Abstract
Isolated pancreatic metastasis from malignant melanoma is rare. Pancreatic metastasis is difficult to diagnose in patients with unknown primary malignant melanoma. Endoscopic ultrasound-guided fine-needle aspiration plays an important role in confirming the diagnosis. A 67-year-old woman was referred to our institution because of a mass in her pancreas. Computed tomography and magnetic resonance imaging revealed a 35-mm mass localized on the pancreatic tail, with low attenuation, surrounded by a high-attenuation rim. Endoscopic ultrasonography revealed a hypoechoic mass with central anechoic areas. Endoscopic ultrasound-guided fine-needle aspiration of the mass was performed, and the pathological diagnosis was malignant melanoma. Intense fluorodeoxyglucose uptake was observed in the pancreatic tail on positron emission tomography–computed tomography. No other malignant melanoma was found. Distal pancreatectomy was performed. Six months postoperatively, positron emission tomography–computed tomography revealed high uptake in the left nasal cavity, and biopsy revealed the mass to be a malignant melanoma, indicating that the primary site of the malignant melanoma was the left nasal cavity and that the pancreatic mass and peritoneal lesion were metastases. The patient had survived > 2 years after the distal pancreatectomy. Pancreatic resection of isolated pancreatic metastasis can possibly prolong survival; however, metastatic melanoma usually has poor prognosis.
Highlights
Pancreatic metastases are rare, ranging from 2 to 5% of pancreatic malignancies [1, 2]
Isolated pancreatic metastasis is a rare event that represents about less than 1% of metastatic melanomas [6]
We present a unique case of malignant melanoma with isolated pancreatic metastasis diagnosed by Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and was treated with distal pancreatectomy
Summary
Pancreatic metastases are rare, ranging from 2 to 5% of pancreatic malignancies [1, 2]. There are only a few reports on surgically resected pancreatic metastasis of malignant melanoma diagnosed by EUS-FNA [3, 7, 8]. We present a unique case of malignant melanoma with isolated pancreatic metastasis diagnosed by EUS-FNA and was treated with distal pancreatectomy. A 67-year-old woman, who had been healthy all her life, presented to the referring hospital with left upper quadrant abdominal pain Her ultrasonogram and computed tomography (CT) showed a mass in the pancreas, and the patient was referred to our institution for further examination. The primary site of the malignant melanoma was the left nasal cavity, and the pancreatic mass, left infraclavicular lymph, and peritoneal lesion were metastases.
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