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Case Reports
. 2023 Aug 22:11:2050313X231194150.
doi: 10.1177/2050313X231194150. eCollection 2023.

Primitive rectal melanoma: A rare case report

Ibtissam Elouali  1 , Kawtar Imrani  1 , Kenza Berrada  1 , Hiba Zahi  1 , Ahmed Jahid  2 , Nabil Moatassim Billah  1 , Ittimade Nassar  1
Affiliations
Case Reports

Primitive rectal melanoma: A rare case report

Ibtissam Elouali et al. SAGE Open Med Case Rep. .

Abstract

Mucosal melanoma is a rare subtype of melanoma distinct from the cutaneous type in its clinical and biological aspects, requiring different therapeutical management. Anorectal melanomas represent less than 1% of anorectal cancers and 0.3% of malignant melanomas, and they are by far the most studied type. Proctologic examination, colonoscopy, and biopsy can establish a correct diagnosis. Imaging techniques, especially MRI can show some characteristic features, but it is essentially performed for extension assessment. We report the case of a 63-year-old man who consulted for rectal bleeding. The proctological examination found a brownish ulcerative-vegetating tumor of 3 cm in diameter located 3 cm from the anal rim. The endoscopic examination revealed a predominance of ulcerative budding lesions and the biopsy specimen confirmed a rectal melanoma. The extension assessment, based on a computed tomography scan and MRI did not show locoregional or distant metastases. Radiotherapy and abdominoperineal resection with pelvic node dissection was the treatment of choice with good evolution.

Keywords: Rectal; imaging; melanoma.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A contrast-enhanced computed tomography (CT) scan in a 63-year-old man with protruding anal lesion diagnosed with melanoma of the rectum shows on coronal (a) axial (b) and sagittal (c) images a heterogeneous, irregular endophytic rectal tumor without extension into peri rectal fat (red arrow).
Figure 2.
Figure 2.
MRI of the pelvis of the same patient demonstrates an intermediate signal lobulated rectal mass on sagittal T2w images (a) (red arrow), T1 hyperintense (b), restrictive in diffusion sequences (c), and strongly enhancing in post-enhanced and subtracted images (e, f). This mass extends to anal sphincters but respects the peri-rectal fat. Mesorectal lymphadenopathy is also found (f) (white arrow).
Figure 3.
Figure 3.
Extemporaneous anatomopathological study of the mesorectal lymph node showed an infiltrated lymph node parenchyma by a melanoma of cordal and massive architecture, composed of epitheloid or spindle-shaped cells of large size endowed with oval nuclei with nucleolated heterogeneous chromatin.
Figure 4.
Figure 4.
Squamous (anal) type mucosa. In the lamina propria, with tumoral proliferation of fusiform cells arranged in bundles and epitheloid cells arranged in thecae.
See this image and copyright information in PMC

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