Malignant Melanoma: a Rare Cause of Obstructive Jaundice
- PDF / 905,677 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 29 Downloads / 201 Views
GI IMAGE
Malignant Melanoma: a Rare Cause of Obstructive Jaundice Amaninder Dhaliwal 1 & Jessica McKeown 2 & Ishfaq Bhat 3 Received: 4 September 2020 / Accepted: 15 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
A 71-year-old male with past medical history of hypertension, cholecystectomy, and malignant melanoma of back status post resection presented to an outside hospital with complaints of jaundice, right upper quadrant abdominal pain, and weight loss (8 lbs) for one month. Magnetic resonance cholangiopancreatography (MRCP) performed there showed a hypo-enhancing mass extending from the hepatic hilum along segment 5/6 intrahepatic ducts and marked intrahepatic biliary ductal dilation (Fig. 1). He was given the presumed diagnosis of cholangiocarcinoma and transferred to our hospital for further evaluation and management. On examination, patient appeared cachectic and jaundiced. Abdomen was nontender and without any palpable mass. Laboratory evaluation was significant for AST 200 U/L, ALT 321 U/L, ALP 620 U/L, total bilirubin 16.5 mg/dL, and lipase of 274 U/L. Endoscopic retrograde cholangiography (ERCP) revealed a 2-cm stricture at the common hepatic duct/hilar area with a filling defect. The right and left intrahepatic bile ducts were
dilated (Fig. 2). Brushings were obtained for cytology. Spyglass cholangioscopy found a soft, bile-stained mass which was biopsied, and tissue sent for pathology. The right and left hepatic ducts were stented with plastic double pig tail stents to allow for adequate bile drainage. Pathology showed benign biliary epithelium with plasmacytoid tumor cells, morphologically consistent with melanoma. The neoplastic cells were positive for S100 and SOX10 (Fig. 3), while negative for CK7, CK20, CDX2, CK17, and NKX3.1. On further testing, the biopsy tested positive for BRAF mutation. Full body PET-CT scan showed no other sites of abnormal uptake outside of the liver. No skin lesions concerning for melanoma was noted on dermatology exam. Patient was not a surgical candidate due to the tumor location. He was started on chemotherapy and radiation.
* Amaninder Dhaliwal [email protected] Jessica McKeown [email protected] Ishfaq Bhat [email protected] 1
Division of Gastroenterology and Hepatology, Moffitt Cancer Center, 12902 USF Magnolia Drive, FOB 2 GI program, Tampa, FL 33612, USA
2
Division of Internal Medicine, University of Nebraska Medical Center College of Medicine, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, USA
3
Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, USA
Fig. 1 MRCP showing mass and intrahepatic biliary ductal dilation
J Gastrointest Surg
Malignant melanoma of the biliary tract (MM-BT) is an extremely rare entity and often metastatic but primary lesions have been reported in the literature.1, 2 This case likely represents a metastatic lesion given our patient’s prior history of skin melanoma, although the possibility of a
Data Loading...
