Resección laparoscópica de metástasis intestinales de melanoma maligno

Objetivos: El melanoma cutáneo presenta un alto potencial metastásico y constituye la fuente extraabdominal más frecuente de lesión del intestino delgado. El diagnóstico de metástasis gastrointestinales es a menudo una expresión de enfermedad avanzada, con una supervivencia media de entre 6 y 9 meses.Material y Métodos: Presentamos el caso un paciente varón de 63 años diagnosticado de melanoma cutáneo que acudió a urgencias por dolor abdominal y estreñimiento. Se realizó una TC abdominal donde se informó de la existencia de 2 lesiones metastásicas a nivel de intestino delgado que condicionaban oclusión intestinal.Resultados: El paciente fue intervenido quirúrgicamente bajo abordaje laparoscópico con resección de los dos segmentos intestinales afectos y anastomosis intracorpórea. El informe histopatológico confirmó que se trataban de metástasis de melanoma.Discusión y Conclusión: La oclusión intestinal por metástasis de melanoma maligno es muy infrecuente. La cirugía es el tratamiento de elección en pacientes con metástasis intestinales de melanoma. El tratamiento quirúrgico puede mejorar el pronóstico y estaría indicado casos de metástasis únicas o pacientes sintomáticos con intención paliativa. El abordaje mínimamente invasivo ofrece resultados oncológicos similares a la laparotomía.Aims: Cutaneous melanoma has a high metastatic potential, being the most frequent extra-abdominal source of small bowel metastasis. The diagnosis of gastrointestinal metastases is often an expression of advanced disease, with an average survival of 6-9 months.Material and Methods: We herein present the case of a 63-year-old male patient diagnosed with cutaneous melanoma who arrived to the emergency department complaining of abdominal pain and constipation. An abdominal CT scan was performed, it revealed two metastatic lesions in the small bowel which marked the mechanical obstruction.Results: Patient underwent a laparoscopy and both involved segments were removed. Pathology exam confirmed the diagnosis of melanoma metastases.Discussion and Conclusions: Surgery excision is the treatment of choice in patients with small bowel metastases from melanoma. Surgical management can improve the prognosis and it would be indicated in cases of single metastases or symptomatic patients with a palliative intention. Minimally invasive approach provides similar oncological results as conventional laparotomy.Small bowel obstruction due to metastases of malignant melanoma is extremely rare.

Clinicopathology and Outcomes of Small Bowel Metastases: A Retrospective Study of 31 Consecutive Cases

BACKGROUND The small bowel (SB) is a rare site for distant metastasis. Few recent studies have systematically reported on the clinicopathology and outcomes of SB metastasis. This study aimed to describe the clinicopathology and outcomes of SB metastasis. METHODS A retrospective study involving patients diagnosed with SB metastasis at a single medical center between January 2009 and December 2019 was conducted. Patients with secondary SB cancer with direct invasion or peritoneal carcinomatosis by a primary tumor were excluded. The demographic characteristics of the patients, clinical patterns of primary cancer and SB metastasis, and outcomes were analyzed. RESULTS During the 10-year period, we identified 31 patients eligible for analysis. The female:male ratio was 8:24, and the median patient age was 63.5 years. Metastasis of lung cancer to the SB was noted most frequently. Most patients presented with abdominal pain, gastrointestinal bleeding, or abnormal imaging findings. The interval between primary cancer and SB metastasis was 19.2 months. Sole SB metastasis was noted in 20 patients (64.5%). Twenty-two (70.1%) patients underwent surgical intervention. The median survival was 6.6 months. Conclusions Distant metastasis of other primary cancers to the SB is noted extremely rarely. The presence of SB metastasis indicated extremely poor prognosis. Surgery plays an important role in ameliorating critical symptoms However, surgery does not confer survival benefits.

Haemorrhagic small bowel melanoma metastasis: a clinical rarity

We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest–abdomen–pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.