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Case Reports
. 2022 Oct 6;10(28):10136-10145.
doi: 10.12998/wjcc.v10.i28.10136.

Metastatic multifocal melanoma of multiple organ systems: A case report

Vaidota Maksimaityte  1 , Rosita Reivytyte  2 , Gabriele Milaknyte  3 , Ugnius Mickys  4 , Gintare Razanskiene  4 , Domantas Stundys  3 , Edita Kazenaite  3 , Jonas Valantinas  3 , Ieva Stundiene  3
Affiliations
Case Reports

Metastatic multifocal melanoma of multiple organ systems: A case report

Vaidota Maksimaityte et al. World J Clin Cases. .

Abstract

Background: Malignant melanoma is becoming more common among middle-aged individuals all over the world. Melanoma metastasis can be found in various organs, although metastases to the spleen and stomach are rare. Herein we present a rare metastatic multifocal melanoma, clinically and histologically mimicking lymphoma, with metastases of multiple organs.

Case summary: A 46-year-old Caucasian male with a history of nodular cutaneous malignant melanoma was presented with nausea, general weakness, shortness of breath, abdominal enlargement, and night sweating. The abdominal ultrasound revealed enlarged liver and spleen with multiple lesions. Computed tomography demonstrated multiple lesions in the lungs, liver, spleen, subcutaneous tissue, bones and a pathological lymphadenopathy of the neck. Trephine biopsy and the biopsy from the enlarged lymph node were taken. Tumor cells showed diffuse or partial positivity for melanocytic markers, such as microphthalmia - associated transcription factor, S100, HMB45 and Melan-A. The tumor harbored BRAF V600E mutation, demonstrated by immunohistochemical labelling for BRAF V600E and detected by real-time polymerase chain reaction test. Having combined all the findings, a diagnosis was made of a metastatic multifocal melanoma of the stomach, duodenum, liver, spleen, lungs, lymph nodes and bones. The patient refused treatment and died a week later.

Conclusion: This case report highlights the clinical relevance of rare metastatic multifocal melanoma of multiple organ systems.

Keywords: BRAF V600E; Case report; Gastrointestinal tract; Metastatic melanoma; Multifocal; Nodular.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Computed tomography scan. A: Lesions in the liver, spleen, subcutaneous tissue (arrows); B: Lesions in the lungs (arrow); C: Pathological lymphadenopathy of the neck (arrow).
Figure 2
Figure 2
Upper endoscopy. A: Atypical ulcers of the duodenum; B: Atypical polyps in gastric fundus (arrow); C: Atypical polyp in descending part of the duodenum.
Figure 3
Figure 3
Stomach lesion and duodenal biopsy. A: Stomach lesion biopsy. Ulcerated diffuse infiltrate in body-type mucosa; B: Duodenal biopsy. Subtle focal infiltrate in lamina propria, composed of medium-sized dyscohesive cells.
Figure 4
Figure 4
Immunohistochemistry. Tumor cells diffusely and intensely positive for microphthalmia-associated transcription factor, diffusely positive for CD99, partially positive for S100 and focally faintly positive for HMB45 and Melan-A. Ki-67 proliferation index was up to 80%. MiTF: Microphthalmia-associated transcription factor.
Figure 5
Figure 5
Bone marrow trephine biopsy. A: Metastatic melanoma with focal necrosis replacing hematopoietic tissue; B: Diffuse compact infiltrate of epithelioid cells with clear or pale cytoplasm and oval, indented or elongated nuclei.
Figure 6
Figure 6
Strong diffuse tumor positivity for BRAF. A: Gastric biopsy, B: Bone marrow trephine biopsy.
Figure 7
Figure 7
Case history timeline. CT: Computed tomography.
See this image and copyright information in PMC

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