Primary gastric melanoma: A case report with imaging findings and 5-year follow-up

Abstract

BACKGROUNDMost melanomas identified in the stomach are metastatic; primary gastric melanoma (PGM) is extremely rare, and the relevant studies are relatively scarce. PGM may be incorrectly diagnosed as other gastric malignant tumor types.CASE SUMMARYWe describe a rare case of PGM confirmed through long-term clinical observation and pathological diagnosis. A 67-year-old woman presented to our hospital with recurrent chest tightness and chest pain. Digital gastrointestinal radiography revealed a circular shadow in the gastric cardia. Computed tomography (CT) revealed a heterogeneous tumor with uneven enhancement. Enlarged lymph nodes were noted in the lesser curvature of the stomach. On magnetic resonance imaging (MRI), T1- and T2-weighted imaging revealed hyperintensity in and hypointensity in the tumor, respectively, both of which increased substantially after uneven enhancement. Near total gastrectomy was performed, and the tumor was pathologically confirmed to be a gastric melanoma. Because no other possible primary site of malignant melanoma was suspected, a clinical diagnosis of PGM was made. The patient was followed for nearly 5 years, during which she received CT reexamination, but no recurrence or metastasis was observed.CONCLUSIONCertain imaging characteristics could be revealed in PGM. Imaging examination can be of great value in preoperative diagnosis, differential diagnosis, and follow-up of patients with PGM.

Primary gastric melanoma in a young woman: A case report

“…In our case, dysphagia and wasting were the main clinical manifestations. For the case reported by Wang et al [ 1 ], the patient presented with recurrent chest tightness and chest pain as the initial symptoms. Both of the cases reported by Augustyn et al [ 3 ] and Bolzacchini et al [ 4 ] were hospitalized in an emergency with gastrointestinal bleeding.…”

“…On diffusion-weighted imaging, the tumor demonstrates a considerably high signal intensity. Thus, MRI is very helpful in the diagnosis of PGM and is even considered as the gold-standard preoperative assessment technique[ 1 ]. However, MRI is expensive and rarely used in physical examination.…”

“…The concept of primary gastrointestinal melanoma (PGIM) is controversial, and it remains unknown whether the absence of primary skin lesions is merely due to spontaneous regression. Nevertheless, reports of cases of PGIMs without primary skin lesions are increasing in the literature[ 1 , 3 , 4 ], supporting the theory of PGIMs being a distinctive entity. Cheung et al [ 5 ] reviewed 659 PGIMs that had been reported from 1973 to 2004, and calculated an annual incidence of approximately 0.47 cases per million in 2000.…”

“…Melanomas are malignant tumors that develop from melanocytes. Although they usually occur in the skin, oropharynx, and eyes, rare cases have been reported in the digestive tract, involving the esophagus, stomach, and intestines[ 1 ]. Melanoma of the gastrointestinal tract is generally considered to be metastatic, and it has been reported that up to 4% of patients with cutaneous melanoma have clinical gastrointestinal tract involvement antemortem and up to 60% at autopsy[ 2 ].…”

Unraveling the identity of gastric cardiac cancer

“…The gastric cardia is also one of the most common regions of the stomach for primary gastric melanoma to occur. 42 Once diagnosed, early GCC has a natural history of very slow progression. Two separate case reports from Japan described 8-and 12year intervals between the initial diagnosis of early GCC and death from other causes in two elderly Japanese men who were deemed unfit for either endoscopic or surgical intervention.…”