Ileal Malignant Melanoma Causing Intussusception: Report of a Case

Cutaneous malignant melanoma (MM) often metastasizes to the gastrointestinal (GI) tract; however, primary MM of the small intestine is a controversial diagnosis. We report the case of a 76-year-old woman found to have a primary MM in the ileum. After clinical evaluation, the radiological workup, which included magnetic resonance enteroclysis (MRE), revealed a large polypoid intraluminal tumor. She underwent laparotomy and the lesion was excised. Histological examination of the resected specimen revealed morphological and immunohistochemical characteristics of MM and a detailed postoperative examination failed to identify a primary lesion on the skin, anus, oculus, or any other site. The patient died of brain metastasis 6 months after surgery. According to our review of the literature, this is the first case of primary MM of the small intestine diagnosed with the help of MRE.     

Malignant Melanoma of the Gallbladder: A Report of Two Cases and Review of the Literature

Melanoma metastatic to the gallbladder is rare. When present, it is often part of a widespread complex of metastases. Primary gallbladder melanomas are also extremely rare and can sometimes be difficult to distinguish from metastatic lesions. The optimal treatment for malignant melanoma of the gallbladder remains unclear, and prognosis is generally poor. We present here two cases of patients with metastatic lesions to the gallbladder. One patient presented with symptomatic cholelithiasis and was found incidentally to have a metastasis. Another patient had known a metastasis, but underwent curative resection of the only site of disease. We review the published literature for gallbladder melanoma, both primary and metastatic to determine the role of surgery in this disease.     

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.     

肾恶性间叶瘤的诊断与治疗（附3例报告并文献复习）

目的：探讨肾恶性间叶瘤的诊断、治疗及预后.方法：回顾性分析3例肾恶性间叶瘤患者的临床资料：男2例,女1例.年龄48～68岁,平均57岁.CT平扫均为肾脏巨大不均质肿物,其中伴有大块状钙化2例,增强扫描不均质肿物有轻至中度强化.3例患者均行根治性肾切除术,术后辅以化疗或放疗.结果：3例患者术后存活6～18个月,平均11个月.结论：肾恶性间叶瘤临床罕见,术前诊断困难,确诊需依靠病理检查.综合分析临床资料及提高对此病的临床认识是避免误诊的关键.根治性切除术是其主要治疗手段,但预后不佳.     

Malignant melanoma with mesenteric metastasis causing an intrapelvic abscess: Report of a case

We present herein the case of a 66-year-old woman with disseminated malignant melanoma in whom a metastasis in the ileal mesentery ruptured into the peritoneal cavity causing an acute abdomen. The patient suddenly developed lower abdominal pain and a computed tomography (CT) scan of the pelvis confirmed the presence of an intrapelvic abscess. At emergency laparotomy, a 10×10 cm ruptured metastatic melanoma was found in the ileal mesentery, which demonstrated no communication with the ileum itself. To our knowledge, no other case of an acute abdomen being caused by the rupture of mesenteric metastatic melanoma lacking any communication with the bowel lumen has ever been reported.     

Small Bowel Perforation Caused by Metastasis from an Extra-Abdominal Malignancy: Report of Three Cases

Small bowel perforation is rarely caused by metastasis from an extra-abdominal malignancy. This report describes three cases of small bowel perforation that occurred secondary to a metastatic tumor. The first case involved a 72-year-old man with malignant lymphoma of the larynx that had been treated with chemo- and radiation therapy; the second involved a 70-year-old man with rhabdomyosarcoma of the mediastinum that had been treated with radiation therapy; and the third involved a 41-year-old man with lung carcinoma that had been treated with surgery 10 months prior to perforation. Each patient presented with acute abdominal pain, had X-ray findings of free air in the abdomen, and underwent limited emergency surgery. Wedge resection and closure of the ileum was performed for the first patient and partial bowel resection with the creation of an intestinal stoma was performed for the second and third patients. In each case, the histologic findings of the resected specimens were consistent with the extra-abdominal primary tumors. Although the patients recovered sufficiently to begin eating and moving about, all three died of cancer or cancer-related complications within 45 days of surgery. We conclude that surgeons should be aware of the poor prognosis of such patients and perform only the minimal surgery required. Received: April 7, 2000 / Accepted: September 26, 2000     

Spontaneous Pneumothorax in Children with Osteosarcoma: Report of Three Cases and Review of the Literature

Spontaneous pneumothorax is a rare manifestation of primary lung cancer or metastasis. It is estimated that < 1% of all cases of spontaneous pneumothorax are tumor-associated and metastatic osteogenic or soft-tissue sarcomas are associated most commonly with pneumothorax especially in the setting of cytotoxic chemotherapy or radiotherapy. In this article, we report three pediatric cases with osteosarcoma that developed spontaneous pneumothorax during chemotherapy with a review of the literature. Two of them had lung metastasis at the time of the detection of pneumothorax and the remaining patient was found to have a bronchopleural fistula.

SPx is an emergency situation and early diagnosis and management can improve prognosis and quality of life of the patient however the optimal management has yet to be determined.     

原发性小肠恶性肿瘤的治疗和预后(36例回顾性分析)

目的：研究小肠恶性肿瘤的临床特点以及决定预后的因素。方法：回顾性分析了我院１９７４年至１９９９年收治的３６例原发性恶性小肠肿瘤病例（不包括壶腹周围癌）,其中以淋巴瘤居多,占４７．２％。临床症状无特异性,内镜和消化道钡餐检查是主要诊断手段。５０％的病例在手术时已有远处转移,仅１８例获根治性切除。结果：３０例成功地进行了随访。小肠恶性肿瘤患者术后５年生存率为４７．３％。Ｃｏｘ模型多因素分析显示,远处转移和肿瘤大小对生存率有显著影响。结论：早期诊断、早期治疗是提高小肠恶性肿瘤预后的主要手段,对无远处转移的病例应争取根治术。     

Primary Malignant Melanoma of the Small Intestine: Report of a Case

The small intestine is the most common site of gastrointestinal (GI) metastases from cutaneous malignant melanoma; however, primary malignant melanoma originating in the small intestine is extremely rare. We report the case of a 72-year-old man found to have a primary malignant melanoma in the ileum. The patient presented with anorexia, weight loss, diffuse colicky abdominal pain, and episodic rectal bleeding. A preoperative diagnosis of a small intestinal tumor was based on the findings of enteroclysis and computed tomography scanning. This diagnosis was confirmed at laparotomy and an enterectomy was performed. Histopathological examination of the resected specimen clarified the exact nature of the lesion, confirming the diagnosis of melanoma. A thorough postoperative investigation did not reveal a primary lesion in the skin, anus, oculus, or any other location. Thus, we diagnosed this tumor as a primary lesion. One year after his operation, the patient remains well without any evidence of recurrence. Primary malignant melanoma of the small intestine is an extremely rare lesion, which must be differentiated from other intestinal tumors. Received: August 6, 2001 / Accepted: March 5, 2002     

Recurrent Lumbosacral Metastases from Intracranial Meningioma. Report of a Case and Review of the Literature

We report a case of a 31 year-old woman who in 1991 presented a clinical history of headaches, nausea and vomiting. CT scan showed a right frontotemporal meningioma. The first operation achieved a macroscopically complete resection. The tumour was histologically classified as a transitional meningioma. There were recurrences of the intracranial meningioma in 1994, 1996, 1997 and 1998. These recurrences were accompanied by differentiation to atypical and anaplastic meningioma. In all of these operations, a macroscopically complete resection of the tumour was performed. In 1996 adjuvant radiation therapy was given. In 1998 therapy with bromocriptine was adopted. In April 1999, the patient presented with lumbosacral pain associated with L5 bilateral sciatica. MRI showed a gadolinium enhancing mass lesion at L5-S1 level. Complete tumour resection was performed. The histological findings were the same as in 1998. In December 1999 the patient presented with perineal pain and MRI showed a L4 and S3 recurrence and the tumour was resected. The histological findings were those of a malignant meningioma. In February 2000 an intracranial recurrence was detected and operated on. The histological diagnosis was malignant meningioma. A review of the literature was undertake and is discussed.     

Primary Malignant Melanoma of the Oesophagus

Primary malignant melanoma arising in the oesophagus is a rare condition with a dismal prognosis. The diagnosis is often made following surgical resection even though the endoscopic features may be pathognomonic. The classical treatment is oesophagectomy even though the advanced disease stage at the time of presentation and aggressive biological behaviour of the tumour usually results in a fatal outcome. We report the case of a male patient initially diagnosed with squamous oesophageal carcinoma and treated with conventional neo-adjuvant chemo-radiotherapy. Poor clinical and radiological response resulted in a review of the original histology confirming a diagnosis of primary malignant melanoma of the oesophagus. The subsequent alteration in management conferred the patient an improved quality of life. A short review of the literature on primary malignant melanoma of the oesophagus supplements this case report.     

Malignant Gastrointestinal Stromal Tumors of the Small Intestine: A Review of 50 Cases From a Prospective Database

Background: Malignant gastrointestinal stromal tumors (M-GIST) are rare mesenchymal tumors originating in the wall of the gastrointestinal (GI) tract. Previous studies have included limited numbers of patients, and most included malignant and benign cases from throughout the GI tract. We reviewed the experience of a single tertiary cancer care center with M-GIST of the small intestine only.Methods: A prospective database identified all patients seen from 1989 to 1998. Clinical and pathological data, treatment, and outcome were analyzed. Overall median follow-up time was 24 months (range, 1-176 months).Results: Fifty patients (31 male, 19 female) were identified. Mean age at diagnosis was 55 years. Disease was localized in 11 patients, locally advanced (invasion into adjacent organs/peritoneum) in 24 patients, perforated in 4 patients, multiple primary lesions in 2 patients, and distant metastases in 9 patients. All patients underwent resection, which was complete in 70%. Locoregional recurrence (LR) developed in 43% (median, 25 months), and distant metastases in 59% (median, 21 months) of patients at risk. At last follow-up, 14 patients were alive (6 disease-free), 2 had died disease-free, and 34 died with recurrent disease. Overall survival (OS) was similar for localized and locally advanced disease; OS also was similar for patients with multiple primaries and distant metastases at diagnosis. Patients were grouped into three stages: (I) patients with localized and locally advanced disease; (II) patients with perforated; and (III) patients with multiple primaries and distant metastases. Actuarial OS at 5 years was 41% (n = 50)—42% for those with complete resection and 8% for incomplete resection. Univariable analysis showed that earlier stage at diagnosis (P = .001) and completeness of resection (P = .004) predicted for longer OS.Conclusions: Most patients with M-GIST of the small intestine relapse following resection, but survival may be prolonged. In univariable analysis, stage at presentation and complete resection were significant prognostic variables for OS; grade was not significant. Localized and locally advanced M-GIST of the small intestine have a mean OS > 5 years. Complete resection should be the goal of initial surgical treatment.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16-19, 2000.     

Primary Intracranial Malignant Schwannoma of Trigeminal Nerve. A Case Report with Review of the Literature

The authors report a rare case of primary intracranial malignant schwannoma of the trigeminal nerve occuring in a 30-year-old woman without von Recklinghausen's neurofibromatosis (VRNF). The tumour arose from the intracranial part of the left trigeminal nerve, without skull base destruction. The tumour was partially removed operatively, followed by focal 50 Gy irradiation, but unfortunately the tumour showed rapid regrowth. A second operation was attempted, but she died of cerebral infarction soon after operation. Histologically, the original tumour was characterized by the presence of foci of extremely high cellularity, pleomorphism and mitosis in an otherwise typical benign schwannoma. Immunohistochemically, the tumour cells were positive for S-100 protein even in the atypical areas, suggesting the tumour to be of Schwann cell origin. However, the recurrent tumour was composed of undifferentiated spindle cells, which were negative for S-100 protein. Thus, it is possible to consider that the S-100 protein expression could reflect the degree of differentiation of Schwann cells. Furthermore, the postoperative irradiation might have exacerbated the malignant progression in the present case.     

Thoracic Intradural Extramedullary Lipomas. Report of Three Cases and Review of the Literature

Summary. Summary. Background: Indication for surgery and the surgical strategy for treatment of spinal intradural lipomas are still discussed controversially. Among spinal lipomas the cervicothoracic region is rarely affected. We report on our experience with spinal decompression for the treatment of three intradural thoracic lipomas. Findings: Three adult patients with extramedullary intradural lipomas of the thoracic spinal cord demonstrated progressive neurological symptoms and signs without evidence of growth of the lipoma. All patients underwent surgery with decompression of the affected spinal levels. No attempt was made to reduce the size of the lipomas. Postoperatively, each patient demonstrated significant clinical improvement. Interpretation: Attempts to remove lipomas are associated with significant risks of surgical morbidity. Lipomas are hamartomas which change their size according to alterations of body fat. Therefore, decompression of the affected spinal levels is sufficient to achieve significant neurological improvement.     

睾丸鞘膜恶性间皮瘤1例并文献复习

目的：分析睾丸鞘膜恶性间皮瘤并总结其临床特点、诊断及治疗。方法：报告1例睾丸鞘膜恶性间皮瘤的I艋床表现、治疗经过、病理结果,并回顾文献对该病的相关报道。结果：患者经手术治疗后出院,术后病理提示左睾丸鞘膜恶性间皮瘤,肿瘤未侵及睾丸。精索切缘未见肿瘤残余。免疫组化标记：CK5／6（＋）,Vimentin（＋）,EMA（＋）,CK8（＋）。术后密切随访中。结论：睾丸鞘膜恶性间皮瘤是一种罕见的泌尿生殖系恶性肿瘤,诊断主要依据病理,治疗以根治性睾丸切除术为一线治疗方式,预后多不良。该病的发生可能与石棉等多种因素相关。     

Malignant Melanoma of the Kidney Presenting as a Primary Tumor

We report a case of malignant melanoma of the kidney presenting as a primary tumor. This tumor was found incidentally in a 74-year-old woman. The patient underwent a right radical nephrectomy, and has been living tumor free for 2 years and 3 months. This is the first reported case of primary renal malignant melanoma. We discuss the probability that this tumor is renal in origin and directly linked to the origin of malignant melanoma.     

Bronchial Lipoma:Three Cases and Review of the Literature

Three cases of bronchial lipoma are described, all in men and all localized in the right bronchus of the upper lobe. Extirpation of the upper lobe was performed in all three cases. The number of collected cases of bronchial lipoma is hereby brought to 51. The earlier literature is surveyed, and some of these cases are reported on with regard to sex, age, localization, and treatment. It is concluded that lobectomy may be the most effective treatment where the lipoma occludes only one bronchial lobe. When the lipoma is localized in the main bronchus or more centrally one should wait for the regression of any possible changes in the lung parenchyma after local removal of the tumor.