Primary malignant melanoma of the esophagogastric junction: Report of a case

INTRODUCTIONPrimary malignant melanoma of the gastrointestinal tract is very rare, especially in the stomach. We report an extremely rare case of primary malignant melanoma of the esophagogastric junction mainly situated in the stomach.PRESENTATION OF CASEThe patient was a 72-year-old woman who complained of shortness of breath due to severe anemia. Upper endoscopy revealed a soft easy-bleeding polypoid tumor just adjacent to the esophagogastric junction in the stomach. Biopsy of the tumor did not indicate a definite result, except malignant tumor. We performed total gastrectomy with splenectomy, and histological and immunohistological examination revealed malignant melanoma of the esophagogastric junction. She had no remote metastasis or lymphnodal metastasis at the point of surgery; however, she died of multiple metastases 11 months after the operation.DISCUSSIONA definite preoperative diagnosis of primary malignant melanoma was very difficult to make from the preoperative biopsy specimen. This present case was first misinterpreted as undifferentiated carcinoma, or malignant lymphoma. Following the diagnosis of malignant melanoma, the question arose as to whether this was primary or metastatic (as malignant melanoma from other sites is known to metastasize to the stomach). Finally this tumor was diagnosed as a primary one due to the pathologic characteristics such as the existence of junctional activities.CONCLUSIONWe report an extremely rare case of primary malignant melanoma of the esophagogastric junction present in the stomach.     

A case of solitary pulmonary metastasis of choroidal melanoma with an exceptionally long disease-free period

INTRODUCTIONChoroidal melanoma is the most common primary malignant intraocular tumor in adults. And its metastatic spread has been considered to be hematogenous with the liver being the most common site, and a solitary pulmonary metastasis without hepatic involvement is quite rare.PRESENTATION OF CASEWe report the case of a 61-year-old woman with a solitary pulmonary metastasis from choroidal melanoma, which had been originally treated with enucleation 13 years ago. Video-assisted thoracoscopic surgery (VATS) right upper lobectomy was performed for the right upper lobe tumor, which was histopathologically confirmed to be metastatic choroidal melanoma.DISCUSSIONOur case is quite unusual in 2 points; firstly, a solitary pulmonary metastasis without hepatic involvement is rare. Secondly, this mode of metastasis with an exceptionally long disease-free period (13 years) is also rare.CONCLUSIONA pulmonary metastasis from choroidal melanoma is described with reference to relevant literature.     

Solitary metastatic gallbladder malignant melanoma originated from the nasal cavity: A case report

INTRODUCTIONSolitary gallbladder metastasis of malignant melanoma is rare and generally originates from skin melanoma. We report a case of gallbladder metastasis from a malignant melanoma of the nasal mucosa that was surgically treated.PRESENTATION OF CASEA 77-year-old Japanese woman diagnosed with malignant melanoma of the left sinonasal cavity three years ago underwent follow-up PET–CT and FDG uptake was detected only at the gallbladder. The nasal melanoma had been stable for the last 1.5 years after chemoradiation and her general condition was good. Cholecystectomy was performed with partial liver resection. Lymphadenectomy of the hepatoduodenal ligament was also performed. The tumor was soft and whitish, and was microscopically diagnosed as a poorly differentiated malignant melanoma that was not similar to the nasal cavity melanoma. No further metastasis is observed for more than 13 months after surgery.DISCUSSIONIn the literature, cutaneous melanoma is described as the origin of most metastatic gallbladder melanomas; however, no skin lesion was evident in this case. We believe that the poorly differentiated compartment of the nasal melanoma had metastasized to the gallbladder.CONCLUSIONFor patients with melanomas and gallbladder tumors, the possibility that metastasis could occur should be considered when selecting optimal treatment. Even when original melanoma is present, surgical treatment for gallbladder metastasis may be useful depending on the patient's conditions.     

Solitary Splenic Metastasis of Lung Cancer Presenting as Benign Cystic Disease

Solitary splenic metastasis from primary lung cancer is extremely rare. Here, we demonstrated a solitary splenic metastasis of primary lung cancer that was difficult to distinguish from benign cystic disease. A 69-year-old-female was diagnosed as middle lobe lung cancer. Although preoperative abdominal computed tomography (CT) demonstrated a low-density splenic nodule, fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed no fluorodeoxyglucose uptake in the splenic nodule. Therefore, the nodule was diagnosed as benign cystic disease and middle lobe lobectomy was performed. Postoperative pathologic examination demonstrated papillary-predominant adenocarcinoma with mucin, and the tumor was diagnosed as primary lung cancer. However, the splenic nodule continued to increase postoperatively. Splenectomy was undergone 30 months after the pulmonary resection and the splenic tumor was diagnosed as the splenic metastasis of lung cancer. In the 24 months since the splenectomy, no recurrence has been observed in the absence of treatment. Splenectomy was an effective treatment for solitary splenic metastasis of lung cancer in this case. FDG uptake in the splenic tumor was not evident due to marked mucus production.     

Successful treatment of triple primary tumor

INTRODUCTIONThe occurrence of multiple primary tumors is rare. Only limited number of cases with triple malignancy have been reported. We report here a rare case of a woman presented synchronous triple tumors, in her lung, breast, skin.PRESENTATION OF CASEA 56-year-old woman presented with invasive ductal carcinoma of breast, non-small cell lung cancer and malignant melanoma. The patient undergone mastectomy and malignant melanoma tumor excision on-site. After operation stereotactic radiotherapy was given to her lung tumor. Six course of chemotherapy was given to her. She is alive with no progression.DISCUSSIONThe patient was diagnosed with melanoma and staging by FDG/PET. There is not any study about routine using PET/CT in the melanoma staging.CONCLUSIONThis is a very rare synchronous triple tumor case.     

A rare case of human pulmonary dirofilariasis with a growing pulmonary nodule after migrating infiltration shadows,mimicking primary lung carcinoma

IntroductionPulmonary dirofilariasis is a rare pulmonary parasitic infection by the nematode Dirofilaria immitis. It is characterized by an asymptomatic pulmonary nodule usually seen on chest X-ray. The differential diagnosis of pulmonary dirofilariasis includes other pulmonary diseases, primary lung carcinoma and metastatic lung tumor.Case presentationPulmonary dirofilariasis was diagnosed in a woman who presented with interstitial pneumonia. Growth of the pulmonary nodule was detected subsequent to hemoptysis. The histological diagnosis was made based on a wedge resection performed under video-associated thoracic surgery (VATS).ConclusionPulmonary dirofilariasis often varies in its clinical course. The diagnosis is best made using wedge resection under VATS.     

Choriocarcinoma of the lung: report of a case

In this report, a 27-year-old woman with a solitary pulmonary nodule is described. Because computed tomography-guided biopsy could not confirm the diagnosis, surgical treatment was performed by video-assisted thoracic surgery. Histological findings showed cytotrophoblasts and syncytiotrophoblasts, suggesting choriocarcinoma. However, there were no abnormal findings on gynecological examination, including ultrasonography, magnetic resonance imaging, and positron-emission tomography. Choriocarcinoma is a malignant neoplasm and can arise after a pregnancy, as a component of germ cell tumors, or in association with a poorly differentiated somatic carcinoma. Our patient, a young female with an antecedent gestation, has no recurrence after surgery. There were tumor emboli in pulmonary arteries and no component of primary lung carcinoma on histological examination. These findings indicate that the lesion was a metastasis of gestational choriocarcinoma. A rare case of a patient with metastatic gestational choriocarcinoma of a solitary pulmonary nodule without any uterine abnormality is presented.     

A case report of anorectal malignant melanoma with mucosal skipped lesion

IntroductionWe report our experience involving a case of relatively rare anorectal malignant melanoma with skipped lesion.Presentation of caseThe patient was a 72-year-old man who had visited a local clinic complaining of a mass in the anal region, whereupon he was referred to our hospital on suspicion of a malignant melanoma. Close examination revealed a 25-mm black type 1 tumor one-third the size of the circumference of the anal canal and located externally to it. We performed transanal resection of the tumor and confirmed a diagnosis of malignant melanoma. Notably, multiple macular black lesions spaced away from the main lesion were observed during surgery in half of the circumference of the anal canal, from the tumor to the pectinate line. A biopsy of the area also revealed malignant melanoma; therefore, we performed abdominoperineal resection. Pathological diagnosis indicated a submucosal depth; the patient was thus diagnosed with T4 N2c M0 stage IIIb malignant melanoma and was followed on an outpatient basis.DiscussionPatients with anorectal malignant melanoma have very poor prognoses owing to early lymph node metastasis and hematogenous metastasis. Our case illustrates that small anorectal malignant melanoma lesions can spread from the main lesion and invade the mucosa; examinations may sometimes miss such skipped lesions.ConclusionSkipped lesions can occur in anorectal melanomas; thus, careful scrutiny of such lesions is required. Moreover, lesion resection is critical for anorectal malignant melanomas.     

Endobronchial metastasis from adenocarcinoma of gastric cardia 7 years after potentially curable resection

Endobronchial metastasis (EBM) is a rare form of metastasis from extrapulmonary malignant tumors, although there are few reports of EBM from gastric cancer specifically. We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography. On diagnosis of primary lung cancer, she underwent pulmonary lobectomy, but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer. Six months later, she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen. She is still alive at 33 mo after the lobectomy. Generally, the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival. Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.     

A surgical case of methotrexate-associated lymphomatoid granuloma

We reported a surgical case of methotrexate-associated lymphomatoid granuloma. A 69-year-old female had been treated with methotrexate for rheumatoid arthritis for 35 months. The patient underwent partial resection of the right upper pulmonary lobe for lung cancer when she was 67 years old. A nodule was detected in the left lung field on a chest radiograph performed during the postoperative follow-up period. Computed tomography revealed a 28-mm nodule in the lower left pulmonary lobe. A transbronchial biopsy examination did not lead to a diagnosis. The pulmonary nodule subsequently increased in size. We suspected a malignant tumor and performed lower left lobectomy. A pathological examination revealed lymphomatoid granuloma. Finally, the patient was diagnosed with methotrexate-associated lymphomatoid granuloma based on her history of oral methotrexate treatment.     

Malignant melanoma metastatic to the cavernous sinus and skull with an unknown primary origin: report of a case]

A rare case of malignant melanoma metastatic to the cavernous sinus and skull, with an unknown primary origin, is reported. A 46-year-old man noticed diplopia, lt. ptosis and swelling in the parietal and maxillary regions. The parietal skull tumor and the maxillary lymph node were excised and histological examination revealed malignant melanoma. Because of its roentogenological characteristics, the lesion of the cavernous sinus was also thought to be the site of metastasis of malignant melanoma. This case is rare because the initial symptom was cavernous sinus syndrome, and no involvement of brain parenchyma was observed.     

Malignant tumors of the hard palate: Report of 4 cases and review of the literature

IntroductionCancer of the hard palate is a fairly rare malignant tumor. Different histological types have been described in the hard palate, and that can affect its different structures.Diagnosis is based on biopsy with histological examination and possibly on immunohistochemical markers to confirm the diagnosis and exclude other diagnostic hypotheses.The aim of this study was to determine histopathologic, clinical and therapeutic characteristics of malignant tumors of the hard palate.Patients and methodsA retrospective review of 4 patients who underwent Surgical resection by trans oral approach was performed for different histological types of malignant tumors of the hard palate. These included squamous cell carcinoma (case1 and case 2), mucosal melanoma (case 3), and adenocarcinoma (case 4).ResultsThe T stage was analyzed for all cases. Two cases were classified as T2 stage with a tumor size between 2 and 4 cm and the two others, given the extension to the maxillary and nasal cavity were classified as T4a. Cervical lymph node metastasis was found in three patients.DiscussionSurgical resection is the treatment of choice for malignant tumors of the hard palate. There is a variety of surgical procedures that can be used via a trans oral approach. Reconstruction of palatal defects with a prosthesis is sufficient, whereas larger defects will require a local, regional or even microvascular free tissue flap. The differences between these surgical techniques are presented, and indications are discussed.ConclusionThe therapeutic management for malignant tumors of the hard palate is essentially surgical, with or without postoperative radiotherapy, discussed on a case-by-case basis. Survival rate depends on several factors, including early diagnosis, histological characteristic and appropriate management.     

Multiple Metastatic Malignant Melanoma Presenting Intraluminal Gallbladder Bleeding

We report a case of malignant melanoma of unknown primary origin presenting metastasis in various organs as well as intraluminal gallbladder bleeding due to gallbladder metastasis. A 58-year-old woman was diagnosed with stage IV metastatic malignant melanoma. Because she exhibited acute cholecystitis and hemobilia due to malignant melanoma of the gallbladder, laparoscopic cholecystectomy was performed to relieve the symptoms. The resected gallbladder specimen showed a pedunculated black mass indicating malignant melanoma. Pathologic examination and immunohistochemical analysis revealed malignant melanoma of the gallbladder. Only a few cases of gallbladder malignant melanoma presenting hemobilia have been reported; here we present our case, including the experience of multidisciplinary treatment.Key words: Gallbladder malignant melanoma, Hemobilia, Laparoscopic cholecystectomyMalignant melanoma can metastasize to various organs. Metastasis often occurs in the lungs, liver, brain, and gastrointestinal tract; however, reported cases of metastatic melanoma of the gallbladder are rare. Though gallbladder melanoma is usually asymptomatic, acute cholecystitis is the most common presentation among symptomatic cases. Other symptoms, such as obstructive jaundice, external biliary fistula, and hemobilia, are rare and found in very few reports. Here, we report a case of multiple metastases of malignant melanoma of unknown primary origin, for which we performed laparoscopic cholecystectomy to treat continuous bleeding from the gallbladder. We conclude that cholecystectomy is indicated for symptomatic stage IV gallbladder of melanoma cases, because the patient who underwent cholecystectomy not only experiences resolved symptoms but also maintained a survival benefit with improved quality of life.     

Primary pulmonary carcinoid tumor with metastasis to endometrial polyp

INTRODUCTIONA carcinoid tumor occurring in the endometrium has been documented in the literature, but there is no report in regard to carcinoid tumor metastasis to endometrium.PRESENTATION OF CASEWe report a case of a malignant carcinoid metastasis to an endometrial polyp. Patient underwent hysteroscopy, and polypectomy. The pathology demonstrated an endometrial polyp containing a 4 mm x 5 mm nodule of metastatic carcinoid tumor, consistent with metastasis from patient's known pulmonary carcinoid. The tumor was morphologically similar to the tumors of the right lung, with similar immune-profile.DISCUSSIONThis patient presented with a suspicious pelvic ultrasound. Due to her age, the first priority was to exclude uterine cancer. The endometrial polyp, which was found, had a small focus of metastatic carcinoid tumor. To the best of our knowledge, this finding has not been previously recorded in the literature. Our patient also had a history of metastatic carcinoid tumor to breast. This finding is also very uncommon.CONCLUSIONThis is the first case in the literature described a malignant carcinoid metastasis to an endometrial polyp.     

Unusual case of cavitary lung metastasis of esophageal cancer: A case report

Introduction and importanceCavitary lung metastases are rare. We experienced lung metastasis of esophageal cancer with a cavity, which is extremely rare.Case presentationA 69-year-old female diagnosed with thoracic esophageal cancer underwent radical esophagectomy. Pathological diagnosis was T3N0M0-pStageII. Cavitary lesion appeared in the lower lobe of the right lung 12 months after surgery. We suspected an inflammatory change and followed up strictly. On Computed tomography (CT) image 18 months after surgery, the cavitary lesion slightly increased in size, showing wall thickening and fluid inside. Fluid collection disappeared after antibiotic treatment. The patient was followed for 4 weeks without antibiotics and fluid collection reappeared. Cavitary lesion resection for the purpose of diagnosis was planned because malignancy could not be excluded, although the readministration of antibiotics was also considered. Thoracoscopic partial resection of the right lower lobe of the lung was performed. Histopathological examination showed squamous cell carcinoma which was similar in morphology to esophageal cancer. The final diagnosis was lung metastasis of esophageal cancer.Clinical discussionMetastatic lung cancer with a cavity is rare, accounting for approximately 4% of all cases. Moreover, Lung metastasis of esophageal cancer with a cavity is extremely rare.ConclusionsThe specimen collection, including total biopsy, should be aggressively performed when diagnosing cavitary lung disease in patients with a history of neoplastic disease.     

Primary mucosal malignant melanoma of the oral cavity

Mucosal malignant melanoma arising from the head and neck region is a rare entity, and it is more aggressive than cutaneous melanoma. Furthermore, the complex anatomy of the oral cavity makes complete surgical excision difficult. Thus, early diagnosis and treatment of a mucosal lesion are important. In this study, three mucosal malignant melanoma cases and the literature have been reviewed. Three cases who presented with a primary malignant melanoma of the oral cavity have been retrospectively analyzed. All three patients were female with a mean age of 31.3 years, and the median follow-up period was 18.6 (6–36) months. The tumor was located on the maxillary gingiva in case 1 and in the hard palate–maxillary gingiva in cases 2 and 3. Case 2 had a distant metastasis during first admission. The tumor was excised with a 2-cm surgical margin in all cases. Case 2 received adjuvant chemotherapy. During the follow-up period, case 1 had a cervical lymphadenopathy 8 months after the first operation, so she underwent cervical lymph node dissection then received chemotherapy. Melanoma of the oral cavity is very rare with an extremely poor prognosis. As some melanomas may be amelanotic, a high index of suspicion is necessary. A biopsy should be taken from any suspicious lesion in the oral cavity. Surgical excision combined with adjuvant therapy is the main treatment approach for these cases. Prognosis of the disease depends on early diagnosis and treatment. A multicenter prospective study is required to introduce staging of the disease and the optimal treatment regimen.     

A case of pulmonary metastasis of malignant fibrous histiocytoma with left atrial infiltration via the pulmonary vein

We report a case of a woman who at age 58 had an operation on the right femur for malignant fibrous histiocytoma (MFH). At age 63, a chest X-ray examination disclosed a tumor shadow, for which we suspected metastasis from the MFH. Chest computed tomography showed that the tumor had infiltrated to the left atrium via the pulmonary vein. We operated on the patient, first dividing the arterial supply to the lower lobe, and then opening the pericardium. We blocked the lower pulmonary vein and left atrium with a Cooley-Dera clamp and resected the tumor. The tumor was polypoid and had invaded the left atrium. Fifteen months after this lung surgery, the patient was diagnosed with a brain tumor, which was resected. Invasive primary lung cancer to the left atrium via the pulmonary vein is common, but metastasis from a sarcoma such as MFH to the left atrium via the pulmonary vein is extremely rare.     

A first reported case of metastatic anorectal amelanotic melanoma with a marked response to anti-PD-1 antibody nivolumab: A case report

IntroductionAnorectal amelanotic melanoma (AAMM) is a rare disease with poor prognosis. A standard treatment strategy for AAMM has not been established.Presentation of caseWe report a case of successful treatment of AAMM with nivolumab. A 67-year-old man was referred for colonoscopy which revealed type I tumor in the rectum. AAMM was diagnosed with immunostaining histopathological biopsy findings. Enhanced computed tomography (ECT) revealed the rectal tumor without distant organ metastasis. We performed laparoscopy-assisted abdominoperineal resection. ECT at three months after surgery revealed liver metastases and right ischial bone metastasis. Although we had started dacarbazine monotherapy, black spots that were suspicious of skin metastases had appeared on systemic skin. Therefore, we started nivolumab therapy. ECT at 3 months after initiation of nivolumab showed shrinkage of liver metastasis. We have continued strict follow-up every 2 months and checked no oncologic progression at 17 months after initiation of nivolumab.DiscussionThe anti-PD-1 antibody have improved prognosis of malignant melanoma. However, there are no reports of nivolumab for treatment of AAMM.ConclusionsOur patient is the first reported case of AAMM treated with nivolumab. We consider that nivolumab will be effective for non-cutaneous malignant melanoma.     

Primary Malignant Melanoma of the Small Intestine: a Case Report

The small intestine is the most common site of gastro-intestinal metastasis from cutaneous malignant melanoma. A primary origin at this site has been reported in rare cases. We report a case of a 71-year-old man with a primary malignant melanoma in the jejunum. The patient presented with weakness, weight loss, non-specific abdominal pain and episodes of fainting. After clinical examination, laboratory evaluation and radiological work-up, which included CT of the abdomen, the patient was diagnosed with a tumour mass in the jejunum. This diagnosis was confirmed at laparotomy. The patient underwent enterectomy with wide excision of the tumour. A primary malignant melanoma of the small intestine is an extremely rare neoplasm.

A definite diagnosis can only be made after a thorough investigation has been made to exclude the co-existence of a primary lesion elsewhere. Curative resection of the tumour remains the treatment of choice.