Digestive and Liver Disease 46 (2014) 1133
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Dark macules in the upper gastrointestinal tract: An ominous sign Faidon-Marios Laskaratos a , Roopinder Gillmore b , Ian Clark c , Edward J. Despott a,∗ a
Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, London, United Kingdom Department of Oncology, Royal Free Hospital and UCL School of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom c Department of Cellular Pathology, Royal Free Hospital and UCL School of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom b
A previously healthy 42-year-old man presented with a 3month history of non-specific abdominal pain associated with anorexia, nausea and vomiting. Apart from slightly elevated liver enzymes, his laboratory investigations were unremarkable. An abdominal ultrasound showed multiple liver lesions consistent with metastases; a computed tomography scan of his chest, abdomen and pelvis confirmed these findings, however no primary lesion was identified. At upper gastrointestinal endoscopy, multiple dark brown macules (2–5 mm in diameter) were seen within the stomach (Fig. 1A) and duodenum (Fig. 1B). Histological examination of biopsies of these lesions with immunostaining with Melan-A showed features of metastatic malignant melanoma (Fig. 1C). On thorough examination of the skin, no primary lesion was identified. Malignant melanoma is known to frequently metastasise to the gastrointestinal tract, with liver, small bowel, colonic and gastric involvement in decreasing order of frequency [1]. Typical endoscopic appearances of melanoma metastases include polypoid masses, nodules and ulcers but the finding of multiple dark flat macules, as described in our case has only been reported in a few cases previously [1]. The incidence of melanoma of unknown origin is low (2–6%) and a presentation with gastric and duodenal metastases as described here is unusual. Despite chemotherapy, the patient succumbed to his disseminated disease about 2 months after diagnosis. Fig. 1.
Reference [1] Köklü S, Gültuna S, Yüksel I, et al. Diffuse gastroduodenal metastasis of conjunctival malignant melanoma. American Journal of Gastroenterology 2008;103:1321–3.
∗ Corresponding author. Tel.: +44 2077940500; fax: +44 2084233588. E-mail address: [email protected] (E.J. Despott). http://dx.doi.org/10.1016/j.dld.2014.07.017 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Dark macules in the upper gastrointestinal tract: An ominous sign Faidon-Marios Laskaratos a , Roopinder Gillmore b , Ian Clark c , Edward J. Despott a,∗ a
Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, London, United Kingdom Department of Oncology, Royal Free Hospital and UCL School of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom c Department of Cellular Pathology, Royal Free Hospital and UCL School of Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom b
A previously healthy 42-year-old man presented with a 3month history of non-specific abdominal pain associated with anorexia, nausea and vomiting. Apart from slightly elevated liver enzymes, his laboratory investigations were unremarkable. An abdominal ultrasound showed multiple liver lesions consistent with metastases; a computed tomography scan of his chest, abdomen and pelvis confirmed these findings, however no primary lesion was identified. At upper gastrointestinal endoscopy, multiple dark brown macules (2–5 mm in diameter) were seen within the stomach (Fig. 1A) and duodenum (Fig. 1B). Histological examination of biopsies of these lesions with immunostaining with Melan-A showed features of metastatic malignant melanoma (Fig. 1C). On thorough examination of the skin, no primary lesion was identified. Malignant melanoma is known to frequently metastasise to the gastrointestinal tract, with liver, small bowel, colonic and gastric involvement in decreasing order of frequency [1]. Typical endoscopic appearances of melanoma metastases include polypoid masses, nodules and ulcers but the finding of multiple dark flat macules, as described in our case has only been reported in a few cases previously [1]. The incidence of melanoma of unknown origin is low (2–6%) and a presentation with gastric and duodenal metastases as described here is unusual. Despite chemotherapy, the patient succumbed to his disseminated disease about 2 months after diagnosis. Fig. 1.
Reference [1] Köklü S, Gültuna S, Yüksel I, et al. Diffuse gastroduodenal metastasis of conjunctival malignant melanoma. American Journal of Gastroenterology 2008;103:1321–3.
∗ Corresponding author. Tel.: +44 2077940500; fax: +44 2084233588. E-mail address: [email protected] (E.J. Despott). http://dx.doi.org/10.1016/j.dld.2014.07.017 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
