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Journal of Clinical Oncology, Vol 22, No 23 (December 1), 2004: pp. 4854-4855 © 2004 American Society of Clinical Oncology. DOI: 10.1200/JCO.2004.02.023
Uncommon Presentations of Cancer PatientsCASE 3. Positron Emission Tomography-Computed Tomgraphy Diagnosis of Metastatic Melanoma With IntussusceptionThe Center for Cancer Care at Goshen Health System, Goshen, IN; and John Wayne Cancer Institute and Nuclear Oncology Center, Santa Monica, CA A 49-year-old woman with advanced metastatic melanoma presented with gradually worsening, intermittent, colicky abdominal pain. Abdominal computed tomography (CT) scans (Fig 1A, B, and E) revealed a midabdominal intussusception. Positron emission tomography (PET) scan (Fig 1D) and PET-CT fusion images (Fig 1C and F) showed intense fluorodeoxyglucose (FDG) uptake at the apex of the intussusception, consistent with metastatic melanoma as a lead point. PET scan also showed multiple other foci of uptake in the chest, liver, and spleen indicating a widespread disease. The patient was conservatively managed with nasogastric decompression and parenteral nutrition while being treated with a biochemotherapy protocol of cisplatin, vinblastine, dacarbazine, high-dose decrescendo interleukin-2, and interferon. Clinical resolution of obstructive picture was observed in 5 days. Restaging PET-CT scan following completion of two cycles of biochemotherapy revealed dramatic regression of disease with more than 50% reduction in tumor volume in abdominal and hepatic lesions.
Approximately 8% of stage IV melanoma patients have clinically diagnosed gastrointestinal-tract metastases; the incidence is close to 60% in postmortem studies. The most common site is small bowel, and the patients present with bleeding or obstructive symptoms. Surgery has a well-defined role in the management of melanoma gastrointestinal metastases if they are symptomatic or they represent the only identifiable site of metastatic involvement.1 Intermittent intussusception as a cause of abdominal pain and/or obstruction is not well known. FDG-PET imaging is very useful in the management of patients with melanoma with a sensitivity of 100% for lesions greater than 1 cm.2 PET-CT fusion technology combines CT’s structural information with PET’s physiologic information in one set of images. PET-CT technology has significantly improved image interpretation, especially in the anatomic locations such as the abdomen, where specificities of each modality alone are relatively poor. Combination of anatomic and biologic information leads to better appreciation of individual clinical problems and improved patient management. Concurrent biochemotherapy modified by decrescendo interleukin-2 is an effective regimen with and overall response rate of 57% (23% complete response), and is a viable option in patients with advanced metastatic melanoma.3 Gastrointestinal lesions respond to biochemotherapy as favorably as any other metastatic melanoma lesions. Authors’ Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest.
REFERENCES
1. Ollila DW, Essner R, Wanek LA, et al: Surgical resection for melanoma metastatic to the gastrointestinal tract. Arch Surg 131:975-980, 1996 2. Gulec SA, Faries MB, Lee CC, et al: The role of fluorine-18 deoxyglucose positron emission tomography in the management of patients with metastatic melanoma: Impact on surgical decision making. Clin Nuc Med 28:961-965, 2003[CrossRef][Medline]
3. O’Day SJ, Gammon G, Boasberg P, et al: Advantages of concurrent biochemotherapy modified by decrescendo IL-2, GMCSF, and tamoxifen for patients with metastatic melanoma. J Clin Oncol 17:2752-2761, 1999
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Copyright © 2004 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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