DOI: 10.1148/radiol.2321030909
Primary Malignant Melanoma of the Rectum: CT Findings in Eight Patients1
Kyoung Won Kim, MD,
Hyun Kwon Ha, MD,
Ah Young Kim, MD,
Tae Kyoung Kim, MD,
Jung-Sun Kim, MD,
Chang Sik Yu, MD,
Sung Won Park, MD,
Mi-Suk Park, MD,
Hye Jin Kim, MD,
Pyo-Nyun Kim, MD,
Jin Cheon Kim, MD and
Moon-Gyu Lee, MD
1 From the Departments of Radiology, Pathology, and Surgery, Asan Medical Center, University of Ulsan College of Medicine 388–1, Poongnap-dong, Songpa-ku, Seoul 138–736, Korea. Received June 9, 2003; revision requested August 21; revision received November 13; accepted December 9. Address correspondence to H.K.H. (e-mail: hkha@amc.seoul.kr).
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Figure 1a. Primary rectal malignant amelanotic melanoma in a 74-year-old woman. (a, b) Contrast material-enhanced transverse CT scans show a bulky polypoid intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) is mild and confined within the perirectal space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction. The luminal caliber (arrowheads) of the upper rectum is normal. Also, note the left obturator lymphadenopathy (arrow).
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Figure 1b. Primary rectal malignant amelanotic melanoma in a 74-year-old woman. (a, b) Contrast material-enhanced transverse CT scans show a bulky polypoid intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) is mild and confined within the perirectal space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction. The luminal caliber (arrowheads) of the upper rectum is normal. Also, note the left obturator lymphadenopathy (arrow).
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Figure 1c. Primary rectal malignant amelanotic melanoma in a 74-year-old woman. (a, b) Contrast material-enhanced transverse CT scans show a bulky polypoid intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) is mild and confined within the perirectal space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction. The luminal caliber (arrowheads) of the upper rectum is normal. Also, note the left obturator lymphadenopathy (arrow).
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Figure 2a. Primary rectal malignant melanotic melanoma in a 57-year-old woman. (a, b) Contrast-enhanced transverse CT scans show a bulky intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) extends to the presacral space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction (curved arrow) and also shows enlarged lymph nodes (arrowheads) in the perirectal and the right internal iliac lymph node stations. (d) Photograph of a gross specimen shows a large, lobulated intraluminal fungating mass in the distal rectum, abutting the anorectal junction (arrowheads). (e) Photomicrograph shows melanin pigmentation (arrowheads) scattered in the tumor, a finding that is typical of melanotic melanoma. (Hematoxylin-eosin stain; original magnification, x40.)
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Figure 2b. Primary rectal malignant melanotic melanoma in a 57-year-old woman. (a, b) Contrast-enhanced transverse CT scans show a bulky intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) extends to the presacral space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction (curved arrow) and also shows enlarged lymph nodes (arrowheads) in the perirectal and the right internal iliac lymph node stations. (d) Photograph of a gross specimen shows a large, lobulated intraluminal fungating mass in the distal rectum, abutting the anorectal junction (arrowheads). (e) Photomicrograph shows melanin pigmentation (arrowheads) scattered in the tumor, a finding that is typical of melanotic melanoma. (Hematoxylin-eosin stain; original magnification, x40.)
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Figure 2c. Primary rectal malignant melanotic melanoma in a 57-year-old woman. (a, b) Contrast-enhanced transverse CT scans show a bulky intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) extends to the presacral space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction (curved arrow) and also shows enlarged lymph nodes (arrowheads) in the perirectal and the right internal iliac lymph node stations. (d) Photograph of a gross specimen shows a large, lobulated intraluminal fungating mass in the distal rectum, abutting the anorectal junction (arrowheads). (e) Photomicrograph shows melanin pigmentation (arrowheads) scattered in the tumor, a finding that is typical of melanotic melanoma. (Hematoxylin-eosin stain; original magnification, x40.)
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Figure 2d. Primary rectal malignant melanotic melanoma in a 57-year-old woman. (a, b) Contrast-enhanced transverse CT scans show a bulky intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) extends to the presacral space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction (curved arrow) and also shows enlarged lymph nodes (arrowheads) in the perirectal and the right internal iliac lymph node stations. (d) Photograph of a gross specimen shows a large, lobulated intraluminal fungating mass in the distal rectum, abutting the anorectal junction (arrowheads). (e) Photomicrograph shows melanin pigmentation (arrowheads) scattered in the tumor, a finding that is typical of melanotic melanoma. (Hematoxylin-eosin stain; original magnification, x40.)
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Figure 2e. Primary rectal malignant melanotic melanoma in a 57-year-old woman. (a, b) Contrast-enhanced transverse CT scans show a bulky intraluminal mass (arrows) that is focally expanding and obscuring the lumen in the distal rectum just above the anal verge. Perirectal infiltration (arrowheads) extends to the presacral space. (c) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction (curved arrow) and also shows enlarged lymph nodes (arrowheads) in the perirectal and the right internal iliac lymph node stations. (d) Photograph of a gross specimen shows a large, lobulated intraluminal fungating mass in the distal rectum, abutting the anorectal junction (arrowheads). (e) Photomicrograph shows melanin pigmentation (arrowheads) scattered in the tumor, a finding that is typical of melanotic melanoma. (Hematoxylin-eosin stain; original magnification, x40.)
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Figure 3a. Primary rectal malignant melanotic melanoma in a 63-year-old man. (a) Contrast-enhanced transverse CT scan obtained at the level just above the anal verge shows a bulky intraluminal fungating mass (straight arrows) that is focally expanding and obscuring the distal rectal lumen, a perirectal lymphadenopathy (curved arrow) that is compressing the rectum, and a perirectal infiltration (arrowheads). (b) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction (straight arrows) and also shows lymphadenopathy (curved arrow) in the right internal iliac lymph node station. Perirectal infiltration (arrowheads), extending to the presacral space, is also demonstrated.
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Figure 3b. Primary rectal malignant melanotic melanoma in a 63-year-old man. (a) Contrast-enhanced transverse CT scan obtained at the level just above the anal verge shows a bulky intraluminal fungating mass (straight arrows) that is focally expanding and obscuring the distal rectal lumen, a perirectal lymphadenopathy (curved arrow) that is compressing the rectum, and a perirectal infiltration (arrowheads). (b) Transverse CT scan obtained at the level of the upper rectum shows no evidence of colonic obstruction (straight arrows) and also shows lymphadenopathy (curved arrow) in the right internal iliac lymph node station. Perirectal infiltration (arrowheads), extending to the presacral space, is also demonstrated.
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Figure 4a. Primary rectal malignant melanoma in a 70-year-old woman. (a, b) Contrast-enhanced transverse CT scans show uneven concentric wall thickening (straight arrows) of the distal rectum just above the anal verge. Perirectal infiltration extends to the pararectal space (arrowheads). Lymphadenopathy (curved arrow) involving the perirectal lymph node station is also seen. (c) Transverse CT scan of the upper abdomen shows a large lobulated hepatic mass, which is suggestive of hepatic metastasis. The diagnosis of primary rectal melanoma and hepatic metastasis was assigned on the basis of histopathologic findings in biopsy specimens of the rectal and hepatic masses.
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Figure 4b. Primary rectal malignant melanoma in a 70-year-old woman. (a, b) Contrast-enhanced transverse CT scans show uneven concentric wall thickening (straight arrows) of the distal rectum just above the anal verge. Perirectal infiltration extends to the pararectal space (arrowheads). Lymphadenopathy (curved arrow) involving the perirectal lymph node station is also seen. (c) Transverse CT scan of the upper abdomen shows a large lobulated hepatic mass, which is suggestive of hepatic metastasis. The diagnosis of primary rectal melanoma and hepatic metastasis was assigned on the basis of histopathologic findings in biopsy specimens of the rectal and hepatic masses.
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Figure 4c. Primary rectal malignant melanoma in a 70-year-old woman. (a, b) Contrast-enhanced transverse CT scans show uneven concentric wall thickening (straight arrows) of the distal rectum just above the anal verge. Perirectal infiltration extends to the pararectal space (arrowheads). Lymphadenopathy (curved arrow) involving the perirectal lymph node station is also seen. (c) Transverse CT scan of the upper abdomen shows a large lobulated hepatic mass, which is suggestive of hepatic metastasis. The diagnosis of primary rectal melanoma and hepatic metastasis was assigned on the basis of histopathologic findings in biopsy specimens of the rectal and hepatic masses.
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Copyright © 2004 by the Radiological Society of North America.
