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2014 | 9 | 6 | 762-767

Article title

Metastatic lesions in the gastroduodenum - an unusual manifestation of malignant melanoma and pulmonary adenocarcinoma


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The gastrointestinal tract (GIT) is an unusual site for metastasis. The rate of GIT metastases detected clinically is very low because of unspecific symptoms and signs of GIT involvement, which include general weakness, tiredness, weight loss, unspecific abdominal pain, fatigue, and anemia. We report clinical, endoscopic, and pathological patterns of two patients (malignant melanoma and primary lung tumor) with metastatic lesions in the gastroduodenum. The first case is a 59-year-old man with unspecific symptoms as nausea, vomiting and abdominal pain. He underwent resection of skin melanoma on his back one year before. Upper gastrointestinal endoscopy revealed two melanotic polypoid masses with ulcerations at the tip, one in the stomach and one in the duodenal bulb. Endoscopic biopsy of these polypoid masses and immunohistochemical stains confirmed the diagnosis of metastatic malignant melanoma. The second case is a 73-year-old man with a two-day history of melena and unspecific abdominal pain. Three weeks before, the patient was operated on for the adenocarcinoma of the lung. Endoscopy of the upper gastrointestinal tract revealed irregular polypoid mass with ulcerations at the tip: three of the stomach mucosa, two in the duodenal bulb and more than ten hemorrhagic polypoid masses at the desendent duodenum. Biopsies of these lesions confirmed the diagnosis of metastatic lung adenocarcinoma. In patients with a history of malignant melanoma and lung cancer unspecific symptoms, like abdominal pain, anemia, and gastrointestinal bleeding gastroduodenal metastases should be suspected. The diagnosis requires careful endoscopic examinations of the mucosa for metastatic lesions and biopsy with special immunohistochemical stains.










Physical description


1 - 12 - 2014
16 - 8 - 2014


  • Clinic of gastroenterology and hepatology, Clinical Center Nis, 18000, Nis, Serbia


  • [1] Oda I, Kondo H, Yamao T et al. Metastatic tumors to the stomach: analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases. Endoscopy 2001; 33: 507–510 http://dx.doi.org/10.1055/s-2001-14960[Crossref]
  • [2] Taal BG, Westerman H, Boot H et al. Clinical and endoscopic features of melanoma metastases in the upper GI tract. Gastrointest Endosc 1999; 50: 261–263 http://dx.doi.org/10.1016/S0016-5107(99)70236-1[Crossref]
  • [3] Trouillet N, Robert B, Charfi S et al. Gastric metastases. An endoscopic series of ten cases. Gastroenterol Clin Biol. 2010; 34:305–309 http://dx.doi.org/10.1016/j.gcb.2010.01.019[Crossref]
  • [4] De Palma GD, Masone S, Rega M et al. Metastatic tumors to the stomach: clinical and endoscopic features. World J Gastroenterol. 2006; 12:7326–7328 [PubMed]
  • [5] Pommer B, Probst A, Messmann H. Gastric metastases from malignant melanoma. Endoscopy. 2008; 40:E30–1 http://dx.doi.org/10.1055/s-2007-995434[Crossref]
  • [6] Liang KV, Sanderson SO, Nowakowski GS et al. Metastatic malignant melanoma of the gastrointestinal tract. Mayo Clin Proc. 2006; 81:511–516 http://dx.doi.org/10.4065/81.4.511[Crossref]
  • [7] Gatsoulis N, Roukounakis N, Kafetzis I et al. Small bowel intussusception due to metastatic malignant melanoma. A case report. Tech Coloproctol 2004; 8:141–143 http://dx.doi.org/10.1007/s10151-004-0137-6[Crossref]
  • [8] Dequanter D, Sales F, Legendre H et al. Surgical resection for gastrointestinal metastatic melanoma. Ann Chir. 2004; 129:278–281 http://dx.doi.org/10.1016/j.anchir.2004.01.016[Crossref]
  • [9] Shenoy S, Cassim R. Metastatic melanoma to the gastrointestinal tract: role of surgery as palliative treatment. W V Med J. 2013; 109:30–33
  • [10] Malladi V, Palanivelu C, Mathew S et al. Malignant melanoma metastatic to the stomach and duodenum. Indian J Gastroenterol 2005; 24:133 [PubMed]
  • [11] Wysocki WM, Komorowski AL, Darasz Z. Gastrointestinal metastases from malignant melanoma: report of a case. Surg Today. 2004; 34:542–566 http://dx.doi.org/10.1007/s00595-004-2741-5[Crossref]
  • [12] Kitajima K, Bardier-Dupas A, Breton S et al. Variant on Manifestation of Duodenal Metastasis 26 Years after Initial Diagnosis of Primary Cutaneous Melanoma. Case Rep Gastroenterol 2010; 4:93–99 http://dx.doi.org/10.1159/000290383[Crossref]
  • [13] Stukavec J, Horák L. The malignant melanoma metastasis into the stomach corpus. Rozhl Chir 2005; 84:148–150 [PubMed]
  • [14] Oosting SF, Peters FT, Hospers GA et al. A patient with metastatic melanoma presentig with gastrointestinal perforation after decarbazine infusuion: a case report. J Med Case Rep 2010; 4:10 http://dx.doi.org/10.1186/1752-1947-4-10[Crossref]
  • [15] Uchiyama S, Imamura N, Ohuchida J et al. Late recurrence of malignant melanoma in the duodenum. Hepatogastroenterology 2008; 55:1619–1621 [PubMed]
  • [16] Retsas S, Christofyllakis C. Melanoma involving the gastrointestinal tract. Anticancer Res 2001; 21:1503–1508 [PubMed]
  • [17] Schuchter LM, Green R, Fraker D. Primary and metastatic diseases in malignant melanoma of the gastrointestinal tract. Curr Opin Oncol 2000; 12:181–185 http://dx.doi.org/10.1097/00001622-200003000-00014[Crossref]
  • [18] Schmid-Wendtner MH, Baumert J, Eberle J et al. Disease progression in patients with thin cutaneous melanomas (tumour thickness ≤0.75 mm): clinical and epidemiological data from the Tumour Center Munich 1977–98. Br J Dermatol 2003;149:788–793 http://dx.doi.org/10.1046/j.1365-2133.2003.05599.x[Crossref]
  • [19] Guitart J, Lowe L, Piepkorn M et al. Histological characteristics of metastasizing thin melanomas: a case-control study of 43 cases. Arch Dermatol 2002; 138:603–608
  • [20] Nicolaou N, Morris A, Motley R. Disease progression in patients with thin cutaneous melanomas [letter and reply]. Br J Dermatol 2004; 150:1223–1224 http://dx.doi.org/10.1111/j.1365-2133.2004.05989.x[Crossref]
  • [21] Sugimoto M, Gotohda N, Kato Y et al. Pancreatic resection for metastatic melanoma originating from the nasal cavity: a case report and literature review. Anticancer Res 2013; 33:567–573 [PubMed]
  • [22] Opric D, Bilanovic D, Granic M et al. Visceral metastases of melanoma-single institution experience an analysis of 15 cases. Acta Chir Iugosl 2006; 53:79–82 http://dx.doi.org/10.2298/ACI0603079O[Crossref]
  • [23] Erasmus JJ, McAdams HP, Rossi SE. Primary pulmonary neoplasms. In: Haaga JR, Dogra VS, Forsting M, Gilkeson RC, Ha HK, Sundaram M, editors. CT and MRI of the whole body. 5th ed. Philadelphia, PA: Louis: Mosby; 2008. p. 942.
  • [24] Nakamura E, Shimizu M, Itoh T et al. Secondary tumors of the pancreas: clinicopathological study of 103 autopsy cases of Japanese patients. Pathol Int 2001; 51:686–690 http://dx.doi.org/10.1046/j.1440-1827.2001.01258.x
  • [25] Maeno T, Satoh H, Ishikawa H et al. Patterns of pancreatic metastasis from lung cancer. Anticancer Res 1998; 18:2881–2884 [PubMed]
  • [26] Berger A, Cellier C, Daniel C et al. Small bowel metastases from primary carcinoma of the lung: clinical findings and outcome. Am J Gastroenterol 1999; 94:1884–1887 http://dx.doi.org/10.1111/j.1572-0241.1999.01224.x[Crossref]
  • [27] Goh BK, Yeo AW, Koong HN et al. Laparotomy for acute complications of gastrointestinal metastases from lung cancer: is it a worthwhile or futile effort? Surg Today 2007; 37:370–374 http://dx.doi.org/10.1007/s00595-006-3419-y[Crossref]
  • [28] Casella G, Di Bella C, Cambareri AR et al. Gastric metastasis by lung small cell carcinoma. World J Gastroenterol 2006; 12:4096–4097 [PubMed]
  • [29] Suzaki N, Hiraki A, Ueoka H et al. Gastric perforation due to metastasis from adenocarcinoma of the lung. Anticancer Res 2002; 22:1209–1212 [PubMed]
  • [30] Garwood RA, Sawyer MD, Ledesma EJ et al. A case and review of bowel perforation secondary to metastatic lung cancer. Am Surg 2005; 71:110–116 [PubMed]
  • [31] Kim MS, Kook EH, Ahn SH et al. Gastrointestinal metastasis of lung cancer with special emphasis on a long-term survivor after operation. J Cancer Res Clin Oncol 2009; 135:297–301 [PubMed][Crossref]
  • [32] Bastos I, Gomes D, Gouveia H et al. Colonic metastasis of a lung carcinoma with ileocolic fistula. J Clin Gastroenterol 1998; 26:348 http://dx.doi.org/10.1097/00004836-199806000-00031[Crossref]
  • [33] Miyazaki K, Satoh H, Sekizawa K. Metastasis to appendix from lung adenocarcinoma. Int J Gastrointest Cancer 2005; 36:59–60 http://dx.doi.org/10.1385/IJGC:36:1:059[Crossref]
  • [34] Goldstein EB, Savel RH, Walter KL et al. Extensive stage small cell lung cancer presenting as an acute perforated appendix: case report and review of the literature. Am Surg 2004; 70:706–709 [PubMed]
  • [35] Kawahara K, Akamine S, Takahashi T et al. Anal metastasis from carcinoma of the lung: report of a case. Surg Today 1994; 24:1101–1103 http://dx.doi.org/10.1007/BF01367465[Crossref]
  • [36] Kostakou C, Khaldi L, Flossos A et al. Melena: a rare complication of duodenal metastases from primary carcinoma of the lung. World J Gastroenterol 2007; 13:1282–1285 http://dx.doi.org/10.3748/wjg.v13.i8.1282[Crossref]
  • [37] Lee PC, Lo C, Lin MT et al. Role of surgical intervention in managing gastrointestinal metastases from lung cancer. World J Gastroenterol 2011; 17:4314–4320 http://dx.doi.org/10.3748/wjg.v17.i38.4314[Crossref]
  • [38] Rossi G, Marchioni A, Romagnani E et al. Primary lung cancer presenting with gastrointestinal tract involvement: clinicopathologic and immunohistochemical features in a series of 18 consecutive cases. J Thorac Oncol 2007; 2:115–120 http://dx.doi.org/10.1097/01243894-200702000-00004[Crossref]
  • [39] Saad RS, Silverman JF, Khalifa MA et al. CDX2, cytokeratins 7 and 20 immunoreactivity in rectal adenocarcinoma. Appl Immunohistochem Mol Morphol 2009; 17:196–201 http://dx.doi.org/10.1097/PAI.0b013e31819268f2[Crossref]
  • [40] Chen ZM, Wang HL. Alteration of cytokeratin 7 and cytokeratin 20 expression profile is uniquely associated with tumorigenesis of primary adenocarcinoma of the small intestine. Am J Surg Pathol 2004; 28:1352–1359 http://dx.doi.org/10.1097/01.pas.0000135520.72965.50[Crossref]
  • [41] Rossi G, Pelosi G, Graziano P et al. A reevaluation of the clinical significance of histological subtyping of non-small-cell lung carcinoma: diagnostic algorithms in the era of personalized treatments. Int J Surg Pathol 2009; 17:206–218 http://dx.doi.org/10.1177/1066896909336178[Crossref]

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