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. 2016 Jul 15;14(1):185.
doi: 10.1186/s12957-016-0938-x.

Anorectal malignant melanoma: curative abdominoperineal resection: patient selection with 18F-FDG-PET/CT

Claudius Falch  1 , Sven Mueller  2 , Andreas Kirschniak  2 , Manuel Braun  2 , Alfred Koenigsrainer  2 , Bernhard Klumpp  3
Affiliations

Anorectal malignant melanoma: curative abdominoperineal resection: patient selection with 18F-FDG-PET/CT

Claudius Falch et al. World J Surg Oncol. .

Abstract

Background: Anorectal malignant melanomas (ARMM) are rare tumors, characterized by an early lymphatic spread and distant metastasis, resulting in an extremely poor overall survival. The objective of this study was to determine the pattern of regional lymph node metastasis (LNM) by computed tomography (CT) and 18F-FDG-PET/CT in patients undergoing abdominoperineal resection (APR) and its impact on oncologic outcome.

Methods: A retrospective analysis of six consecutive patients who underwent APR due to primary ARMM was performed. Patients were staged by CT and PET/CT.

Results: Four out of six patients had preoperative LNM involvement (two patients inguinal and perirectal, one iliacal, one perirectal), with two of them presenting with distant metastases additionally. Inguinal/iliacal LNM in two patients as well as liver metastasis in one patient was seen in PET/CT and missed by CT. The three patients with initial inguinal/iliacal LNM died during the observation period (overall survival: 10 (6-18) months). The three patients without inguinal/iliacal LNM involvement are currently alive, one patient showing a slowly progressive disease since 5 years, and two patients are tumor-free since 8.5 and 1.5 years (the patients had initial perirectal LNM).

Conclusions: In ARMM, PET/CT is superior to CT in detection of LNM and distant metastasis. APR is possibly a curative approach if the PET/CT shows exclusively perirectal LNM despite locally advanced tumor growth.

Keywords: Abdominoperineal resection; Anal melanoma; Anus neoplasms; Colorectal surgery; Computed tomography; PET; Rectal melanoma.

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Figures

Fig. 1
Fig. 1
CT and PET/CT for pelvic imaging in anorectal malignant melanoma. A seventy-three-year-old female patient (patient 5) with a small iliacal lymph node metastasis on the right side (dashed arrow) and a relapse from anal melanoma. Contrast-enhanced CT reveals a small lymph node beside the right internal iliac artery of round configuration with uncertain dignity (a). PET/CT, however, indicates increased FDG uptake suspicious for metastasis (b). The follow up examination 9 months later provides clear evidence of progressive lymphatic metastasis on the right iliac side (arrow) on CT (c) and PET/CT (d) images. The lymph node is enlarged with a destroyed anatomical structure and increased glucose uptake. PET/CT enabled detection of lymph node metastasis in an early state
Fig. 2
Fig. 2
CT and PET/CT for hepatic imaging in anorectal malignant melanoma. A sixty-three-year-old male patient (patient 2) with a large anorectal melanoma, inguinal lymphatic metastases on both sides, and distant metastases. PET/CT depicts two hepatic metastases in segment six (b) and eight (not in the picture) without any corresponding findings on contrast-enhanced CT (a). Staging based on CT underestimated tumor stage by missing the distant metastatic spread completely in this patient
See this image and copyright information in PMC

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