Review of clinical and endoscopic features of metastatic tumors of the gastrointestinal tract

Bashir, Showkat; Borum, Marie

doi:10.4103/0976-5042.155233

Cited by 1 publication

(1 citation statement)

References 26 publications

(36 reference statements)

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“…2 However, clinical symptoms and antemortem diagnosis of gastrointestinal metastases of melanoma are much lower. 3 The classic endoscopic appearance of melanoma metastases is that of a submucosal nodule with central ulceration, producing the typical "target" or "bull's eye" lesion; however, lesions can present with variable degrees if ulceration and pigmentation, making histologic examination imperative. 3…”

Section: Answer To: Image 2 (Page 1289): Gastroduodenal Metastases Of Cutaneous Melanomamentioning

confidence: 99%

Deep Beneath the Skin: An Unusual Causa of Melena

2017

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Question: A 76-year-old man presented to the emergency department complaining of exertional dyspnea in the previous 3 weeks and an episode of presyncope that day. He denied orthopnea, paroxysmal nocturnal dyspnea, and precordial pain. On further questioning, the patient revealed a 3-week history of melena. He denied hematemesis, hematochezia, hematuria, or any other macroscopic blood loss. Physical examination was unremarkable except for mucocutaneous pallor. Electrocardiography was normal. Bloodwork revealed a low hemoglobin of 6.7 g/dL, normal high-sensitivity troponin I, and low B-type natriuretic peptide.The patient had a history of a grade IIB malignant melanoma of the dorsum resected 5 years earlier and remained under annual surveillance consultations. He also had arterial hypertension, type 2 diabetes, and was medicated with acetylsalicylic acid, metformin, a statin, and 3 antihypertensive drugs.Upper gastrointestinal endoscopy revealed multiple gastric (Figure A) and duodenal nodular lesions (Figure B, C), 20 mm in diameter, with a pigmented and ulcerated center, which were biopsied. The histopathologic examination showed invasion of gastric and duodenal mucosa by neoplastic pigmented cells which stained positive for Melan-A on immunohistochemistry (Figure D, E).What is the diagnosis? Look on page 1290 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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Section: Answer To: Image 2 (Page 1289): Gastroduodenal Metastases Of Cutaneous Melanomamentioning

confidence: 99%