Fan Wen-Juan, Cheng Heng-Hui, Wei Wang
Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Wuhan 430030, Hubei Province, China.
World J Gastrointest Oncol. 2023 Jan 15;15(1):205-214. doi: 10.4251/wjgo.v15.i1.205.
Melanoma is the most aggressive form of skin cancer, with a tendency to metastasize to any organ. Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide. Small intestine cancers especially small intestine metastases are relatively rare. Small intestine metastases are seldom described and likely underdiagnosed. Intussusception is most common in pediatric age, and in adults are almost 5% of all cases.
A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital, complaining of intermittent melena for 1 mo. Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass, indicating a neoplastic lesion with jejunojejunal intussusception. The patient underwent partial small bowel resection. Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma. The patient refused further anti-tumor treatment after the surgery. Ten months after the first surgery, the patient presented with melena again. Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall, and routine conservative treatment was given. Three months later, the patient developed melena again. The patient underwent a second surgery, and multiple metastatic melanoma lesions were found. The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.
Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.
黑色素瘤是最具侵袭性的皮肤癌形式，有转移至任何器官的倾向。恶性黑色素瘤是全球皮肤癌相关死亡的最常见原因。小肠癌尤其是小肠转移瘤相对罕见。小肠转移瘤很少被描述且可能诊断不足。肠套叠在儿童期最常见，在成人中占所有病例的近5%。
一名有肢端恶性黑色素瘤病史的75岁男性因间歇性黑便1个月入住我院消化内科。磁共振小肠造影显示空肠壁部分增厚并形成软组织肿块，提示空肠空肠套叠的肿瘤性病变。患者接受了部分小肠切除术。病理检查和免疫组化染色显示为小肠转移性黑色素瘤。术后患者拒绝进一步抗肿瘤治疗。首次手术后10个月，患者再次出现黑便。计算机断层扫描小肠造影显示吻合口正常，肠壁无增厚，给予常规保守治疗。3个月后，患者再次出现黑便。患者接受了第二次手术，发现多处转移性黑色素瘤病灶。患者拒绝辅助抗肿瘤治疗，在最近一次随访时仍存活。
任何有恶性黑色素瘤病史且有胃肠道症状的患者都应怀疑有小肠转移性黑色素瘤。
