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DOI: 10.1055/a-2092-0107
Primary malignant melanoma of the pancreas diagnosed by endoscopic ultrasonography-guided fine-needle biopsy
Clinical Trials Registration: Southern Medical University Nanfang Hospital NCT05549856
Endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) plays an important role in obtaining pathology specimens from pancreatic lesions. FNB needles have been designed to acquire larger “core” specimens that preserve tissue architecture and permit histologic evaluation and immunohistologic staining [1] [2]. In this study, we report an extremely rare case of primary pancreatic melanoma diagnosed by EUS-FNB using a 22-gauge Franseen needle.
A 59-year-old woman presented with a 2-day history of abdominal pain. Her laboratory tests including liver function, pancreatic amylase, and tumor markers were all within normal limits. Computed tomography revealed a low-density round lesion measuring 4.5 × 5.1 cm in the head of the pancreas with invasion into the portal vein ([Fig. 1]). Positron emission tomography/computed tomography showed a cystic tumor at the head of the pancreas with a moderate level of glucose metabolism ([Fig. 2]). To determine the diagnosis, we carried out EUS-FNB of the pancreatic mass ([Fig. 3 a], [Video 1]) and obtained a large amount of black tissue ([Fig. 3 b]). Hematoxylin and eosin staining showed atypical tumor cells accompanied by melanin deposition ([Fig. 4 a]); immunohistochemically, the tumor cells were positive for melanocytic marker Human Melanoma Black 45 (HMB-45) ([Fig. 4 b]) and Melan-A. The pathological findings revealed malignant melanoma of the pancreas, and we carefully re-checked that there were no pigmented spots on the skin or oral mucosa. Eventually, the patient was diagnosed with primary melanoma of the pancreas. She has received regular toripalimab immunotherapy combined with anlotinib, and after two cycles of therapy her abdominal pain was significantly relieved.
Video 1 Endoscopic ultrasonography-guided fine-needle biopsy of primary malignant melanoma of the pancreas.
Quality:
To our knowledge, this is the first case of primary malignant melanoma of the pancreas diagnosed using the EUS-FNB technique. As our case has demonstrated, EUS-FNB was crucial for the tissue acquisition and pathological diagnosis.
Endoscopy_UCTN_Code_CCL_1AZ_2AB
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Publication History
Article published online:
12 June 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Polkowski M, Jenssen C, Kaye P. et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline March 2017. Endoscopy 2017; 49: 989-1006
- 2 Bang JY, Hebert-Magee S, Hasan MK. et al. Endoscopic ultrasonography-guided biopsy using a Franseen needle design: initial assessment. Dig Endosc 2017; 29: 338-346