A Case of Primary Small Bowel Melanoma Diagnosed by Single-Balloon Enteroscopy

Jun Young Shin, In Suh Park, Byoung Wook Bang, Hyung Kil Kim, Yong Woon Shin, Kye Sook Kwon, Jun Young Shin, In Suh Park, Byoung Wook Bang, Hyung Kil Kim, Yong Woon Shin, Kye Sook Kwon

Abstract

Although metastasis from cutaneous malignant melanoma to the small intestine is not uncommon, primary small bowel melanoma (SBM) is extremely rare. This case report describes a rare case of primary SBM, diagnosed by single-balloon enteroscopy. A 74-year-old man presented with recurrent melena. Upper endoscopy and colonoscopy were unremarkable. Abdominal computed tomography (CT) revealed an ileal mass with ileo-ileal intussusception. Subsequent single-balloon enteroscopy identified an ileal tumor, which was histologically diagnosed as melanoma. Extensive clinical examination did not reveal any primary cutaneous lesions. To the best of our knowledge, this is the first case of primary SBM in South Korea.

Keywords: Intestine, small; Melanoma; Single-balloon enteroscopy.

Conflict of interest statement

Conflicts of Interest:The authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Abdominal computed tomography (CT) showing 4 cm polypoid enhancing mass with ileo-ileal intussusception in the distal ileum (arrow). (A) Coronal image; (B) Axial image.
Fig. 2.
Fig. 2.
Single-balloon enteroscopy showing 4 cm darkish polypoid mass obstructing the lumen approximately 60 cm proximal to the ileocecal valve.
Fig. 3.
Fig. 3.
Histologic examination of endoscopic biopsy specimen showing infiltration of large atypical cells with prominent nucleoli and melanin pigment (A) and positive immunohistochemical staining for HMB-45 and S-100 (B,C). (A) Hematoxylin and eosin staining (H&E), ×40. (B) Immunohistochemical staining for HMB-45 (red color) (×200). (C) Immunohistochemical staining for S-100 protein (brown color) (×200).
Fig. 4.
Fig. 4.
Gross and histologic examination of surgical specimen. (A) Gross findings showed 4 cm darkish polypoid ileal mass with regional darkish lymph node. (B) Melanin pigment is observed in the tumor cells (Hematoxylin and eosin staining [H&E], ×400). (C) Immunohistochemical staining for S-100 protein is positive (×200). (D) Immunohistochemical staining for HMB-45 is positive (×200).

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