Rare cause of massive gastrointestinal bleeding. A case of metastatic melanoma

The case of a 76-year-old patient, with a history of melanoma, admitted to the department of gastroenterology with symptoms of hypovolemic shock, caused by massive gastrointestinal bleeding. Clot-covered melanoma metastases were detected in both gastroduodenoscopy and colonoscopy. Gastrointestinal melanoma metastases are found in the majority of patients with advanced melanoma during autopsy; however, they are rarely detected in intravital studies and can be misdiagnosed as other benign lesions in endoscopy. In cases of patients with history of melanoma, metastases should be considered as the cause of non-specific abdominal symptoms, anemia, or bleeding from the gastrointestinal tract.

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Three Cases of Pyogenic Granuloma of the Gastrointestinal Tract

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz122.006 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S119-S119

Author(s):

Yukihiro Nakanishi ◽

Preeti Behl ◽

Byron Crawford

Keyword(s):

Gastrointestinal Tract ◽

Pyogenic Granuloma ◽

Right Hemicolectomy ◽

Capillary Hemangioma ◽

Deficiency Anemia ◽

Significant Drop ◽

Massive Gastrointestinal Bleeding ◽

History Of ◽

Mixed Inflammatory Infiltrate ◽

Pedunculated Polyp

Abstract Pyogenic granuloma also known as lobular capillary hemangioma occurs commonly in the skin and oral mucosa. This entity has been rarely reported in the gastrointestinal tract. We herein report three cases of pyogenic granuloma, located in the duodenum, ileum, and rectum, respectively. Case 1 is a 54-year-old female with a history of angioimmunoblastic T-cell lymphoma who underwent an esophagogastroduodenoscopy for severe heartburn. The endoscopy showed a 13-mm nonbleeding, pedunculated polyp in the second portion of duodenum, which was removed using a hot snare after injection of epinephrine. The patient had an episode of massive gastrointestinal bleeding postpolypectomy, with a significant drop of her hemoglobin, which was managed with blood transfusion. Case 2 is a 68-year-old male with a history of right hemicolectomy due to trauma who had a colonoscopy for chronic diarrhea. The colonoscopy revealed a 14-mm, nonbleeding, pedunculated polyp in the ileum, located 3 cm from the ileocolonic anastomosis. The polyp was removed with hot snare, without complications. Case 3 is a 44-year-old female with morbid obesity who underwent a colonoscopy for iron-deficiency anemia. The colonoscopy showed an 8-mm multilobulated sessile lesion in the distal rectum, which was completely removed using hot snare. No complications were seen postpolypectomy. Histological examination of all the three polyps showed a proliferation of capillary-sized blood vessels with a mixed inflammatory infiltrate, resembling granulation tissue. Additionally, the ileal polyp in our case had marked eosinophilic infiltrate, the etiology of which remains unknown. In conclusion, pyogenic granuloma, given its vascular nature, can be a cause of bleeding in the gastrointestinal tract. Awareness regarding this rare entity is important for its proper diagnosis and treatment.

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Metastatic Melanoma Presenting as Intussusception in an 80-Year-Old Man: A Case Report

Case Reports in Pathology ◽

10.1155/2013/672816 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Sarah Alghamdi ◽

Yumna Omarzai

Keyword(s):

Differential Diagnosis ◽

Small Intestine ◽

Gastrointestinal Tract ◽

Metastatic Melanoma ◽

Clinical Presentation ◽

Gastrointestinal Symptoms ◽

Common Site ◽

Neoplastic Process ◽

History Of ◽

Uncommon Neoplasm

Malignant melanoma of the gastrointestinal tract is an uncommon neoplasm that could be primary or metastatic. Small intestine represents the most common site for the metastatic melanoma; however, it could be found anywhere in the gastrointestinal tract. Intussusception is a rare cause of intestinal obstruction in adults compared to children. In 90% of the cases, the underlying cause can be found, and in 65% of the cases, intussusception is caused by the neoplastic process. The majority of the neoplasms are benign, and about 15% are malignant. Metastatic melanoma is one of the most common metastatic malignancies to the gastrointestinal tract; however, the premortem diagnosis is rarely made. Here, we report an uncommon clinical presentation of metastatic melanoma causing intussusception in an 80-year-old man. This diagnosis should be considered in a differential diagnosis in any patient who presents with gastrointestinal symptoms and a history of melanoma.

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Metastatic melanoma of the stomach and the duodenum

Archive of oncology ◽

10.2298/aoo0602060b ◽

2006 ◽

Vol 14 (1-2) ◽

pp. 60-61 ◽

Cited By ~ 1

Author(s):

Daniela Benedeto-Stojanov ◽

Aleksandar Nagorni ◽

Vesna Zivkovic ◽

Jovica Milanovic ◽

Dragan Stojanov

Keyword(s):

Malignant Melanoma ◽

Metastatic Melanoma ◽

Duodenal Bulb ◽

Gastrointestinal Symptoms ◽

Endoscopic Biopsy ◽

Upper Gastrointestinal Endoscopy ◽

Primary Malignancy ◽

Melanoma Metastases ◽

History Of ◽

One Year

A case of metastatic melanoma of the antrum and duodenal bulb is reported with rare endoscopic findings. A 59-year-old male patient was presented with nausea, vomiting, and abdominal pain one year after excision of malignant melanoma from the back. The tumor was classified as Clark IV, Breslow III. Upper gastrointestinal endoscopy revealed one melanotic polypoid mass with ulcerations at the tip in the antrum and two in the duodenal bulb. Endoscopic biopsy of these polypoid masses showed malignant melanoma metastases. Patients with gastrointestinal symptoms and a history of melanoma should be investigated for the presence of gastrointestinal metastases even if the original primary malignancy was diagnosed years prior to the patient presentation.

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A Case of Gastric Metastatic Melanoma 15 Years after the Initial Diagnosis of Cutaneous Melanoma

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/7684964 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Sohail Farshad ◽

Scott Keeney ◽

Alexandra Halalau ◽

Gehad Ghaith

Keyword(s):

Gastrointestinal Tract ◽

Metastatic Melanoma ◽

Chest Wall ◽

Cutaneous Melanoma ◽

Delayed Diagnosis ◽

Gastric Cardia ◽

Rare Occurrence ◽

Endoscopic Appearance ◽

Common Cancer ◽

History Of

Melanoma is the most common cancer to metastasize to the gastrointestinal tract; however, metastasis to the stomach is a rare occurrence. We present the case of a patient with a history of melanoma of the chest wall 15 years prior to presentation who initially presented to the hospital with sepsis but was later found to have metastatic melanoma in the gastric cardia. This case illustrates the rare occurrence of metastatic melanoma to the stomach which occurred 15 years after the initial skin diagnosis of melanoma was made, its endoscopic appearance, and how the nonspecific symptoms frequently lead to a delayed diagnosis or one that is not made at all until after autopsy. For these reasons, endoscopy should be promptly performed if there is a suspicion of gastrointestinal metastatic melanoma.

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Recurrent Mantle Cell Lymphoma Presenting as Gastrointestinal Bleeding

Case Reports in Gastroenterology ◽

10.1159/000488193 ◽

2018 ◽

Vol 12 (2) ◽

pp. 379-384 ◽

Cited By ~ 4

Author(s):

Rafeeq Ahmed ◽

Kishore Kumar ◽

Jasbir Makker ◽

Masooma Niazi ◽

Bhavna Balar

Keyword(s):

Abdominal Pain ◽

Gastrointestinal Tract ◽

Gastrointestinal Bleeding ◽

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

Duodenal Bulb ◽

Colon Polyps ◽

Ascending Colon ◽

Mantle Cell ◽

History Of

Mantle cell lymphoma is a rare and aggressive subtype of B-cell non-Hodgkin lymphomas. Mantle cell lymphoma frequently involves extranodal sites, and gastrointestinal tract is involved microscopically and macroscopically in more than 80% of cases. We present two cases of recurrent mantle cell lymphoma presenting with lower and upper gastrointestinal bleeding, respectively. A 58-year-old woman with a history of recurrent mantle cell lymphoma treated with chemotherapy and stem cell transplantation presented with left-sided abdominal pain and hematochezia. Colonoscopy showed a mass-like lesion in the ascending colon, polyps in the ascending colon, and splenic flexure. A 68-year-old man with a history of mantle cell lymphoma treated with chemotherapy presented with epigastric pain and melena. Esophagogastroduodenoscopy showed a large polypoidal ulcerated mass with oozing in the duodenal bulb. Biopsies in both patients were suggestive of mantle cell lymphoma. Patients with mantle cell lymphoma could be asymptomatic or may present with abdominal pain, obstruction, diarrhea, or gastrointestinal bleeding. In patients presenting with gastrointestinal symptoms, endoscopy must be pursued and biopsies must be taken for any suspicious lesions as well as normal mucosa to exclude mantle cell lymphoma as an etiology for the lesion or symptoms. Even though there are no standard guidelines for endoscopic screening of gastrointestinal tract in asymptomatic patients, one should be aware of involvement of gastrointestinal tract in the early course of disease or recurrent disease. Although mantle cell lymphoma is initially responsive to chemotherapy, it eventually becomes refractory with a median survival of 3–5 years.

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Case 17.25

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0443 ◽

2014 ◽

pp. 837-838

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Metastatic Melanoma ◽

Signal Intensity ◽

Equilibrium Phase ◽

Gadoxetate Disodium ◽

Left Hepatic Lobe ◽

Hepatic Lobe ◽

Melanoma Metastases ◽

Phase Images ◽

History Of

51-year-old man with a history of metastatic melanoma Axial precontrast 3D SPGR images (Figure 17.25.1) reveal multiple T1 hyperintense lesions throughout the liver, representing melanoma metastases. Note also geographic decreased signal intensity in the left hepatic lobe, likely representing fibrotic changes from previous radiotherapy. Many of the lesions are more difficult to visualize on equilibrium phase images obtained 20 minutes after gadoxetate disodium (Eovist) administration (...

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Aorto-duodenal fistula: a rare but serious complication of gastrointestinal hemorrhage. A case report

Acta medica Lituanica ◽

10.6001/actamedica.v23i3.3380 ◽

2016 ◽

Vol 23 (3) ◽

pp. 165-168 ◽

Cited By ~ 2

Author(s):

Jolanta Šumskienė ◽

Edita Šveikauskaitė ◽

Jūratė Kondrackienė ◽

Limas Kupčinskas

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Gastrointestinal Bleeding ◽

Aortic Surgery ◽

Abdominal Aortic ◽

Massive Gastrointestinal Bleeding ◽

Horizontal Part ◽

History Of ◽

Granulomatous Aortitis ◽

Upper Gastrointestinal

A primary aortoduodenal fistula (PADF) is a rare cause of gastrointestinal bleeding that is difficult to diagnose (and sometimes not diagnosed until a laparotomy.) A PADF is associated with high mortality if undiagnosed and untreated (the mortality rate of nearly 100% in the absence of a surgical intervention). While this condition is extremely rare with an incidence rate at autopsy of 0.04% to 0.07%, a secondary ADF occurs much more commonly (the post-operative incidence of 0.5% to 2.3%) and is due to prior aortic surgery and/or the placement of a synthetic aortic graft. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm or without it when no identifiable source of bleeding is found. We present an autopsy case of a 59-year-old man with no history of an abdominal aortic aneurysm who presented with intermittent massive gastrointestinal bleeding. The autopsy revealed a pinhole fistula. It was identified between an atherosclerotic abdominal aortic aneurysm and the lower horizontal part of the duodenum. Our case indicates that the aortoenteric fistula can result in fatal gastrointestinal bleeding. This case is unique in that the fistula formed as a result of a complex atherosclerotic abdominal aorta and a localized necrotizing granulomatous aortitis the etiology of which was not clear.

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