Malignant Melanoma of the Small Bowel Presenting with Intussusception in a Woman: A Case Report

Abstract

Primary malignant melanoma originating in the small bowel is very rare. We report the case of primary malignant melanoma of the small bowel with secondary intussusception in a 51-year-old female with no prior history of cutaneous melanoma. The patient was admitted to the hospital for clinical bowel obstruction after 6 months of varying symptoms of antecedent syncopal events secondary to profound anemia due to iron deficiency followed later by vomiting, abdominal pain and weight loss. A CT scan showed intussusception and she underwent a small bowel resection. Diagnosis of malignant melanoma was confirmed post-operatively following immunohistochemistry. The patient history and postoperative investigation excluded the existence of a primary lesion elsewhere. Our case represents an aggressive primary small bowel melanoma presenting as intussusception.

Multiple gastrointestinal melanoma causing small bowel intussusception

“…It was postulated that neural crest cells migrate from the umbilical mesenteric canal into the GI tract, which later differentiate into APUD cells. These cells undergo neoplastic transformation to form melanoma which may explain the commonest site of GI melanoma being at ileum, the distal end of umbilical mesenteric canal [1,3,4,6].…”

“…Small bowel melanoma is aggressive, and with metastasis, its prognosis is worse than the cutaneous or extraintestinal melanomas. The medial survival time reported is about 6 months with 5 years overall survival of less than 10% [5,6]. The aggressive tumor biology with poor prognosis making many reserved for the benefit from operative exploration in the asymptomatic patient.…”

“…The inciden-tal finding on imaging would often require surgical resection to confirm the diagnosis of intestinal melanoma [1,5]. GI melanoma, likewise any mucosal melanoma, are more aggressive than cutaneous melanoma with a median survival of about 4 to 6 months and a 5-year overall survival rate of less than 10% [6]. Despite the poor prognosis, operative management remains the mainstay of treatment in small bowel melanoma.…”

“…Despite the poor prognosis, operative management remains the mainstay of treatment in small bowel melanoma. There was little evidence on the benefit of chemotherapy [6,7]. Though there was a report on dacarbazine, many did not survive long enough to initiate the palliative treatment [8].…”

Metastatic Melanoma Causing Recurrent Intussusception and Perforation of Small Bowel: Case Reports and Literature Review

“…The small intestine has an abundant blood supply allowing for metastasis from cutaneous melanomas [5]. Primary intestinal melanoma tends to occur in the ileum as a solitary intramural lesion, whereas secondary intestinal melanoma tends to arise in both the jejunum and ileum with multiple polypoid submucosal lesions.…”