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GE-Portuguese Journal of Gastroenterology

versão impressa ISSN 2341-4545

GE Port J Gastroenterol vol.30 no.1 Lisboa fev. 2023  Epub 01-Jun-2023 

Images in Gastroenterology and Hepatology

Gastric Metastatic Melanoma Mimicking a Hyperplastic Lesion

Metástase gástrica de melanoma a mimetizar lesão hiperplásica

Cláudia Martins Marques Pinto1 

Marta Rodriguez1 

Madalena Souto Moura2 

Mariana Afonso2 

Pedro Bastos1 

Mário Dinis Ribeiro1  3 

1Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

2Pathology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

3MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal

A 56-year-old woman was submitted to an upper gastrointestinal endoscopy due to a recent history of epigastric pain. Endoscopic examination revealed a 20-mm 0-IIa type lesion in the great curvature of the proximal corpus with a hyperplastic appearance and a dark coloration area in one of the edges (Fig. 1, 2). Biopsy of the lesion was suggestive of mesenchymal proliferation and some cells with moderate cytologic atypia. The patient was then referred to our Endoscopy Department to undergo endoscopic resection. Due to the previous histological result, we decided to perform an endoscopic ultra-sonography that showed thickening of the superficial layers of the mucosa. Endoscopic biopsies were repeated, and pathological evaluation revealed diffuse involvement of the lamina propria by a malignant neoplasm, composed of cells with nuclear pleomorphism and high mitotic rate, entrapping benign gastric glands. Immunohistochemistry showed diffuse positivity for melanocytic markers (PS100, SOX10 and MelanA) and negativity for cytokeratins, DOG-1 and CD45 (Fig. 3, 4). Given the clinical history of a malignant melanoma of the third left hand finger submitted to amputation 5 years before, a diagnosis of gastric metastasis of malignant melanoma was made. Thoraco-abdomino-pelvic computed tomography and PET scan showed no other metastasis. After multidisciplinary discussion, total gastrectomy was proposed to the patient given the location of the lesion (proximal corpus). During surgery, it was decided to perform an atypical gastrectomy following endoscopic tattoo. The histological specimen confirmed the diagnosis of malig-nant melanoma with free surgical margins. The patient is currently under clinical and imagiological (PET scan) surveillance.

Fig. 1 Endoscopic image of a gastric lesion 0-IIa with hyperplastic appearance of the mucosa. 

Fig. 2 Endoscopic image of the lesion with a dark coloration area of 5 mm in one of the edges. 

Fig. 3 Gastric body mucosa with normal epithelial cells and a diffuse infiltration of the lamina propria by sheets of malignant neo-plastic cells. HE staining, ×40. 

Fig. 4 Diffuse positivity for MelanA and PS100. 

Malignant melanoma is a frequent source of metastases in the gastrointestinal tract [1]. The most frequent location is the small bowel followed by the colon and rectum; gastric metastases are rare [1, 2]. Metastatic disease is usually diagnosed within the first 3 years, but metastases after 15 years have also been reported [3]. Lesions mimicking submucosal or primary gastric ulcerated tumours are the most frequent presentation, although endoscopic findings are variable [2, 4].

It is important to keep in mind the different possible endoscopic appearances of metastatic lesions to avoid further delay in diagnosis and treatment. Immunohisto-chemistry is an imperative tool for making a correct diagnosis in these circumstances.


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2. El-Sourani N, Troja A, Raab HR, Antolovic D. Gastric Metastasis of Malignant Melanoma: Report of a Case and Review of Available Literature. Viszeralmedizin. 2014 Aug;30(4):273-5. [ Links ]

3. Farshad S, Keeney S, Halalau A, Ghaith G. A Case of Gastric Metastatic Melanoma 15 Years after the Initial Diagnosis of Cutaneous Melanoma. Case Rep Gastrointest Med. 2018 Jul;2018:7684964. [ Links ]

4. Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, risk factors, pathogenesis, diagnosis and classification. In Vivo. 2014 Nov-Dec;28(6):1005-11. [ Links ]

Statement of Ethics Patient consent was obtained for publication of the case (including publication of images).

Funding Sources The authors have no funding source to declare.

Received: March 02, 2021; Accepted: April 21, 2021

Correspondence to: Cláudia Martins Marques Pinto,

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Author Contributions

C.M.M. Pinto wrote the manuscript. M. Rodriguez, M. Souto Moura, M. Afonso, P. Bastos and M. Dinis-Ribeiro wrote and revised the manuscript. M. Souto Moura and M. Afonso collected the pathology images. All authors approved the final version. C. Pinto is the article guarantor.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License