Amaris Manuel A, Kallas Henrique E, Gonzalo David H, Orlando Frank A
Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, United States.
Division of Geriatrics, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States.
Front Med (Lausanne). 2023 Nov 2;10:1268973. doi: 10.3389/fmed.2023.1268973. eCollection 2023.
A 72-year-old man visited cardiology for exertional chest pain, lightheadedness, and fatigue. Six years prior, he was surgically treated for cutaneous malignant melanoma of the lower back. After a negative cardiac work-up, primary care diagnosed severe iron deficiency anemia. Emergent upper and lower gastrointestinal (GI) endoscopy revealed simultaneous melanoma metastases to the stomach and colon with discrete macroscopic features. Metastatic disease, including brain, lung, and bone, was discovered on imaging. Treatment included immunotherapy with nivolumab and stereotactic radiosurgery of the brain metastases, and our patient has remained in continued remission even after 2 years. Melanoma with GI tract (GIT) metastasis has a poor prognosis and rarely presents symptomatically or with synchronous gastric and colonic lesions. This case illustrates the importance of early primary care involvement to expedite work-up for multifocal GI metastases in patients with a remote melanoma history presenting with symptoms related to iron deficiency anemia (IDA).
一名72岁男性因劳力性胸痛、头晕和疲劳就诊于心脏病科。6年前，他因下背部皮肤恶性黑色素瘤接受了手术治疗。经过全面的心脏检查未见异常后，初级保健医生诊断为严重缺铁性贫血。急诊上、下消化道内镜检查发现胃和结肠同时存在黑色素瘤转移，具有明显的宏观特征。影像学检查发现包括脑、肺和骨在内的转移病灶。治疗包括使用纳武单抗进行免疫治疗和对脑转移瘤进行立体定向放射外科治疗，我们的患者即使在2年后仍持续缓解。伴有胃肠道转移的黑色素瘤预后较差，很少出现症状或同时出现胃和结肠病变。本病例说明了早期初级保健参与对于加快对有远处黑色素瘤病史且出现与缺铁性贫血（IDA）相关症状的患者进行多灶性胃肠道转移检查的重要性。
