MALIGNANT MELANOMA METASTASIZED TO THE SMALL INTESTINE-REPORT OF A CASE

We experienced a rare case of malignant melanoma metastasized to the small intestine. A 59-year-old man, who had been diagnosed as having a malignant melanoma of the nasal cavity two years earlier, had been admitted to the Department of Otorhinolaryngology in our hospital several times for anticancer drug treatment. On November 6, 1994, he was seen at the Department of Surgey in the hospital because of upper abdominal pain. He had a protuberant tense abdomen with slight tenderness and bilateral nasal bleeding with anemia. Plain abdominal roentgenograms showed multiple, small fluid levels of the small bowel. These findings were suggestive of obstruction of the small intestine. Nasogastric long tube suction was continued and intravenous hyperalimentation was given. After relief of the intestinal obstruction, an abdominal firm mass was palpated and a barium meal study demonstrated a filling defect in the ileum. The preoperative diagnosis was made as metastatic malignant melanoma to the ileum. At operation, endoscopic examination of the small intestine showed a 3.0×3.0 cm nodular mass in the ileum with no other lesions. Partial resection of the ileum with the tumor was performed. Macroscopic examination of the resected specimen revealed a brown nodular mass with an ulcer, 2.5×2.5 cm in size, which occupied most of the intestinal wall area. In immunohistological stainig, S-100 antibody was positive. The histological diagnosis was thus established as metastatic malignant melanoma to the ileum. The patient was discharged on the 14th day after the surgery following an uneventful postoperative course. However, he died of metastatic lung cancer with no abdominal complaints one year after the operation.