RESUMO
Non-cutaneous melanoma is a very rare clinical entity. Gastric melanoma can be primary or secondary, but determining their nature is in most cases very challenging. To date, very few cases of primary gastric melanoma have been described in the literature. We report the first case of primary gastric melanoma documented in a Romanian patient, confirmed through clinical, imagistic, and pathological diagnosis. A 68-year-old female patient presented to our hospital with complaints of dyspepsia, abdominal pain, and weight loss. Esophagogastroduodenoscopy revealed two large sessile masses in the gastric fundus, which was histologically compatible with melanoma; immunohistochemistry staining was positive for vimentin, S100 protein, HMB45 antibody and Melan A/MART1, and negative for pan-CKAE1/AE3, leukocyte common antigen and DOG1. Extensive dermatological and ophthalmological examinations did not identify a primary lesion. The patient was therefore diagnosed with primary melanoma of the stomach. At the time of the diagnosis, multiple bone and pulmonary metastases were detected and considering the poor general status of the patient, surgery was not recommended. She died three months following diagnosis. A review of the literature identified only 32 other reported cases of primary gastric melanoma, all in individuals ≥50 years of age and most of them in male patients. Partial or total gastrectomy was the usual treatment of choice, but prognosis was overall poor. Awareness of this rare condition must be increased among healthcare providers, as early detection can improve survival chances.
RESUMO
Colorectal carcinoma represents a major cause of mortality and 0.2-12% of resected colonic polyps have malignant cells inside. We performed a retrospective study of patients with resected polyps during a period of 13 years. A total of 905 patients had 2033 polyps removed; 122 polyps (109 patients) had malignant cells. Prevalence of malignant polyps with submucosal invasion was 1.23% and for all polyps with malignant cells was 6%; malignant polyps had a larger size (23.44 mm mean diameter) vs benign polyps (9.63 mm); the risk of malignancy was increased in polyps larger than 10 mm, in lateral spreading lesions and in Paris types 0-Ip, 0-Isp, in sigmoid, descending colon and rectum, in sessile serrated adenoma and traditional serrate adenoma subtypes of serrated lesions and in tubulovillous and villous adenoma. In 18 cases surgery was performed, in 62 patients only colonoscopic follow-up was made and in 35 patients no colonoscopic follow-up was recorded. From initially endoscopic resected polyps, recurrence was noted in seven (11.3%) cases; there was a trend toward association with depth of invasion, piecemeal resection, right and rectum location, sessile and lateral spreading type and pathological subtype. In surgical group, post-therapeutic staging was available in 11 cases; nodal involvement was noted in three (27.27%) cases; none had lymphatic or vascular invasion in endoscopically resected polyps. Four patients with no macroscopic local recurrence underwent surgery with no residual tumor. The rate of metastasis was 16.67% in surgical group and 1.61% in endoscopic group. Evaluation of lymph node (LN) invasion was available for 11 operated patients, with LN invasion (N1) in three patients, local residual tumoral tissue in one patient with incomplete resection and no residual tumor (R0 resection) in four patients with endoscopic resection before surgery.
