Description
The upper specimen from the small intestine shows little abnormality other than the presence of a
thin exudate on the serosa. The lower specimen shows, from the front, a diffuse infiltration of pale
tissue occupying much of the thickness of the bowel wall above, but probably only the outer muscle
and serosa below. The mucosa appears intact. Posteriorly the bowel is dilated producing a cyst in
the wall of which tumour can be seen; to one side there is an ulcerated area in which there are
flecks of dark material. No perforation can be seen, but there is exudate on the serosa of bowel
indicating peritonitis.
History
This man presented at the age of 49 with a melanoma on the back of the right shoulder;
a right-sided block dissection of the neck was made, to be followed by the removal of involved
lymph nodes on the left side of the neck 2 years later. Three years after the original lesion cerebral
secondaries were demonstrated; a year later he presented with severe abdominal pain; laparotomy
showed peritonitis with perforation of a cystic area on the ante-mesenteric border of the proximal
jejunum. Microscopy showed the presence of metastatic melanoma in the intestine.