Melanoma metastásico en intestino delgado: causa infrecuente de perforación: reporte de caso / Metastatic melanoma in the small intestine: infrequent cause of perforation: case report / Melanoma metastático em intestino delgado: causa rara de perfuração: relato de caso

El intestino delgado es el sitio de asiento más frecuente del melanoma metastásico. Su diagnóstico es un desafío por cursar asintomático o con síntomas inespecíficos. Son pocos los casos que presentan complicaciones, siendo infrecuente la peritonitis por perforación. El objetivo del trabajo es comunicar el caso clínico de una peritonitis por perforación de una metástasis de melanoma en intestino delgado. Caso clínico: Paciente de sexo masculino de 66 años con diagnóstico de melanoma de cuello y secundario óseo, encefálico y pulmonar, fue intervenido de urgencia por peritonitis aguda por perforación de metástasis en intestino delgado. El estudio histológico confirmó secundarismo de melanoma cutáneo. Conclusión: Sabiendo que el yeyuno íleon es el sitio de asiento más frecuente de las metástasis de melanoma, ante la presencia de síntomas digestivos inespecíficos o anemia se debe sospechar su compromiso y evaluar posibles alternativas terapéuticas.

The small intestine is the most frequent site of metastatic melanoma. However, its diagnosis continues to be a challenge since it is usually asymptomatic or with non-specific symptoms. Few cases result in complications, peritonitis due to perforation being infrequent. The objective of the work is to report a clinical case of peritonitis due to perforation of a melanoma metastasis in the small intestine. Clinical case: A 66-year-old male patient diagnosed with melanoma of the neck and secondary bone, brain and lung melanoma, underwent emergency surgery for acute peritonitis due to perforation of metastasis in the small intestine, which was resected and anastomosed. The histology confirmed the secondary nature of the cutaneous melanoma. Conclusion: Knowing that the jejunum-ileum is the most frequent site of melanoma metastases, in the presence of non-specific digestive symptoms or anemia, its involvement should be suspected and possible therapeutic alternatives should be evaluated.

O intestino delgado é o local mais frequente de melanoma metastático. O diagnóstico é um desafio por ser assintomático ou apresentar sintomas inespecíficos. Há poucos casos que apresentam complicações, sendo pouco frequente a peritonite por perfuração. O objetivo deste trabalho é relatar um caso clínico de peritonite por perfuração de metástase de melanoma no intestino delgado. Caso clínico: Paciente do sexo masculino, 66 anos, diagnosticado com melanoma no pescoço com metástase óssea, cefálica e pulmonar. Foi submetido a cirurgia de emergência por peritonite aguda por perfuração de metástases do intestino delgado. O estudo histológico confirmou melanoma cutâneo. Conclusão: Sabendo que o jejuno e o íleo é o local mais frequente de metástase de melanoma, na presença de sintomas digestivos inespecíficos ou anemia deve-se suspeitar de seu acometimento e avaliar possíveis alternativas terapêuticas.

Adenocarcinoma del intestino delgado asociado al síndrome de Lynch / Adenocarcinoma of the small intestine associated with Lynch syndrome

El síndrome de Lynch (SL) es una enfermedad autosómica dominante causada por una mutación en los genes de reparación del ADN que predispone al cáncer colorrectal (CCR) y a otros tumores extracolónicos. Entre estos predominan los del endometrio, estómago, tracto urinario alto y ovario. La incidencia de los tumores de intestino delgado (TID) si bien es baja (0,4-2,9%), supera en más de 25 veces a la de la población general. El objetivo de este trabajo es presentar un caso de carcinoma del duodeno en un paciente masculino de 47 años con criterios de Amsterdam II, y discutir las características de los TID en el SL.

Lynch Syndrome (LS) is an autosomal dominant condition caused by mutations in the mismatch repair genes that predispose to colorectal cancer (CRC) and other extracolonic tumors. Among these, endometrial, gastric, ovarian, and urinary tract tumors are the commonest. The incidence of small bowel tumors (SBT), although low (0.4-2.9%), exceeds in more than 25 times that of the general population. The purpose of this paper is to communicate a case of carcinoma of the duodenum in a 47 years old male with Amsterdam II criteria, and discuss the characteristics of SBT in LS.

Metastatic choriocarcinoma in the small bowel: a case report

Choriocarcinoma is a highly malignant form of gestational trophoblastic disease. It is characterized by metastatic potential, rapid growth and deeply invasion into blood vessel and then widespread dissemination metastasis. However, the most common sites of metastatic choriocarcinoma are lung, vagina, liver, and brain. But, metastatic choriocarcinomas rarely is extended to gastrointestinal system. It is important to keep in mind that despite extensive metastasis, choriocarcinoma is very curable disease. Due to high responsibility of this disease, early diagnosis of choriocarcinoma and treatment with chemotherapy can prevent mortality and morbidity of these patients. In this case report, we present a rare case of metastatic choriocarcinoma in the small bowel after normal term pregnancy. A 34-years-old woman G4, P4, L4 presented with abnormal postpartum vaginal bleeding [45 days] and unresponsive to usual medical and surgical therapy [oxytocine, methergine, antibiotic, and double curettage]. The patient was admitted in the Ghaem Hospital, Mashhad University of Medical Sciences in April 2013. She suffered from rectal hemorrhage and severe weakness. Because of unsuitable condition and shock, laparotomy was performed and small bowel involvement was observed. Segmental resection of small bowel detected metastatic choriocarcinoma of the lesion. We couldn't rescue our patient due to unresponsive to combination chemotherapy [actino-mycine, methotrexate, cyclophosfamide, vincrystine, etoposide]. In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage

Síndrome de carcinoide con manifestación inicial a nivel valvular cardíaco: a raíz de un caso clínico / Carcinoid syndrome presenting as valvular diseas: report of one case

Carcinoid syndrome is observed in one third of carcinoid tumors and usually appears when there are liver metastases. One of the main complications of this syndrome is the appearance of tricuspid or pulmonary valvular disease. We report a 56 years old male presenting with malaise and a weight loss of 10 kg. On physical examination, a heart murmur suspicious of a double tricuspid lesion was found. The echocardiogram was suggestive of a carcinoid valvular disease. The abdominal CAT scan showed a small bowel tumor. Urinary 5-hydroxy-indol- acetic acid values were highly elevated. The patient was subjected to excision of the distal ileum, liver metastasectomy and hemicolectomy. The pathological study of the surgical piece confirmed the diagnosis of carcinoid tumor. Two years after surgery, the patient is in stable conditions.

Intussuscepção de delgado por melanoma maligno de sítio primário incerto / Small bowel intussusception for malignant melanoma of uncertain primary site

A metástase do melanoma maligno do intestino delgado é incomum. As manifestações clínicas são inespecíficas, e o quadro de abdome agudo obstrutivo pode ser a primeira manifestação. Apresenta-se um caso de intussuscepção intestinal devido a um melanoma metastático de sítio primário não detectado. São discutidos sua etiologia, seu diagnóstico e seu tratamento (AU)

Malignant melanoma metastasis to the small bowel is uncommon. Its clinical presentation is inespecific and an obstructive acute abdomen syndrome could be its first manifestation. A case of intestinal intussusception due to a metastatic melanoma with no primary site detected is described. Etiology, diagnosis and treatment are discussed (AU)

Hepatic angiosarcoma with metastasis to small intestine

Hepatic angiosarcomas are rare tumours with poor prognosis, with patients usually dying within 6 months. Metastases mainly occur in lymph nodes, spleen, lungs, bones and adrenals. Metastasis to small intestine is even rarer. Similarly, primary or metastatic angiosarcomas in small intestine are extremely rare, often present with recurrent gastrointestinal bleeding and anemia, and have an extremely poor prognosis. Both primary or metastatic intestinal angiosarcomas may exhibit epithelioid morphology. It may be very difficult to differentiate between primary and secondary cases in intestine and especially when the tumour exhibits epithelioid morphology

Metastasis de carcinoma de mama en ileon-colon y vesicula biliar simulando enfermedades inflamatórias / Breast carcinoma metastasis in ileum-colon and gallbladder simulating inflammatory diseases

Las metástasis en aparato digestivo, extrahepático son poco frecuentes y se caracterizan por presentarse luego de un período de latencia largo que va de 3 a 20 años, sus síntomas son inespecíficos y simulan enfermedades inflamatórias o segundo tumor. El subtipo histológico más común es el carcinoma lobulillar. Presentamos dos casos de metástasis de carcinoma de mama, uno en íleo-colon y otro en vesícula biliar. Ambas pacientes comenzaron con síntomas que llevaron a diagnósticos de enfermedad de Crohn en el primero y de colecistitis aguda en el caso dos. El diagnóstico se realizó en las piezas quirúrgicas, donde se observaron células de carcinoma lobulillar que infiltraban desde la serosa hasta la mucosa inclusive y con la inmunomarcación que resultaron BCA225, Estrógeno y Progesterona positivos. El tratamiento con radioterapia, quimioterapia u hormonal, mejora la calidad de vida, pero el promedio de sobrevida luego del diagnóstico es de un año.

Carcinoide de intestino delgado: una causa rara de infarto intestino mesentérico / Carcinoid tumor of small intestine, cause of mesenteric intestinal infarction

Las neoplasias del intestino delgado son poco frecuentes. Los carcinoides son el 20 por ciento de éstas. La mayoría son asintomáticos y son hallazgos incidentales, el resto se presenta por sus complicaciones, como cuadros agudos de abdomen, el más frecuente es la oclusión intestinal. El infarto intestino mesentérico y la isquemia intestinal han sido reconocidos como otra presentación muy rara, en estos casos la terapéutica quirúrgica agresiva, a pesar de la gravedad de la presentación, muestra beneficios en el pronóstico. Se presentan 2 casos y se discuten los eventos patogénicos

Hemorragia digestiva baja aguda en coriocarcinoma testicular / Acute low digestive hemorrhage in testicular choriocarcinoma

Se presenta un caso de hemorragia intestinal como manifestación inicial de un coriocarcinoma testicular. El diagnóstico de la causa de hemorragia requirió laparatomfa. Lesión metastástica del intestino delgado debe considerarse como causa de hemorragia en paciente con coriocarcinoma testicular.

Metastases intestinales et vesiculaires d'un melanome malin cutane revelee par une peritonite [a propos d'un cas]

The authors report the case of a 63 year -old woman, with multiple jejunal metastases from a cutaneous malignant melanoma, revealed by a peritonitis. The operation revealed a metastasis of the gall bladder. By means of this case, the authors insist on the frequency of this metastasic localisation in the intestinal tract, on the usual mildness of the symptoms produced by osuch a localisation, and on the usual rapid course of malignat melanoma in the intestine

Abdome agudo obstrutivo por metástase de melanoma maligno: relato de caso / Obstructive acute abdomen by metastatic malignant melanoma: case report

Apresentamos o caso de um paciente com obstruçäo intestinal aguda causada por metástase de melanoma maligno intestinal, o qual tinha sido submetido, dois anos antes, à ressecçäo de um melanoma maligno na regiäo dorsal. Trata-se de uma neoplasia infreqüente cujo sítio metastático, do caso em questÝo, é ainda mais raro.

Melanoma cutâneo com metástases intestinais: relato de dois casos / Cutaneous melanoma with intestinal metastasis: report of 2 cases

O melanoma é um tumor infreqüente que comumente metastatiza para linfonodos regionais e órgäos à distância. As metástases no aparelho gastrointestinal säo freqüentes apesar de serem diagnosticadas pré-operatoriamente em somente cerca de 4% dos casos. Dois casos de melanoma cutâneo com metástases intestinais, um em ceco-íleo terminal e outro em intestino delgado, säo descritos. Discutem-se os aspectos clínicos desta entidade patológica e seu comportamento metastático para o trato gastrointestinal, enfatizando-se a importância de um tratamento cirúrgico agressivo nestes casos