P0208 - A Case of Metastatic Melanoma to the Colon Presenting With Intussusception

Rahul Patel, DO¹, Matthew Everwine, DO², Smita Patel, MD³, Lucy Joo, DO^3
1Jefferson Health, Stratford, NJ; ²Thomas Jefferson University, Voorhees, NJ; ³Jefferson Health, Cherry Hill, NJ

Introduction: Melanoma is a prevalent cutaneous neoplasm that has common metastases to lymph nodes, lungs, liver, bone and brain. While there can be metastases to the gastrointestinal tract, it is rare. When symptomatic, patients usually present with gastrointestinal bleeding. We present a case of metastatic melanoma to the colon that initially presented with intussusception.

Case Description/Methods: A 61-year-old female with a history of melanoma of the right shoulder, diagnosed in 2021, with metastases to the lumbar spine presented to the hospital with abdominal pain. She is currently on nivolumab/relatlimab and had radiation treatment of regional recurrence. Prior to admission, she was experiencing episodes of vomiting and constipation along with intermittent abdominal pain for the past 2 months. On arrival, CT scan with IV contrast showed bowel and mesenteric twisting within the right lower quadrant, ileum, cecum, proximal ascending colon with associated dilation of proximal transverse colon with focal narrowing. A repeat CT was done with oral contrast which showed ileocolic intussusception and a mass of the transverse colon. History revealed her last colonoscopy was in 2016 which was normal without polyps. The patient underwent an exploratory laparotomy where intussusception of the right colon was noted and underwent a right sided hemicolectomy. Surgical pathology of the colon mass showed ulceration and extensive necrosis. Immunohistochemical stains were positive for melan A and SOX10, and negative for CK20 and CKAE1/3. These morphological features in conjunction with a known history of melanoma were consistent with colonic involvement by melanoma. After our patient underwent right sided hemicolectomy, she had a follow up colonoscopy performed. There were no polyps or synchronous lesions found.

Discussion: This case demonstrates a rare presentation of metastatic melanoma to the colon in the form of intussusception. Melanoma of the GI tract is rare and comprises only 1% of GI malignancies. Most patients with melanoma to the colon do not display symptoms. The most common presenting symptom tends to be hematochezia. Our case is of interest because the patient was symptomatic and also did not present with any bleeding.



Disclosures:


Rahul Patel, DO¹, Matthew Everwine, DO², Smita Patel, MD³, Lucy Joo, DO³. P0208 - A Case of Metastatic Melanoma to the Colon Presenting With Intussusception, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.