|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 89-90
18 F-FDG PET/CT imaging in a seldom case of primary malignant melanoma of duodenum
Sachin Jain, Punit Sharma, Sellam Karunanithi, Chandrasekhar Bal, Rakesh Kumar
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||23-Dec-2014|
Dr. Rakesh Kumar
Department of Nuclear Medicine and Positron Emission Tomography, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain S, Sharma P, Karunanithi S, Bal C, Kumar R. 18 F-FDG PET/CT imaging in a seldom case of primary malignant melanoma of duodenum. Indian J Nucl Med 2015;30:89-90
|How to cite this URL:|
Jain S, Sharma P, Karunanithi S, Bal C, Kumar R. 18 F-FDG PET/CT imaging in a seldom case of primary malignant melanoma of duodenum. Indian J Nucl Med [serial online] 2015 [cited 2020 Jan 19];30:89-90. Available from: http://www.ijnm.in/text.asp?2015/30/1/89/147560
We present a case of a 35-year-old male presented with pain abdomen and occasional vomiting of 1 month duration. On clinical examination, an ill-defined, firm mass was palpated in the right hypochondrium region with restricted mobility. Ultrasound of the abdomen reported a mass lesion in right hypochondrium likely arising from the duodenum. Biopsy was then performed from the duodenal mass which revealed histopathological features of malignant melanoma. The tumor cells were immunopositive for S100 and HMB45. The patient was then referred for 18F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) for staging and to rule out other primary focus. PET/CT revealed a large (10.4 × 7.2 cm) soft tissue density mass involving first, second, and third part of duodenum with intense 18 F-FDG avidity (maximum standardized uptake value (SUV max ) - 14.1). The mass was infiltrating the inferior surface of liver. There was no other 18 F-FDG avid focus on whole body PET/CT which could suggest metastasis or primary site [Figure 1]. He underwent surgical resection and is planned for chemoradiotherapy.
|Figure 1: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed a large (10.4 x 7.2 cm) soft tissue density mass involving first, second, and third part of duodenum (a and b, arrows) with intense 18F-FDG avidity (maximum standardized uptake value (SUVmax) - 14.1) (c and d, arrows) with no other 18F-FDG avid focus on whole body PET/CT which could suggest metastasis (e)|
Click here to view
Malignant melanoma, originating from melanocytes, is not a common tumor and accounts for 1-3% of all malignancies.  However, it is the most common metastatic tumor of the gastrointestinal tract, especially the small intestine.  Primary malignant melanoma originating in the small bowel, particularly in the duodenum, is extremely rare. ,, Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains such as HMB45, Melan-A, and S-100 protein. Before making the diagnosis of primary malignant melanoma of the small bowel, thorough systemic examination must be done to rule out the possibility of metastasis from other sites where melanomas preferentially develop such as the skin, retina, anal canal, or under the nail; and less frequently at other locations such as the esophagus, penis, or vagina. Also, there should not be any history of previous removal or spontaneous regression of any atypical melanocytic skin tumor.  18 F-FDG PET/CT in such patients can provide dual advantage. , Firstly, it can rule our primary tumor at other more common sites. Secondly, it can accurately stage the disease. Optimal treatment for malignant melanoma is an extensive and curative surgery, if possible, because other methods including adjuvant radiotherapy, chemotherapy, and immunotherapy cannot offer definite treatment outcome. The time of diagnosis and the presence of metastases are supposed major determinants of prognosis. , Although 18 F-FDG PET/CT has been found to useful in detecting small-bowel metastases in patients with metastatic melanoma, , a case of primary malignant melanoma of the duodenum has not been documented with 18 F-FDG PET/CT. The present case represents the utility of 18 F-FDG PET/CT in the rare primary malignant melanoma of duodenum.
| References|| |
Elsayed AM, Albahra M, Nzeako UC, Sobin LH. Malignant melanomas in the small intestine: A study of 103 patients. Am J Gastroenterol 1996;91:1001-6.
Blecker D, Abraham S, Furth EE, Kochman ML. Melanoma in the gastrointestinal tract. Am J Gastroenterol 1999;94:3427-33.
Houissa F, Bouzaidi S, Mouelhi L, Ben Rejeb M, Moussa A, Mekki H, et al
. Diffuse primary malignant melanoma of the upper gastrointestinal tract. Gastroenterol Clin Biol 2010;34:85-7.
Korkolis DP, Apostolaki K, Gontikakis E, Plataniotis GD, Siskos D, Xinopoulos D, et al
. Primary malignant melanoma of the duodenum: Aggressive management and long-term survival of an unusual oncologic entity. South Med J 2008;101:836-9.
Atmatzidis KS, Pavlidis TE, Papaziogas BT, Papaziogas TB. Primary malignant melanoma of the small intestine: Report of a case. Surg Today 2002;32:831-3.
Strobel K, Skalsky J, Hany TF, Dummer R, Steinert HC. Small bowel invagination caused by intestinal melanoma metastasis: Unsuspected diagnosis by FDG-PET/CT imaging. Clin Nucl Med 2007;32:213-4.
Strobel K, Dummer R, Husarik DB, Pérez Lago M, Hany TF, Steinert HC. High-risk melanoma: Accuracy of FDG PET/CT with added CT morphologic information for detection of metastases. Radiology 2007;244:566-74.
Wade TP, Goodwin MN, Countryman DM, Johnson FE. Small bowel melanoma: Extended survival with surgical management. Eur J Surg Oncol 1995;21:90-1.
Prakoso E, Fulham M, Thompson JF, Selby WS. Capsule endoscopy versus positron emission tomography for detection of small-bowel metastatic melanoma: A pilot study. Gastrointest Endosc 2011;73:750-6.