Squamous cell carcinoma of the rectum: Is chemoradiation sufficient?

Primary squamous cell carcinoma of the rectum is uncommon. We report our experience of a case of squamous cell carcinoma of the rectum treated in our institution. Although primary chemoradiation produces a complete response in many patients, there is no consensus on a non-surgical management in these patients. Such an approach requires a strict surveillance schedule since recurrence is not uncommon. The prognosis of this tumour remains less favorable than its adenocarcinoma counterpart.

Metastatic malignant melanoma of the small bowel--report of two cases.

CASE REPORT: We report two cases of malignant melanoma metastasizing to the ileum and jejunum in a 48-year-old female and 62-year-old male, respectively. The female patient was a known case of vaginal melanoma who on follow-up developed pain abdomen 4 years after excision of the primary, whereas the male patient who was initially referred as pleomorphic spindle cell sarcoma of the groin presented with complaints of bleeding per rectum and melena 6 years later. RESULTS: After preliminary investigations both underwent laparotomy and resection of segments of ileum and jejunum with tumor. Histopathological examination with immunohistochemistry showed features suggestive of metastatic malignant melanoma. DISCUSSION: Metastasis should be suspected in patients with malignant melanoma who develop gastrointestinal symptoms such as abdominal pain, anemia, melena, fatigue, constipation, small bowel obstruction, or perforation. This helps in avoiding a delay in the diagnosis and complications that arise due to metastatic disease. CONCLUSION: Our first patient with primary vaginal melanoma died of multiple metastases 11 months following surgery for the ileal metastasis while the second patient with jejunal metastasis developed recurrent disease in the small bowel and iliac lymph nodes 10 months after surgery. However, in a patient with isolated gastrointestinal metastasis, diagnosed early, with good general condition surgical management should be encouraged when a complete resection of the disease is feasible as no other treatment option is as good for relief of symptoms and prolongation of life.