Mattit Ammar, Marrawi Ibrahim, Kheir Safouh, Khamis Taha, Qatleesh Safaa, Ousta Muhammad Ali
Faculty of Medicine, Al-Sham Private University, Damascus, Syria.
Faculty of Medicine, Al-Sham Private University, Damascus, Syria.
Int J Surg Case Rep. 2024 Mar;116:109388. doi: 10.1016/j.ijscr.2024.109388. Epub 2024 Feb 14.
Primary small bowel melanoma (PSBM) is a rare form of melanoma that originates from the intestinal mucosa. It is typically asymptomatic; however, it can present with non-specific symptoms, which pose challenges in accurately diagnosing the condition. In rare cases, it may manifest as small bowel obstruction, further adding challenges with diagnosis and management.
A 57-year-old male presented to the hospital with complaints of chronic constipation, abdominal pain, and abdominal enlargement. Computed tomography (CT) scan revealed thickening of the jejunum wall, while endoscopy and biopsy revealed nothing. During surgery, surgeons identified and excised a jejunal mass. Subsequent pathological analysis confirmed the diagnosis of melanoma, and post-surgical examination failed to identify primary cutaneous melanoma.
PSBM is a rare and aggressive tumor often misdiagnosed due to non-specific symptoms and challenging imaging interpretations. Obstruction and intussusception are uncommon presentations. Surgical resection offers symptom control and improved prognosis, but achieving negative margins can be challenging. Early recognition and diagnosis are crucial for optimal management.
The lack of data in the literature presents challenges in identifying and selecting the optimal approach for managing PSBM. Physicians should increase their awareness of this specific type of tumor to facilitate early-stage diagnosis and provide appropriate care for patients.
原发性小肠黑色素瘤(PSBM)是一种罕见的黑色素瘤,起源于肠黏膜。它通常无症状;然而,它可能表现出非特异性症状,这给准确诊断该病带来了挑战。在罕见情况下,它可能表现为小肠梗阻,这进一步增加了诊断和治疗的难度。
一名57岁男性因慢性便秘、腹痛和腹部膨隆到医院就诊。计算机断层扫描(CT)显示空肠壁增厚,而内镜检查和活检未发现异常。手术中,外科医生发现并切除了一个空肠肿物。随后的病理分析确诊为黑色素瘤,术后检查未发现原发性皮肤黑色素瘤。
PSBM是一种罕见且侵袭性强的肿瘤,常因非特异性症状和具有挑战性的影像学解读而被误诊。梗阻和肠套叠是不常见的表现。手术切除可控制症状并改善预后,但实现切缘阴性可能具有挑战性。早期识别和诊断对于最佳治疗至关重要。
文献中缺乏数据给识别和选择PSBM的最佳治疗方法带来了挑战。医生应提高对这种特殊类型肿瘤的认识,以促进早期诊断并为患者提供适当的治疗。