found in 35,6 % of patients with melanoma [3]. Metastases to the gut typically develop in the serosa or submucosa and produce intraluminal lesions that can lead to obstruction, ulcerated mucosal lesions, or submucosal polypoid masses that may result in intussusception. The most common clinical condition in patients with metastatic lesions of the gut is small bowel obstruction, in addition pain, fever, ascites, bleeding, and perforation have all been described [4]. Metastases to the GI tract may be difficult to diagnose, small bowel metastases, however, are detectable radiographically in only 50 % of cases [4].

Differential Diagnosis List

Final Diagnosis

Jejunal metastases of malignant melanoma

URL:	https://www.eurorad.org/case/782
DOI:	10.1594/EURORAD/CASE.782
ISSN:	1563-4086