Saudi Journal of Gastroenterology
Home About us Instructions Submission Subscribe Advertise Contact Login    Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 1325 


 
LETTER TO THE EDITOR Table of Contents   
Year : 2009  |  Volume : 15  |  Issue : 2  |  Page : 141
Obstructive jaundice due to primary choroidal malignant melanoma metastasis: An unusual presentation


Department of Surgical Gastroenterology, Jagjivanram Railways Hospital, Maratha Mandir Marg, Mumbai Central, Mumbai, India

Click here for correspondence address and email
 

How to cite this article:
Maheshwari G, Shivathirthan N, Haldar PJ, Kamath D. Obstructive jaundice due to primary choroidal malignant melanoma metastasis: An unusual presentation. Saudi J Gastroenterol 2009;15:141

How to cite this URL:
Maheshwari G, Shivathirthan N, Haldar PJ, Kamath D. Obstructive jaundice due to primary choroidal malignant melanoma metastasis: An unusual presentation. Saudi J Gastroenterol [serial online] 2009 [cited 2019 Dec 14];15:141. Available from: http://www.saudijgastro.com/text.asp?2009/15/2/141/49011


Metastatic melanoma of the common bile duct (CBD) is very rare, with only 18 cases reported so far. [1] A 45-year-old male operated 3 years previously for malignant melanoma of the right eye presented to the outpatient department for obstructive jaundice since 25 days with gradual progression. An upper gastrointestinal endoscopy revealed a polypoidal lesion in the second part of the duodenum, which was reported histopathologically as metastasis from the malignant melanoma [Figure 1]. A computed tomography scan of the abdomen showed a complex lesion involving the CBD, gall bladder, and right lobe of the liver, possibly because of metastasis from the primary melanoma of the eye. Poststenting, there was a decrease in his bilirubin levels. The patient was advised immunotherapy but as he was not willing, he was given chemotherapy (Temezolamide).

The first case of a metastatic melanoma to the bile duct was described by Spigelberg in 1895 and the second by Duval in 1908. [2] The melanoma secondaries usually arise from the primary skin lesion but, occasionally, may arise from the primary or metastatic melanoma of the gall bladder. The primary melanoma in patients with gastrointestinal tract metastases is typically located in the extremities (15-57% of the cases) and in the trunk (13-54%) and less frequently in the head and neck (5-33%). [3] There have been no case reports yet of primary choroidal melanoma with metastasis to our knowledge in a review of the literature. Patients with metastatic melanoma to the CBD usually present with progressive painless obstructive jaundice. Obstructive jaundice as the first symptom of the disease due to metastatic melanoma causing ampullary obstruction has been reported only once. [4]

It seems reasonable to perform radical surgical resection in patients with potentially curable disease and isolated deposits in the bile duct. If there is a concurrent metastatic disease elsewhere, it is prudent to adopt a less-aggressive approach in order to relieve obstructive jaundice, such as the bypass procedure or stenting. [5]

Patients with gastrointestinal symptoms and a history of melanoma should be investigated for the presence of gastrointestinal metastases even if the original primary malignancy was diagnosed years before the patient presentation.

 
   References Top

1.Colovic RB, Grubor NM, Jovanovic MD. Metastatic melanoma to the common bile duct causing obstructive jaundice: A case report. World J Gastroenterol 2007;13:813-5.  Back to cited text no. 1    
2.Cohen AJ, Thompson LD, Jaques DP, d'Avis JC. Biliary tract melanoma. Mil Med 1990;155:5-8.  Back to cited text no. 2  [PUBMED]  
3.Retsas S, Christofyllakis C. Melanoma involving the gastrointestinal tract. Anticancer Res 2001;21:1503-8.  Back to cited text no. 3  [PUBMED]  
4.Caballero-Mendosa E, Gallo-Reynoso S, Arista-Nasr J, Angeles-Angeles A. Obstructive jaundice as the first clinical manifestation of a metastatic malignant melanoma in the ampulla of Vater. J Clin Gastroenterol 1999;29:188-9.  Back to cited text no. 4    
5.England MD, Sarr MG. Metastatic melanoma: An unusual cause of obstructive jaundice. Surgery 1990;107:595-6.  Back to cited text no. 5  [PUBMED]  

Top
Correspondence Address:
Gaurav Maheshwari
Department of Surgical Gastroenterology, Jagjivanram Railways Hospital, Maratha Mandir Marg, Mumbai Central, Mumbai- 400 007
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.49011

Rights and Permissions


    Figures

  [Figure 1]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2049    
    Printed89    
    Emailed0    
    PDF Downloaded303    
    Comments [Add]    

Recommend this journal