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Multiple nodular lesions by colonic metastatic malignant melanoma
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Digestive and Liver Disease 41 (2009) 169
Image of the Month
Multiple nodular lesions by colonic metastatic malignant melanoma G. Galloro a,∗ , A. Inzirillo c , L. Magno a , G. Diamantis a , M. Inzirillo a , A. Pastore a , S. Ruggiero a , G. Mosella b a
University of Naples “Federico II”, School of Medicine, Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, Special Unit of Surgical Digestive Endoscopy, Via S. Pansini, 5, 80131 Naples, Italy b Unit of Videoassisted Surgery, Italy c Hospital “Monaldi”-Naples, Department of General Surgery, Unit of Digestive Endoscopy, Italy Received 27 March 2008; accepted 21 May 2008 Available online 10 July 2008
A 52 years-old caucasian man was referred from another citizen hospital to our Surgery Department presenting very poor clinical conditions, severe anemia (RGC 3.02 × 106 l−1 – normal value 4.2–5.6, Hb 6.7 g/dl – normal value 12–16), rectorrhagia. Colonoscopy identified multiple nodular lesions, small in size (0.3–0.8 cm), scattered in the rectum and the colon, with spherical shaped without depression or ulceration, dark brown–black pigmented with violaceous ring around the base. These lesions were isolated in the right colon and clustered in the left colon (1). One of the lesions was resected, by inject and cut mucosectomy: histologic (EE stain) and immunohistochemical (HMB 45) (2) examination showed nests of big size epithelioid cells atrophizing colonic mucosa. The EGD finding was negative. Standard chest X-ray examination showed multiple coin lesions of lungs, which were considered to be metastatic tumours. Bronchoscopy confirmed the presence of multiple nodular lesions that resembled those described in the colon. The patient died 2 days after hospitalization following a multiorgan neoplastic failure. Autopsy revealed multiple hepatic methastasis and a subungual lesion of left thumb that proved to be an acral lentiginous melanoma. Usually, colonic metastatic malignant melanoma (1–22%) presents itself with flat, black macular lesions or subpeduncolated lesions, with dark or reddish depression or ulceration [1–3]. The endoscopic appearance of our case is unusual and can imitate a different kind of lesion (for example, a vascular lesion or a Kaposi). ∗
Corresponding author. Tel.: +39 081 746 20 46; fax: +39 081 746 28 15. E-mail address: [email protected] (G. Galloro).
References [1] Kaplan MR, Knittel DR, Lawson, Schafer TW. Panenteric melanosis: an ominous endoscopic finding. Gastrointest Endosc 2005;61(6): 763–5. [2] Tamura S, Aono R, Onishi S, Hashimoto K. Metastatic malignant melanoma involving the colon. Gastrointest Endosc 2000;61(3):393. [3] Chiu HH, Liu YW, Huang CC. Synchronous metastatic malignant melanoma and primary adenocarcinoma in the colon. Gastrointest Endosc 2007;66(3):600.
1590-8658/$30 © 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2008.05.012
Digestive and Liver Disease 41 (2009) 169
Image of the Month
Multiple nodular lesions by colonic metastatic malignant melanoma G. Galloro a,∗ , A. Inzirillo c , L. Magno a , G. Diamantis a , M. Inzirillo a , A. Pastore a , S. Ruggiero a , G. Mosella b a
University of Naples “Federico II”, School of Medicine, Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, Special Unit of Surgical Digestive Endoscopy, Via S. Pansini, 5, 80131 Naples, Italy b Unit of Videoassisted Surgery, Italy c Hospital “Monaldi”-Naples, Department of General Surgery, Unit of Digestive Endoscopy, Italy Received 27 March 2008; accepted 21 May 2008 Available online 10 July 2008
A 52 years-old caucasian man was referred from another citizen hospital to our Surgery Department presenting very poor clinical conditions, severe anemia (RGC 3.02 × 106 l−1 – normal value 4.2–5.6, Hb 6.7 g/dl – normal value 12–16), rectorrhagia. Colonoscopy identified multiple nodular lesions, small in size (0.3–0.8 cm), scattered in the rectum and the colon, with spherical shaped without depression or ulceration, dark brown–black pigmented with violaceous ring around the base. These lesions were isolated in the right colon and clustered in the left colon (1). One of the lesions was resected, by inject and cut mucosectomy: histologic (EE stain) and immunohistochemical (HMB 45) (2) examination showed nests of big size epithelioid cells atrophizing colonic mucosa. The EGD finding was negative. Standard chest X-ray examination showed multiple coin lesions of lungs, which were considered to be metastatic tumours. Bronchoscopy confirmed the presence of multiple nodular lesions that resembled those described in the colon. The patient died 2 days after hospitalization following a multiorgan neoplastic failure. Autopsy revealed multiple hepatic methastasis and a subungual lesion of left thumb that proved to be an acral lentiginous melanoma. Usually, colonic metastatic malignant melanoma (1–22%) presents itself with flat, black macular lesions or subpeduncolated lesions, with dark or reddish depression or ulceration [1–3]. The endoscopic appearance of our case is unusual and can imitate a different kind of lesion (for example, a vascular lesion or a Kaposi). ∗
Corresponding author. Tel.: +39 081 746 20 46; fax: +39 081 746 28 15. E-mail address: [email protected] (G. Galloro).
References [1] Kaplan MR, Knittel DR, Lawson, Schafer TW. Panenteric melanosis: an ominous endoscopic finding. Gastrointest Endosc 2005;61(6): 763–5. [2] Tamura S, Aono R, Onishi S, Hashimoto K. Metastatic malignant melanoma involving the colon. Gastrointest Endosc 2000;61(3):393. [3] Chiu HH, Liu YW, Huang CC. Synchronous metastatic malignant melanoma and primary adenocarcinoma in the colon. Gastrointest Endosc 2007;66(3):600.
1590-8658/$30 © 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2008.05.012