%0 Journal Article
%T ¡°Unsteady Gait¡±: An Uncommon Presentation and Course of Malignant Melanoma in Terminal Ileum¡ªA Case Report and Review of Literature
%A Satya Allaparthi
%A Khalid A. Alkimawi
%J Case Reports in Gastrointestinal Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/958041
%X Malignant melanoma within the gastrointestinal tract is an uncommon neoplasm that is usually metastatic in origin, with primary melanomas being relatively uncommon. Embryologically melanocytes normally exist in the esophagus, stomach, small bowel, and anorectum and this theory supports the primary melanoma of the gastrointestinal tract that has been confirmed for lesions occurring through several published reports. However, most patients with brain metastases from malignant melanoma are diagnosed after treatment for known extracranial metastases and have poor outcomes. Our case is unique in that we discuss an unusual case of 69-year-old female patient presented with unsteady gait as the first symptom of disease and where the presumed primary lesion later was found in the terminal ileum on colonoscopy. Treatment consisted of surgical removal of the terminal ileal lesion with chemotherapy, whole-brain radiotherapy, and cyberknife radiosurgical procedure. Patient was in remission for more than 14 months and later succumbed to disease. Despite the advances in therapeutic options, prognosis for patients with melanoma brain metastases remains poor with a median survival time of six months after diagnosis. 1. Introduction Next to lung cancer, malignant melanoma is the most frequent cause of brain metastasis. In a large series from the Metropolitan Detroit Cancer, the cumulative incidence of melanoma brain metastasis is <10% and usually develop late in the course of the disease [1, 2]. Metastatic spread of tumor cells detached from melanoma into the central nervous system (CNS) occurs haematogenically since lymphatic drainage is absent in the brain. The blood-brain barrier is usually intact in metastases that are smaller than 0.25£¿mm in diameter because melanoma micrometastases are common in the brain and patients can harbor numerous metastases in the brain without any neurological deficits [3, 4]. Furthermore, while melanoma can present in the brain as the first site of metastasis, it is more common for brain metastasis to present later in the course of disease, most often acting as a harbinger of terminal disease. The course of disease is typically characterized by rapid extra cranial progression and short overall survival time despite various local and systemic treatment approaches. While surgery and radiotherapy interventions can prolong the disease-free interval when solitary, large metastases in the brain are found early in the course of melanoma metastasis; these treatments provide only short-term, but nevertheless important, palliation in patients with
%U http://www.hindawi.com/journals/crigm/2013/958041/