Beyond the Surface: A Case Report of a Patient with Small Bowel Metastasis and Melanoma History. Diagnosis and Management.

Background: Malignant melanoma (MM) is one of the most prevalent and deadliest forms of skin cancer, resulting from the malignant transformation of melanocytes. It accounts for approximately 1.7% of global cancer diagnoses and is the fifth most common cancer in the US. MM can metastasize to almost any part of the body, with early detection significantly improving prognosis. Case presentation: We report the case of an 81-year-old female with a history of malignant melanoma (primary lesion on the left calf) and various comorbidities. She presented with severe anemia of unknown origin. A CT scan was performed due to her medical history, revealing a circumferential, asymmetrical parietal thickening at the level of a hypogastric ileal loop. The lesion suggested a tumoral substrate. Subsequent colonoscopy showed no metastatic lesions, but surgical intervention confirmed a malignant melanoma ileal metastasis. The patient underwent laparoscopic segmental resection with favorable post-surgery outcomes. Histopathological examination of the resected tissue confirmed the diagnosis of small intestine secondary lesions from the malignant melanoma. Conclusion: This case underscores the necessity of considering metastatic melanoma in patients with a history of MM and vague gastrointestinal symptoms. Early and accurate diagnosis through advanced imaging and endoscopic techniques can significantly improve patient outcomes.

[Ileum and brain, unusual metastatic sites for a thymoma]. / Iléon et encéphale, des sites métastatiques inhabituels pour un thymome.

INTRODUCTION: Thymomas are epithelial neoplasms of thymic origin, preferentially localized in the anterior mediastinum. Recurrences after surgery are uncommon and usually occur in the intrathoracic area. The occurrence of extra-thoracic metastases is an unusual phenomenon. CASE REPORT: Here we report the case of a 61-year-old man with no special medical history. He smoked about 40 pack years but stopped in 1999. Initially he presented with a mediastinal thymoma and underwent surgical resection. One year later the development of abdominal pain and bowel disorders lead to the discovery of an ileal ulcero-necrotic tumour. After surgical resection, histological examination revealed secondary thymoma. A few months later he underwent cerebral MRI because of neurological symptoms. This revealed a second metastasis located in the brain. Stereotactic radiotherapy led to an improvement. After more than one year of follow-up the patient developed a papillary thyroid carcinoma but there were no signs of recurrence of the thymoma. CONCLUSIONS: Extra-thoracic metastases of thymoma are exceptional but their existence should not be overlooked. Their management is not standardised because of lack of data in the literature. Though surgical excision in oligo-metastatic subjects is a frequently reported therapeutic option, a radiotherapeutic approach, particularly in cerebral situations, could be a credible alternative.

Haemorrhagic small bowel melanoma metastasis: a clinical rarity.

We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest-abdomen-pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.

Metastasis of melanoma to the gastrointestinal tract. Report of three cases / Metástasis de melanoma al tracto gastrointestinal. Reporte de tres casos

Background: Cutaneous melanoma is one of the most common malignancies to metastasize to the gastrointestinal tract. Presence of tumor metastasis is an important prognostic factor. Despite clinical advances, the five-year survival rate of patients with stage IV malignant melanoma is only about 14%. We present three clinical cases with metastasis of cutaneous melanoma. Clinical cases: Man 68 years old and woman 55 years old, with colon metastasis; and man 75 years old with metastasis to the small intestine. All of them underwent resection alone when they presented gastrointestinal symptoms and they obtained relief after it. Two patients had initial cutaneous lesions with Breslow´s thickness < 2 mm. The three patients died months after the surgery. Conclusion: Meticulous attention to patients with prior history of cutaneous melanoma who present with subtle gastrointestinal symptoms is highly recommended.

Introducción: el melanoma cutáneo es una de las neoplasias malignas que con mayor frecuencia metastatiza al tracto gastrointestinal. La presencia de metástasis es un factor pronóstico importante. A pesar de los avances clínicos, la supervivencia libre de enfermedad a 5 años en pacientes con melanoma cutáneo en estadio clínico IV es únicamente de 14%. Se presentan tres casos clínicos, con melanoma cutáneo metastásico a intestino. Casos clínicos: hombre de 68 años y mujer de 55 años de edad, con metástasis en colon; hombre de 75 años de edad con metástasis a intestino delgado. Cuando presentaron síntomas grastrointestinales, fueron tratados únicamente con cirugía, con alivio de los síntomas iniciales. Dos pacientes tenían diagnóstico previo de melanoma cutáneo, con espesor de Breslow < 2 mm. Los tres pacientes fallecieron meses después de la cirugía. Conclusión: se recomienda prestar atención especial a pacientes con historia previa de melanoma cutáneo que presenten síntomas gastrointestinales inespecíficos.

Small bowel obstruction secondary to intramesosigmoid hernia.

Intramesosigmoid hernias are a rare cause of small bowel obstruction. Here, we present such a case with learning points derived from diagnostic dilemma, shared decision making in consent and the management of a rare cause of a common surgical emergency.

Cancer of the mandibular gingiva metastasizing to the small intestine.

Head and neck cancer metastasizing to the small intestine is very rare. Here we report a case of cancer of the mandibular gingiva metastasizing to the small intestine. The patient was an 82-year-old man who had squamous cell carcinoma of the mandibular gingiva staged as T2N2bM0. Two months after surgery, he presented with lower abdominal pain accompanied by signs of peritoneal irritation. Urgent abdominal surgery was performed, during which a crater-shaped perforation was noted on the wall of the ileum. Microscopic findings at this site confirmed a diagnosis of metastatic squamous cell carcinoma in the small intestine from the mandibular gingiva. To our knowledge, this is the first case report of oral cancer metastasizing to the small intestine. If gastrointestinal symptoms appear in a patient with advanced oral cancer, a differential diagnosis of metastasis to the gastrointestinal tract should be kept in mind.

Exploration of the Exact Prognostic Significance of Lymphatic Metastasis in Jejunoileal Neuroendocrine Tumors.

BACKGROUND: How to evaluate the prognostic significance of lymphatic metastasis in patients with small bowel (jejunoileal) neuroendocrine tumors (SBNETs) is still not conclusive. METHODS: Data for patients with SBNETs, but without distant metastasis, were retrieved from the Surveillance, Epidemiology, and End Results database. Recursive partitioning analysis (RPA) was used for classification development by combining examined lymph nodes (ELNs) and lymph node ratio (LNR). RESULTS: Overall, 1925 patient records were retrieved. Patients with N0 and N1 disease (based on the definition of the European Neuroendocrine Tumor Society [ENETS] staging classification) did not have different OS (p = 0.7867), nor did patients with N0, N1 (< 12 positive nodes), and N2 (≥ 12 positive nodes) disease based on the definition of American Joint Committee on Cancer (AJCC) 8th edition staging classification (p = 0.5276). However, Cox regression analysis indicated that both ELNs (hazard ratio [HR] 0.968, 95% confidence interval [CI] 0.949-0.987; p = 0.0013) and LNR (HR 2.288, 95% CI 1.122-3.682; p = 0.0006) were prognostic factors. Using RPA, we combined ELNs and LNR, and patients were reclassified into three groups (group 1: ELNs ≥ 12, any LNR; group 2: ELNs < 12, LNR < 0.35; group 3: ELNs < 12, LNR ≥ 0.35). Survival analysis and multivariate Cox regression showed that groups 1, 2, and 3 had progressively worse survival. Furthermore, we found that ELNs ≥ 12 could remarkably improve patient survival (p < 0.001). CONCLUSIONS: The current definition of lymphatic metastasis could not help predict patient survival. Our newly proposed classification of lymphatic metastasis is better than the ENETS and AJCC 8th edition staging classifications in evaluating the prognostic significance of lymphatic metastasis in SBNETs. Systematic resection of lymph nodes (≥ 12) could help improve patient survival.

Small intestinal obstruction due to the metastasis of intrahepatic cholangiocarcinoma: A case report.

RATIONALE: The small intestine (SI) does not commonly harbor cancer but is occasionally involved by metastatic cancer from other organs. To manage SI cancer appropriately, surveillance for primary origin outside the SI is essential. PATIENT CONCERNS: This study presents a 54-year-old Thai man diagnosed with SI obstruction which required laparoscopy- assisted partial ileal resection. DIAGNOSES: On the basis of the expression pattern of cytokeratins (CKs) and mucins (MUCs) in the resected SI adenocarcinoma, we suspected this was metastasized from the pancreatobiliary tract. Imaging studies revealed a hepatic segmental atrophy with an occlusion of the posterior segmental blanch of the portal vein without any contrast-enhanced lesions in the liver. Pathology of the liver biopsy revealed intrahepatic cholangiocarcinoma (ICC) with the same expression pattern of CKs and MUCs as the SI adenocarcinoma. INTERVENTIONS: Systemic chemotherapy (gemcitabine and cisplatin) was initiated. OUTCOMES: Despite of the chemotherapy for 20 months, he died of ICC. LESSONS: This is the first case of SI obstruction caused by the metastasis of ICC. We demonstrate that immunohistochemical staining of CKs and MUCs discriminate between primary and metastatic SI cancer and predict its primary origin outside the SI. This case also suggests that a hepatic segmental atrophy with portal vein occlusion would be an atypical but important finding to diagnose ICC.

Unusually high levels of serum p53 antibody in recurrent gastric cancer.

Serum tumor markers in patients with cancer assist with establishing diagnosis, estimating prognosis, monitoring treatment, and detecting tumor recurrence. Changes in the p53 tumor suppressor gene are the most common genetic abnormalities in many different human malignancies. Several studies have demonstrated that serum p53 antibodies (S-p53Ab) comprise an early marker of malignant disease, a marker for treatment effects and a prognostic factor for patients with several types of tumors. We recently reported that S-p53Ab is useful for patients with gastric cancer. We describe a rare situation in which unusually high serum p53 antibodies helped to detect recurrent gastric cancer in the small intestine after gastrectomy. Further studies are required to gain a more precise understanding of the clinical impact of S-p53Ab titer monitoring in gastric cancer.

Adenocarcinoma Ex-Goblet Cell Carcinoid of the Appendix With Metastatic Peritoneal Spread to Meckel's Diverticulum and Endometriosis.

Adenocarcinoma ex-goblet cell carcinoid is a very rare and histologically unique appendiceal malignancy with dual glandular and neuroendocrine differentiation. There is a high incidence of this tumor among middle-aged women with metastasis to the gynecologic tract with the mode of metastasis following peritoneal spread rather than hematogenous distribution. Adenocarcinoma ex-goblet cell carcinoid can spread to any peritoneal site including ovaries or omentum. We report a 37-year-old healthy woman who initially presented with right lower quadrant abdominal pain and pseudomyxoma peritonei. Histopathology of the appendectomy specimen revealed an adenocarcinoma ex-goblet cell carcinoid, signet ring cell type. Follow-up right hemicolectomy, omentectomy, bilateral salpingo-oophorectomy, and regional peritoneal resections revealed metastatic involvement by adenocarcinoma ex-goblet cell carcinoid, signet ring cell type. In this report, we describe a case of appendiceal adenocarcinoma ex goblet cell carcinoid with metastases to Meckel's diverticulum and areas of pelvic endometriosis, which have not been previously reported.