A 49-year-old man had a stage IIA nodular melanoma removed from his left arm 2 years earlier. He sought medical attention for epigastric abdominal pain of 2-week progression, nocturnal fever, and constitutional symptoms. Laboratory test results showed microcytic anemia: hemoglobin 8.9 g/dl, mean corpuscular volume 73.7 fl, and elevated C-reactive protein 220 mg/l. Abdominal computed tomography (CT) scan revealed intestinal aneurysmal dilation, together with multiple mesenteric regional adenopathies (Figs. 1 and 2). Given those findings, double-balloon enteroscopy was performed that identified an ulcerated and friable mass, hard upon biopsy sampling, in the first part of the jejunum (Fig. 3). Intestinal primary lymphoma, gastrointestinal stromal tumor (GIST), leiomyosarcoma, and adenocarcinoma were included in the differential diagnosis. The histopathologic study reported metastatic melanoma to the intestine (Figs. 4 and 5). Intestinal resection of the affected segment was carried out, followed by immunotherapy with nivolumab. The majority of intestinal melanomas are metastases from a primary cutaneous melanoma and have a better prognosis. In the present case, the medical history, endoscopic findings, and histopathologic analysis clarified the definitive diagnosis.

Figure 1.

Axial view of the abdominal CT scan showing the mamelonated mass that encompasses several intestinal segments in the left hypochondrium.

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Figure 2.

Coronal view of the abdominal CT scan showing the mamelonated mass in the left hypochondrium.

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Figure 3.

Endoscopic view of the tumor through the enteroscope, showing the intestinal lumen with a darkened, ulcerated, friable mass in the upper zone.

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Figure 4.

Image of the jejunal sample magnified 5 times. Normal intestinal epithelium can be seen to the left, and submucosa with infiltration of atypical pigmented cells to the center right. Stain: hematoxylin and eosin.

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Figure 5.

Image of the jejunal sample magnified 20 times. Melanocytes diffusely infiltrating the tissue (brown color). Stain: MelanA.

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