Pancreatic metastases from ocular malignant melanoma: the use of endoscopic ultrasound-guided fine-needle aspiration to establish a definitive cytologic diagnosis: a case report

Abstract

BackgroundWhen 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 presentationA 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.ConclusionsTo 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.

Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis

“…The acquisition of histological samples that yield an adequate amount of tissue suitable for IHC staining is pivotal for 15,16 An alternative technique is to collect FNA samples in formalin for cell-block preparation and perform subsequent histological analysis. 6,9,17,18 However, this technique has demonstrated lower diagnostic rates, independent of the number of FNA passes. 19 In our study, cell- block analysis was possible in 73.15% of patients after FNA and in 84.16% after FNB.…”

“…Although EUS-FNA is accurate for the identification of neoplastic cells, it has been limiting for providing tissue for IHC staining [ 15 , 16 ]. An alternative technique is to collect FNA samples in formalin for cell-block preparation and perform subsequent histological analysis [ 6 , 9 , 17 , 18 ]. However, this technique has demonstrated lower diagnostic rates, independent of the number of FNA passes [ 19 ].…”

“…For the evaluation of LNs of an unknown origin, such as lymphoma, metastasis, mycobacterial infection, and sarcoidosis, core biopsy with preservation of the LN architecture is particularly important. [8][9][10] Although FNB appears to be the best modality for LN tissue sampling, both procedures are currently equally recommended by the European Society of Gastrointestinal Endoscopy guidelines, due to lack of studies comparing these techniques. 7 Because the etiology of lymphadenopathy can radically affect patient management, accurate understanding of and sampling with the best modality are pivotal to obtain precise diagnosis.…”

Endoscopic Ultrasound-Guided Fine Needle Aspiration and Endoscopic Retrograde Cholangiopancreatography-Based Tissue Sampling in Suspected Malignant Biliary Strictures: A Meta-Analysis of Same-Session Procedures

“…EUS-FNA allows for complete visualization of the pancreas and adjacent organs, and therefore targeted tissue acquision [ 19 - 21 ]. EUS-FNA is considered by most to be the gold-standard technique for pancreatic masses, which are the most common cause of malignant biliary strictures [ 22 , 23 ]. Additionally, a recent systematic review and meta-analysis demonstrated that the pooled sensitivity and specificity of EUS-FNA for malignant biliary obstructions were 75% and 100%, respectively [ 24 ].…”

Application of Digital Minimally Invasive Medicine and Visual Simulation in Surgery

“…Minimally invasive surgery compared to traditional open surgery, the need for more advanced technology and equipment to master the difficulty of surgery itself is also greatly increased, the medical staff, especially the surgeon of the operating process requires more refined, any uncomfortable position or Posture will affect the doctor's operation [6] . Therefore, in the modern minimally invasive operating room in accordance with the ergonomic principles of each subtle design can not be ignored.…”