Primary Malignant Melanoma of the Small Bowel with Hepatic Metastasis: A Case Report

Primary intestinal melanoma is extremely rare, whereas metastatic melanoma of the small bowel is common. In this report, we present a rare case of primary small bowel melanoma with hepatic metastasis. A 51-yearold man presented with constipation and CT identified an ileal mass without bowel obstruction. CT and MRI revealed hepatic metastasis. Ileal mass was confirmed on laparotomy and histologically diagnosed as melanoma.

Ileal intussusception due to primary intestinal melanoma with generalized lymph node metastases- a rare cause of small bowel obstruction

Primary melanomas of small intestine are rare and most of them are metastases from cutaneous melanoma. The features distinguishing primary from metastatic intestinal melanoma are still under debate. Primary intestinal melanoma (PIM) is associated with a worse prognosis and a more aggressive behaviour due to its rapid growth. Hence, we report a case of primary ileal melanoma presenting as intussusception with generalized lymph node metastasis. A 69-year-old lady presented with recurrent abdominal pain, vomiting, distension and low grade fever. On examination, a 4*4 cm right inguinal lymph node was noted with no abnormalities on abdominal and per rectal examination. Computed tomography (CT) revealed ileoileal intussusception which was confirmed on laparotomy and diagnosed as primary ileal melanoma on histopathological examination (HPE). Whole-body Positron Emission Tomography (PET) CT revealed metastasis to lymph nodes all over the body. Intestinal melanomas are rare and mostly occur secondary to primary cutaneous melanoma. The clinical picture of intestinal melanoma is varied, ranging from chronic vague symptoms to surgical emergency such obstruction and bleeding. Treatment of both primary as well as metastatic intestinal melanoma is surgical excision. Intestinal melanoma, in general, carries a bad prognosis than cutaneous melanoma. Owing to the rarity and vague presentation, early diagnosis of intestinal melanoma requires a high index of suspicion, multimodal imaging and timely surgical intervention with adequate resection margins.

An uncommon presentation of a sinister entity

A case of a female patient presenting with clinical findings ominous for a neoplastic bowel obstruction is reported. Abdominal computed tomography demonstrated a bowel obstruction with evidence of intussusception. Laparotomy revealed an irreducible ileoileal intussusception and segments of the jejunum infiltrated with pigmented deposits. There was no perforation and no evidence of an ulcerating or fungating mass. Intestinal melanoma is not an uncommon sequela of cutaneous melanoma, yet the disease can occur as a primary intestinal process, albeit this is a rarity. Surgical resection is the primary treatment modality and may offer the hope of increased symptom-free survival and overall survival for those patients suffering from metastatic or primary melanoma of the small intestine.