De Moura Diogo Turiani Hourneaux, Chacon Danielle Azevedo, Tanigawa Ryan, Coronel Martin, Cheng Spencer, Artifon Éverson L A, Jukemura José, De Moura Eduardo Guimarães Hourneaux
Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6° andar, bloco 3, Cerqueira Cezar, ZIP Code 05403-010, São Paulo, SP, Brazil.
Patology Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, Andar, bloco, Cerqueira Cezar, ZIP Code 05403-010, São Paulo, SP, Brazil.
J Med Case Rep. 2016 Dec 1;10(1):332. doi: 10.1186/s13256-016-1121-2.
BACKGROUND: When encountering solid pancreatic lesions, nonpancreatic primary metastases are rare and differentiating a metastasis from a primary neoplastic lesion is challenging. The clinical presentation and radiologic features can be similar and the possibility of a pancreatic metastasis should be considered when the patient refers to a history of a different primary cancer. Endoscopic ultrasound offers a key anatomical advantage in accessing the pancreas and endoscopic ultrasound-guided fine-needle aspiration has become the gold standard method for diagnosing pancreatic lesions. CASE PRESENTATION: A 58-year-old white Hispanic woman with a history of uveal malignant melanoma, presented with abdominal pain and jaundice. On admission, laboratory tests were performed (her total bilirubin was 6.37 mg/dL with a direct fraction of 5.30 mg/dL). Cross-sectional, abdominal computed tomography with contrast, showed a low-attenuating lesion localized in the pancreatic head (measuring 4 × 3 cm) and a thinner section of the distal bile duct suspicious for compression. Our patient was scheduled for an endoscopic ultrasound-guided fine-needle aspiration to establish a diagnosis. Endoscopic ultrasound showed a solid, hypoechoic, well-defined lesion with regular contours (measuring 3.17 × 2.61 cm), localized between the head and neck of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration was performed with a 22G needle and cytology confirmed the diagnosis of metastatic melanoma. Our patient subsequently underwent right orbital exenteration, followed by duodenopancreatectomy without complications. At the moment our patient is receiving adjuvant chemotherapy at an outside oncology clinic. CONCLUSIONS: To the best of our knowledge, this is a very rare presentation of an ocular malignant melanoma with an isolated pancreatic metastasis causing symptomatic biliary obstruction. Endoscopic ultrasound-guided fine-needle aspiration has proven to be the best method to diagnose solid pancreatic lesions. In this particular case, cytology was essential in confirming the diagnosis and guiding the most adequate therapy, which was a pancreatic resection, ocular exenteration of the melanoma, followed by adjuvant chemotherapy.
背景：遇到胰腺实性病变时，非胰腺原发性转移瘤很少见，鉴别转移瘤与原发性肿瘤性病变具有挑战性。临床表现和放射学特征可能相似，当患者有其他原发性癌症病史时，应考虑胰腺转移的可能性。内镜超声在检查胰腺方面具有关键的解剖学优势，内镜超声引导下细针穿刺已成为诊断胰腺病变的金标准方法。 病例报告：一名58岁的西班牙裔白人女性，有葡萄膜恶性黑色素瘤病史，出现腹痛和黄疸。入院时进行了实验室检查（总胆红素为6.37mg/dL，直接胆红素为5.30mg/dL）。腹部增强CT显示胰头有一个低密度病变（大小为4×3cm），远端胆管较细部分可疑受压。我们的患者计划进行内镜超声引导下细针穿刺以明确诊断。内镜超声显示一个实性、低回声、边界清晰、轮廓规则的病变（大小为3.17×2.61cm），位于胰头和胰颈之间。用22G针进行了内镜超声引导下细针穿刺，细胞学检查确诊为转移性黑色素瘤。我们的患者随后接受了右眼眶内容物剜除术，接着进行了十二指肠胰切除术，无并发症。目前我们的患者正在外部肿瘤诊所接受辅助化疗。 结论：据我们所知，这是一例非常罕见的眼部恶性黑色素瘤表现为孤立性胰腺转移并导致症状性胆管梗阻的病例。内镜超声引导下细针穿刺已被证明是诊断胰腺实性病变的最佳方法。在这个特殊病例中，细胞学检查对于确诊和指导最合适的治疗至关重要，即胰腺切除术、黑色素瘤的眼眶内容物剜除术，随后进行辅助化疗。
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