RESUMEN
In this case report we describe rare metastatic appearance of cutaneous malignant melanoma ( MM) in small intestine followed by clinical appearance of acute surgical abdomen. A 42-year old women operated in our hospital in April 2009. due to unusual naevus on her right arm. Pathologicaly it was MM grossly 1.5 cm, microscopically Breslow 11 mm, Clark's level IV (T4), number of mitosis 1.4 per mm2, without ulcerations. She was sent to continue treatment at the National Referal Center for Melanoma in KB "S. milosrdnice" Zagreb, Croatia. A month later wider excision (3 cm free margin) and sentinel lymph node biopsy (SLNB) was made there followed by axillary lymphadenectomy due to positive axillary finding. She received six cycles of chemotherapy. She arrived in our hospital in May 2010, under clinical picture of small intestine ileus and acute surgical abdomen. After preparation she was operated the same day. The cause of ileus was metastasis of MM in the small interstine. We made intestinal resection with termino-terminal anastomosis. The patient was released to home care ten days after operation without any complication. This case report demonstrates rarely described case of MM metastasis in the small intestine found causing ileus.
Asunto(s)
Ileus/etiología , Neoplasias Intestinales/secundario , Intestino Delgado , Melanoma/secundario , Neoplasias Cutáneas/patología , Adulto , Femenino , Humanos , Neoplasias Intestinales/complicaciones , Melanoma/complicacionesRESUMEN
A 31-year-old man with a history of intravenous drug abuse presented with an inflamed subcutaneous nodule in his left thigh. The nodule measured up to 1.2 cm in largest diameter. Under the clinical impression of an inflamed epidermal cyst or a subcutaneous abscess, surgical excision was performed. Histopathologic examination of the nodule and subsequent polymerase chain reaction (PCR) analysis revealed the presence of the helminth Dirofilaria (D.) repens, a member of the family Filarioidea. Dirofilariasis is a parasitosis caused by D. repens and D. immitis that most frequently affects canines. It can rarely be found in humans, usually in the form of a subcutaneous nodule. In Europe, most cases of human dirofilariasis have been detected in the Mediterranean countries, Ukraine and Russia, but sporadic cases have also been reported in central and north European countries. Dirofilariasis must be distinguished from other forms of filarial disease such as onchocercosis and Wuchereria bancrofti filariasis. Diagnosing dirofilariasis purely by histopathology has its pitfalls, especially when the morphology of the nematode is altered due to inflammatory response or surgical artifacts. PCR analysis offers an opportunity to confirm dirofilariasis and identify the dirofilarial species as well. Briefly, we conclude that a diagnosis of subcutaneous dirofilariasis should be considered in cases of subcutaneous mass in an endemic area of animal dirofilariasis.