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Endoscopy 2003; 35(3): 219-222
DOI: 10.1055/s-2003-37258
Case Report

© Georg Thieme Verlag Stuttgart · New York

Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Melanoma Metastatic to the Pancreas: Report of Two Cases and Review

J.  M.  DeWitt1 , J.  Chappo1 , S.  Sherman1
  • 1Indiana University Medical Center, Indianapolis, Indiana, USA
Further Information

Publication History

Submitted: 24 April 2002

Accepted after Revision: 25 July 2002

Publication Date:
13 February 2003 (online)

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Malignant melanoma is a neoplasm which originates from melanocytes. Surgical exploration for abdominal metastases of cutaneous melanoma reveals pancreatic metastases in 16 % of patients which is usually accompanied by other intra-abdominal spread. Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) of primary and metastatic pancreatic masses have already been described. We report the first use of EUS-FNA for the diagnosis of malignant melanoma metastatic to the pancreas. As our cases illustrate, these lesions may present as either cystic or solid pancreatic masses. Preparation of a cell block from the FNA aspirate and use of immunostaining may help to obtain the diagnosis. Despite thorough examination of the skin and mucous membranes, however, a primary site might not be found in these patients.

References

  • 1 Yasuda K, Mukai H, Fujimoto S. et al . The diagnosis of pancreatic cancer by endoscopic ultrasonography.  Gastrointest Endosc. 1988;  34 1-8
    PubMedSearch in Google Scholar
  • 2 Bhutani M S, Hawes R H, Baron P L. et al . Utility of endoscopic ultrasound-guided fine-needle aspiration in the evaluation of pancreatic masses.  Am J Gastroenterol. 1995;  90 1599
    PubMedSearch in Google Scholar
  • 3 Faigel D O, Kochman M L. The role of endoscopic ultrasound in the preoperative staging of pancreatic malignancies.  Gastrointest Endosc. 1996;  43 626-628
    PubMedSearch in Google Scholar
  • 4 Chang K J, Albers C G, Erickson R A. et al . Endoscopic ultrasound-guided fine-needle aspiration of pancreatic carcinoma.  Am J Gastroenterol. 1994;  89 263-266
    PubMedSearch in Google Scholar
  • 5 Fritscher-Ravens A, Sriram P V, Krause C. et al . Detection of pancreatic metastases by EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 65-70
    CrossrefPubMedSearch in Google Scholar
  • 6 Turnbull A D, Rosen P P, Goodner J T, Beattie E J. Primary malignant tumors of the esophagus other than typical epidermoid carcinoma.  Ann Thorac Surg. 1973;  15 463-473
    PubMedSearch in Google Scholar
  • 7 Stranks G J, Mathai J T, Rowe-Jones D C. Primary malignant melanoma of the oesophagus: case report and review of surgical pathology.  Gut. 1991;  32 828-830
    CrossrefPubMedSearch in Google Scholar
  • 8 Sabanathan S, Eng J, Pradhan G N. Primary malignant melanoma of the esophagus.  Am J Surg Pathol. 1987;  11 46-52
    PubMedSearch in Google Scholar
  • 9 Gates J, Kane R A, Hartnell G G. Primary biliary tract malignant melanoma.  Abdom Imaging. 1996;  21 453-455
    CrossrefPubMedSearch in Google Scholar
  • 10 Gupta R, Rathi P M, Sawant P. et al . Endoscopic appearance of primary anorectal melanoma.  Endoscopy. 1997;  29 230
    PubMedSearch in Google Scholar
  • 11 Guzzo M, Grandi C, Licitra L. et al . Mucosal malignant melanoma of head and neck: forty-eight cases treated at Istituto Nazionale Tumori of Milan.  Eur J Surg Oncol. 1993;  19 316-319
    PubMedSearch in Google Scholar
  • 12 Hatae Y, Kikuchi M, Segawa M, Yonemitsu K. Malignant melanoma of the gallbladder.  Pathol Res Pract. 1978;  163 281-287
    PubMedSearch in Google Scholar
  • 13 Tamura S, Aono R, Onishi S, Hashimoto K. Metastatic malignant melanoma involving the colon.  Gastrointest Endosc. 2000;  52 393
    CrossrefPubMedSearch in Google Scholar
  • 14 Bender G N, Maglinte D D, McLarney J H. et al . Malignant melanoma: patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance.  Am J Gastroenterol. 2001;  96 2392-2400
    PubMedSearch in Google Scholar
  • 15 Lopez-Cantarero Ballesteros M, Fuentes Porcel O, Perez Cabrera B. et al . Melanoma metastasis to the pancreas.  Rev Esp Enferm Dig. 1992;  82 61-62
    PubMedSearch in Google Scholar
  • 16 Kohler B, Riemann J F. Obstructive jaundice due to an intraductal melanoma metastasis.  Endoscopy. 1987;  19 79-80
    PubMedSearch in Google Scholar
  • 17 Oda I, Kondo H, Yamao T. et al . Metastatic tumors to the stomach: analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases.  Endoscopy. 2001;  33 507-510
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Gutman H, Hess K R, Kokotsakis J A. et al . Surgery for abdominal metastases of cutaneous melanoma.  World J Surg. 2001;  25 750-758
    CrossrefPubMedSearch in Google Scholar
  • 19 Woyke S, Domagala W, Czerniak B, Strokowska M. Fine-needle aspiration cytology of malignant melanoma of the skin.  Acta Cytol. 1980;  24 529-538
    PubMedSearch in Google Scholar
  • 20 Czerniak B, Woyke S, Domagala W, Krzysztolik Z. Fine-needle aspiration cytology of intraocular melanoma.  Acta Cytol. 1983;  27 157-165
    PubMedSearch in Google Scholar
  • 21 Basler G C, Fader D J, Yahanda A. et al . The utility of fine-needle aspiration in the diagnosis of melanoma metastatic to lymph nodes.  J Am Acad Dermatol. 1997;  36 403-408
    PubMedSearch in Google Scholar
  • 22 Cangiarella J, Symmans W F, Shapiro R L. et al . Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes.  Cancer. 2000;  90 162-166
    CrossrefPubMedSearch in Google Scholar
  • 23 Perry M D, Gore M, Seigler H F, Johnston W W. Fine-needle aspiration biopsy of metastatic melanoma. A morphologic analysis of 174 cases.  Acta Cytol. 1986;  30 385-396
    PubMedSearch in Google Scholar
  • 24 Kim K, Booth R, Myles J. Transcutaneous fine-needle aspiration biopsy of pancreatic cancer.  Int J Pancreatol. 1990;  7 61-69
    PubMedSearch in Google Scholar
  • 25 Schoengen A, Binder T, Faiss S. et al . Fine-needle aspiration cytology of metastatic malignant melanoma. Improvement of results with ultrasound control.  Hautarzt. 1993;  44 703-707
    PubMedSearch in Google Scholar
  • 26 Voit C, Mayer T, Proebstle T M. et al . Ultrasound-guided fine-needle aspiration cytology in the early detection of melanoma metastases.  Cancer. 2000;  90 186-193
    CrossrefPubMedSearch in Google Scholar
  • 27 Voit C, Mayer T, Proebstle T. et al . Ultrasound-guided fine-needle aspiration cytology (FNAC) of unclear lesions in melanoma patients.  Ultraschall Med. 2000;  21 218-222
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Yoshikane H, Suzuki T, Yoshioka N. et al . Primary malignant melanoma of the esophagus presenting with massive hematemesis.  Endoscopy. 1995;  27 397-399
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Namieno T, Koito K, Ambo T. et al . Primary malignant melanoma of the esophagus: diagnostic value of endoscopic ultrasonography.  Am Surg. 1996;  62 716-718
    PubMedSearch in Google Scholar
  • 30 Kanamoto K, Aoyagi K, Nakamura S. et al . The value of endoscopic ultrasonography in primary malignant melanoma of the esophagus.  Gastrointest Endosc.. 1997;  46 88-89
    PubMedSearch in Google Scholar
  • 31 Kitamura Y, Sakue M, Nishiyama K. et al . A case of metastatic malignant melanoma mimicking pancreatic pseudocyst.  Gan No Rinsho. 1987;  33 748-752
    PubMedSearch in Google Scholar
  • 32 Bianca A, Carboni N, di Carlo V. et al . Pancreatic malignant melanoma with occult primary lesion. A case report.  Pathologica. 1992;  84 531-537
    PubMedSearch in Google Scholar
  • 33 Rutter J E, de Graaf P W, Kooyman C D. et al . Malignant melanoma of the pancreas: primary tumour or unknown primary?.  Eur J Surg. 1994;  160 119-120
    PubMedSearch in Google Scholar
  • 34 Gown A M, Vogel A M, Hoak D. et al . Monoclonal antibodies specific for melanocytic tumors distinguish subpopulations of melanocytes.  Am J Pathol. 1986;  123 195-203
    PubMedSearch in Google Scholar

J. M. DeWitt, M.D.

Department of Medicine · Division of Gastroenterology · Indiana University Medical Center

550 N. University Blvd. · UH 4100 · Indianapolis, IN 46202-5121 · USA ·

Fax: + 1-317-278-8144

Email: jodewitt@iupui.edu