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Primary gastric melanoma presenting with recurrent upper gastrointestinal bleeding
Annals of the Royal College of Surgeons of England
|August 25, 2021
Summary
Primary gastric melanoma, a rare condition, presents diagnostic challenges. This case highlights the difficulty in distinguishing it from metastasis, emphasizing surgical management for bleeding.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Primary gastric melanoma is exceedingly rare, often presenting as advanced disease with poor prognosis.
- Gastrointestinal melanomas are typically metastatic from a cutaneous source.
Observation:
- A 57-year-old male presented with fatigue, hematemesis, and melena, indicating significant gastrointestinal bleeding.
- Endoscopy revealed a bleeding gastric mass; initial histology suggested a mesenchymal tumor, but immunophenotyping confirmed malignant melanoma (S-100, HMB-45, Melan-A positive).
- Benign skin lesions and negative ophthalmologic examination ruled out common metastatic origins, leading to suspicion of primary gastric melanoma.
Findings:
- Positron Emission Tomography/Computed Tomography (PET/CT) showed tracer uptake in the stomach, jejunum, and perigastric lymph nodes, supporting primary advanced gastric melanoma.
- The patient underwent total gastrectomy with partial small bowel resection due to recurrent bleeding requiring transfusions.
Implications:
- This case underscores the diagnostic complexities of primary gastric melanoma, especially when cutaneous and ocular sources are excluded.
- Early surgical intervention may be crucial for managing recurrent bleeding in advanced primary gastric melanoma.
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