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Dark macules in the upper gastrointestinal tract: An ominous sign

Published:August 14, 2014DOI:https://doi.org/10.1016/j.dld.2014.07.017
      A previously healthy 42-year-old man presented with a 3-month history of non-specific abdominal pain associated with anorexia, nausea and vomiting. Apart from slightly elevated liver enzymes, his laboratory investigations were unremarkable. An abdominal ultrasound showed multiple liver lesions consistent with metastases; a computed tomography scan of his chest, abdomen and pelvis confirmed these findings, however no primary lesion was identified. At upper gastrointestinal endoscopy, multiple dark brown macules (2–5 mm in diameter) were seen within the stomach (Fig. 1A ) and duodenum (Fig. 1B). Histological examination of biopsies of these lesions with immunostaining with Melan-A showed features of metastatic malignant melanoma (Fig. 1C). On thorough examination of the skin, no primary lesion was identified.
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