Surgical treatments of recurrent small intestine metastatic melanoma manifesting with gastrointestinal hemorrhage and intussusception: A case report

Figure 1 Preoperative abdominal computed tomography scan. An irregular shape of the jejunum in the left upper quadrant and shadows of fat indicated intestinal intussusception (green arrows). A and B: Representative axial views; C and D: Representative coronal views.

Figure 2 Preoperative magnetic resonance enterography. Partial thickening of the jejunal wall in the left upper quadrant and formation of a soft tissue mass with intussusception (yellow arrows) and intestinal lumen expansion with air and fluid accumulation (red arrows). A-C: Representative axial views; D-F: Representative coronal views.

Figure 3 Histopathological findings of the resected small intestine after the first surgery. A: Representative specimen showing diffuse growth of tumor tissue, the majority located in the submucosa and nearly invading the mucosa (yellow rectangle). Hematoxylin and eosin, × 4; B: Tumor cells were distributed in a patchy pattern. Hematoxylin and eosin, × 10; C: The lesions had large nuclei, prominent nucleoli, and red cytoplasm. Some tumor cells showed pigment granules in the cytoplasm (green arrows). Hematoxylin and eosin, × 20; D: At high power, epithelioid tumor cells contained mitotic figures (yellow arrows). Hematoxylin and eosin, × 40.

Figure 4 Immunohistochemical staining of the resected small intestine after the first surgery. A: HMB45 (+) (× 20); B: Melan-A (+) (× 20); C: S-100 (+) (× 20); D: SOX10 (+) (× 20); E: Braf (-) (× 20); F: Ki-67 (about 50%) (× 20).

Figure 5 Postoperative computed tomography enterography. A-D: Representative postoperative intestinal changes. The anastomotic stoma (green arrows) was normal without thickening of the intestinal wall.

Figure 6 Magnetic resonance enterography after the third admission. A soft tissue mass (24 mm × 21 mm) (green arrows) was detected in the small intestine near the right pelvis, indicating small intestinal tumor with intussusception. A-D: Representative coronal views; E and F: Representative axial views.

Figure 7 Histopathological findings of the resected small intestine after the second surgery. A: Representative specimen showing that diffuse growth of tumor tissue affected the subserous layer. Hematoxylin and eosin, × 4; B: Tumor cells presented with a patchy distribution. Hematoxylin and eosin, × 10; C: Tumors had large nuclei, prominent nucleoli, and red cytoplasm. Some tumor cells showed pigment granules in the cytoplasm (green arrows). Hematoxylin and eosin, × 20; D: Some tumor cells showed pigment granules in the cytoplasm (green arrows). Epithelioid tumor cells contained mitotic figures (yellow arrows). Hematoxylin and eosin, × 40.