Kayla Estepp, DO1, Ross Meidinger, MD2, Hong Qi Peng, MD2
1University of North Dakota, Fargo, ND; 2Sanford Medical Center, Fargo, ND
Introduction: Metastatic lesions of the pancreas are uncommon, with reported frequencies of intrapancreatic metastases ranging from 4.5% to 11%, with isolated metastases around 2% of cases. Metastases from malignant melanoma is quite rare, with fewer then 200 cases reported in literature.
Case Description/Methods: 79-year-old female who presented to ED in June 2018 with fever, dysuria, and dyspnea. Past medical history significant for prednisone dependent sarcoidosis, atrial fibrillation, and basal cell carcinoma. Labs showed elevated WBC and UA concern for UTI. She was admitted for treatment. CT scan was done due to dyspnea showing LLL consolidation. Incidentally, a new 2.6 x 1.8 cm mass within the pancreas neck was seen. At discharge she was referred to our facility for EUS and FNA. EUS showed a pancreatic mass abutting the superior mesenteric vein without invasion. Cytological analysis obtained by EUS-FNA (Fig.1) showed malignant melanoma with abundant melanin pigments (Fig.2). Positive for Sox-10, Melan A and HMB-45. Referral to medical oncology was made for further work-up. PET scan was preformed due to lack of previous melanoma history, showing no evidence of disease outside the pancreatic area (Fig.3). With no primary lesion identified further referrals to Dermatology and Ophthalmology, however these evaluations were negative for overt cutaneous or ocular melanoma. Colonoscopy was performed and showed no lesions. Due to the isolated lesion, deemed an appropriate candidate for resection. September 2018, partial pancreatectomy and regional lymph node resection completed. Pathology of the 4.5 cm pancreatic neck mass, in addition to celiac and portal lymph node, consistent with malignant melanoma. October 2018 started immunotherapy of Opdivo and Ipilumimab. Repeat PET scan showed nodule along right flank, superior to iliac crest, FDG avid, suspicious for melanoma and thought to be the sight of primary lesion. Tolerated immunotherapy well, but in December 2018, was admitted due to respiratory distress secondary to aspiration pneumonia, was transitioned to comfort cares due to worsening clinical status, passing away.
Discussion: This case is a unique presentation of an isolated metastatic pancreatic melanoma, found incidentally in an otherwise asymptomatic patient. With the widespread use of imaging, clinicians can expect an increasing number of “incidentalomas” being found, stressing the role of EUS-FNA in gaining a precise diagnosis which is critical in the overall prognosis and management of patients.
Citation: Kayla Estepp, DO; Ross Meidinger, MD; Hong Qi Peng, MD. P0965 - NOT SO INCIDENTAL: A CASE OF INCIDENTALLY FOUND ISOLATED METASTATIC MELANOMA OF THE PANCREAS. Program No. P0965. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.