Warshowsky E A, McCarthy M, Wells K, Arcidiacono A, Csury L, Nitzkorski J R
Vassar Brothers Medical Center, 45 Reade Pl, Poughkeepsie, NY 12601, United States of America.
Vassar Brothers Medical Center, 45 Reade Pl, Poughkeepsie, NY 12601, United States of America.
Int J Surg Case Rep. 2024 Jun;119:109686. doi: 10.1016/j.ijscr.2024.109686. Epub 2024 Apr 24.
Colorectal cancer (CRC) presenting with synchronous liver metastasis is relatively common, occurring in approximately 20 % of patients. Herein we report an atypical case of a patient who presented with a new, obstructing colon mass with synchronous liver metastasis, biopsy proven to be malignant melanoma.
An 81-year-old male presented to the hospital emergency department with abdominal pain, diarrhea, and 30-pound unintentional weight loss over the past 4 months. Investigations revealed an obstructing cecal mass with multiple large, hypodense hepatic masses suspicious for metastatic disease. A multidisciplinary evaluation ensued, and the decision was made to treat with palliative intent. The patient was surgically treated with a diverting stoma and an intraoperative biopsy of the hepatic masses demonstrated metastatic melanoma. The patient did report a remote history of malignant melanoma and underwent curative-intent resection a decade earlier. There was no evidence of a new primary cutaneous melanoma. A tentative plan for checkpoint inhibitor therapy was discussed, but his medical issues worsened, and the patient died before any anti-cancer therapy could be started.
The clinical picture of obstructing colon mass with synchronous liver masses most commonly represents a colon primary with synchronous liver metastasis. The capacity for melanoma to mimic other pathologies is unusual but has been described, with case reports describing metastasis to the eye, biliary hilum, liver, pancreas, colon, small bowel and brain. This case serves as a good reminder that melanoma may mimic a variety of oncologic presentations, even after a very long disease-free interval.
Our patient suspected to have metastatic colon cancer was found instead to have metastatic melanoma, with significantly different therapeutic options and prognosis.
出现同时性肝转移的结直肠癌（CRC）相对常见，约20%的患者会发生。在此，我们报告一例非典型病例，患者出现新的阻塞性结肠肿块并伴有同时性肝转移，活检证实为恶性黑色素瘤。
一名81岁男性因腹痛、腹泻以及在过去4个月内意外减重30磅就诊于医院急诊科。检查发现盲肠有阻塞性肿块，肝脏有多个大的低密度肿块，怀疑为转移性疾病。随后进行了多学科评估，并决定进行姑息性治疗。患者接受了造口术，术中对肝脏肿块进行活检，结果显示为转移性黑色素瘤。患者确实有恶性黑色素瘤的既往史，十年前接受了根治性切除。没有新的原发性皮肤黑色素瘤的证据。讨论了使用检查点抑制剂治疗的初步计划，但他的病情恶化，在开始任何抗癌治疗之前患者死亡。
阻塞性结肠肿块伴同时性肝脏肿块的临床表现最常见的是结肠原发性肿瘤伴同时性肝转移。黑色素瘤模仿其他病理情况的能力并不常见，但已有相关描述，病例报告中提到黑色素瘤转移至眼、肝门、肝脏、胰腺、结肠、小肠和脑。这个病例很好地提醒我们，即使在很长的无病间隔期后，黑色素瘤也可能模仿多种肿瘤表现。
我们原本怀疑患有转移性结肠癌的患者，结果发现是转移性黑色素瘤，其治疗选择和预后有显著差异。
