Baba Shigeaki, Akiyama Yuji, Endo Fumitaka, Nikai Haruka, Sugimoto Ryo, Umemura Akira, Katagiri Hirokatsu, Hasegawa Yasushi, Iwaya Takeshi, Nitta Hiroyuki, Koeda Keisuke, Sugai Tamotsu, Sasaki Akira
Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Iwate, Japan.
Surg Case Rep. 2021 Dec 20;7(1):268. doi: 10.1186/s40792-021-01345-x.
Metastatic melanoma originating from the choroidal membrane is extremely rare. Here, we report a case of laparoscopic distal pancreatectomy for malignant melanoma that developed after heavy-particle therapy for malignant choroidal melanoma.
A 43-year-old Japanese woman underwent 70 Gy heavy-particle radiotherapy for a right choroidal malignant melanoma. Positron emission tomography-computed tomography examination was performed 4 years after treatment, when contrast accumulation was observed on the posterior wall of the stomach. Endoscopic ultrasonography and computed tomography showed a mass with contrast enhancement in contact with the stomach wall. Based on the imaging findings, a gastrointestinal stromal tumor of the posterior wall of the lower gastric corpus with extramural growth was suspected. Laparoscopic surgery was performed under general anesthesia. A black-pigmented tumor originating from the pancreas was discovered. Following an intraoperative diagnosis of metastasis of malignant melanoma, a laparoscopic distal pancreatectomy was performed. The pathological diagnosis was pancreatic metastasis of malignant melanoma. The patient was treated with adjuvant immune checkpoint inhibitors and chemotherapy after surgery, which led to long-term survival.
Including this case, only eight case reports on pancreatic resection for metastatic ocular malignant melanoma have been reported. The ocular malignant melanoma with distant metastasis has a poor prognosis. Therefore, in our case, careful follow-up is required. A single pancreatic metastasis from a malignant melanoma of the choroid can be successfully managed by laparoscopic radical resection of the pancreas, and molecularly targeted adjuvant chemotherapy.
起源于脉络膜的转移性黑色素瘤极为罕见。在此，我们报告一例因恶性脉络膜黑色素瘤接受重粒子治疗后发生的恶性黑色素瘤行腹腔镜远端胰腺切除术的病例。
一名43岁日本女性因右脉络膜恶性黑色素瘤接受了70 Gy的重粒子放疗。治疗4年后进行了正电子发射断层扫描 - 计算机断层扫描检查，此时在胃后壁观察到造影剂积聚。内镜超声和计算机断层扫描显示一个与胃壁接触的有造影剂增强的肿块。基于影像学表现，怀疑是胃体下部后壁的胃肠道间质瘤伴壁外生长。在全身麻醉下进行了腹腔镜手术。发现一个起源于胰腺的黑色色素沉着肿瘤。术中诊断为恶性黑色素瘤转移后，进行了腹腔镜远端胰腺切除术。病理诊断为恶性黑色素瘤胰腺转移。患者术后接受了辅助免疫检查点抑制剂和化疗，实现了长期生存。
包括本病例在内，关于转移性眼部恶性黑色素瘤胰腺切除的病例报告仅8例。眼部恶性黑色素瘤发生远处转移预后较差。因此，在我们的病例中，需要密切随访。脉络膜恶性黑色素瘤的单一胰腺转移可通过腹腔镜根治性胰腺切除术和分子靶向辅助化疗成功治疗。
