A 44-year-old woman presented with a history of nodular malignant cutaneous melanoma on her left shoulder (Breslow: 3.9 mm; Clark level IV; pT3bN0M0) in 1998.
She was treated with interferon for one year.
Controls every 6 months were negative.
Five years later, he was admitted to the Surgery Department due to an episode of intestinal occlusion.
Abdominal CT: small bowel invagination.
Treatment: emergency surgery: segmental resection of the ileum due to intraosseous tumour affecting the serosa.
More polypoid tumors that were not resected were identified due to lack of perioperative diagnosis during emergency surgery.
The postoperative period was correct and without complications.
Macroscopic study : The floor area is characterized by erosions, folding and two tumors that partially occupy the lumen (3.5 x 1.5 x 4 cm and 1.2 x 1 x 1 cm).
After cutting, the surface was solid, brownish with homogeneous areas and soft consistency.
1.
Microscopically: cells of broad, eosinophilic or clear cytoplasm with a prominent vesicular nucleus and nucleolus.
Focally there was melanine in the cytoplasm.
Abundant mitosis was observed.
Tumor cells ulcerated the mucosa and focally spread throughout the intestinal wall the mesentery and in other areas occupied vascular lumens.
Tumor cells were positive for monoclonal antibodies HMB 45 and S-100 protein.
Based on the clinical information, the histological image and the result of immunohistochemistry, the definitive diagnosis was metastasis of cutaneous melanoma in the small intestine.
A study was initiated to assess the surgical rescue option: small bowel transit, which reports at least two more lesions in the common bile duct junction and a PET scan showed uptake in the abdominal midline.
The patient was reoperated.
Intestinal resection of two segments of the jejunum and ileum was performed, respectively, being macroscopically disease free.
The pathological study showed that the tumors had the same histological characteristics described above.
