ABSTRACT
The intestinal malignant melanoma is a rare occurrence in the daily surgical practice, with difficult diagnosis (even on usual pathologic examination) and therapeutic attitude. Most of the lesions are secondary to a cutaneous primary melanoma, but there are cases in which the original site may not be discovered, and are considered as primitive intestinal melanomas. This paper presents the case of a 50 year old male patient, diagnosed and operated as emergency with acute abdomen caused by a tumoral perforation of the small bowel; several tumors, in different stages of local evolution, were discovered during laparotomy. A triple enterectomy with end-to-end entero-enteral anastomosis was performed, with uneventful postoperative recovery. The later postoperative evolution was marked by the occurrence of multiple subcutaneous recurrences and a bulky metastasis in the mediastinum; 18 month after the initial surgery, the patient died due to the melanoma recurrence. Diagnostic and therapeutic difficulties are discussed in this paper, related especially to the differential diagnosis of the origin of the intestinal lesion (a metastatic melanoma with unknown primary site or a primary malignant melanoma of the small bowel), since no other sites of origin were discovered after a thorough examination.
Subject(s)
Ileal Neoplasms/diagnosis , Ileal Neoplasms/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Jejunal Neoplasms/diagnosis , Jejunal Neoplasms/surgery , Melanoma/diagnosis , Melanoma/surgery , Diagnosis, Differential , Fatal Outcome , Follow-Up Studies , Humans , Ileal Neoplasms/complications , Ileal Neoplasms/pathology , Intestinal Perforation/etiology , Intestinal Perforation/pathology , Jejunal Neoplasms/complications , Jejunal Neoplasms/pathology , Male , Melanoma/complications , Melanoma/pathology , Middle Aged , Neoplasm Invasiveness , Treatment Failure , Treatment OutcomeABSTRACT
Histologic and immunohistochemical changes of the lung vascular and perivascular structures in 37 clinical and paraclinical COBP diagnosed were studied. We noted the deterioration of an important part of the pulmonary capillary network because of the destruction of interalveolar septae, with an intense vascular congestion within restant capillaries. The venules and arterioles have had a fibrosis wall by the replacing of the elastic and muscular fibers with inextensible fibers of collagen. The perivascular stroma was infiltrated by fibroblasts, macrophages, lymphocytes and plasma cells.
