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Clinical Journal of Gastroenterology

, Volume 12, Issue 6, pp 626–636 | Cite as

Isolated pancreatic metastasis from malignant melanoma: a case report and literature review

  • Yoshifumi Nakamura
  • Reiko YamadaEmail author
  • Maki Kaneko
  • Hiroaki Naota
  • Yu Fujimura
  • Masami Tabata
  • Kazuhiko Kobayashi
  • Kyosuke Tanaka
Open Access
Case Report

Abstract

Isolated pancreatic metastasis from malignant melanoma is rare. Pancreatic metastasis is difficult to diagnose in patients with unknown primary malignant melanoma. Endoscopic ultrasound-guided fine-needle aspiration plays an important role in confirming the diagnosis. A 67-year-old woman was referred to our institution because of a mass in her pancreas. Computed tomography and magnetic resonance imaging revealed a 35-mm mass localized on the pancreatic tail, with low attenuation, surrounded by a high-attenuation rim. Endoscopic ultrasonography revealed a hypoechoic mass with central anechoic areas. Endoscopic ultrasound-guided fine-needle aspiration of the mass was performed, and the pathological diagnosis was malignant melanoma. Intense fluorodeoxyglucose uptake was observed in the pancreatic tail on positron emission tomography–computed tomography. No other malignant melanoma was found. Distal pancreatectomy was performed. Six months postoperatively, positron emission tomography–computed tomography revealed high uptake in the left nasal cavity, and biopsy revealed the mass to be a malignant melanoma, indicating that the primary site of the malignant melanoma was the left nasal cavity and that the pancreatic mass and peritoneal lesion were metastases. The patient had survived > 2 years after the distal pancreatectomy. Pancreatic resection of isolated pancreatic metastasis can possibly prolong survival; however, metastatic melanoma usually has poor prognosis.

Keywords

Malignant melanoma Endoscopic ultrasound (EUS) Endoscopic retrograde cholangiopancreatogram (ERCP) Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) Case report 

Introduction

Pancreatic metastases are rare, ranging from 2 to 5% of pancreatic malignancies [1, 2]. The most common primary malignancies that metastasize to the pancreas are renal, lung, breast, and colon cancer, with sarcoma and melanoma observed less commonly [2, 3, 4]. Metastatic melanoma has a poor prognosis; the median survival for patients with stage IV melanoma ranges from 8 to 18 months after diagnosis [5]. Isolated pancreatic metastasis is a rare event that represents about less than 1% of metastatic melanomas [6].

Pancreatic metastases can resemble primary pancreatic malignancies, such as ductal carcinoma or neuroendocrine tumors. Thus, it can be difficult to differentiate pancreatic metastases from primary tumors based only on imaging findings. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) plays an important role in confirming the diagnosis [1]. There are only a few reports on surgically resected pancreatic metastasis of malignant melanoma diagnosed by EUS-FNA [3, 7, 8]. Here, we present a unique case of malignant melanoma with isolated pancreatic metastasis diagnosed by EUS-FNA and was treated with distal pancreatectomy.

Case report

A 67-year-old woman, who had been healthy all her life, presented to the referring hospital with left upper quadrant abdominal pain. Her ultrasonogram and computed tomography (CT) showed a mass in the pancreas, and the patient was referred to our institution for further examination.

Enhanced CT revealed that the mass was localized to the tail of the pancreas, with pancreatic ductal dilatation. The mass was a rounded, well-defined lesion with low attenuation, surrounded by a high-attenuation rim (Fig. 1a). Magnetic resonance imaging (MRI) showed that the center of the mass was hyperintense on T1-weighted image and hypointense on T2-weighted image (Fig. 1b, c). The diffusion-weighted image showed a hyperintense peripheral rim of the mass (Fig. 1d). Endoscopic retrograde cholangiopancreatogram demonstrated smooth narrowing and displacement of the pancreatic duct with upstream dilatation (Fig. 2). EUS revealed the 35-mm mass to be hypoechoic and heterogeneous with central anechoic areas (Fig. 3a, b). Contrast-enhanced EUS (CE-EUS) was conducted using an electronic radial-type endoscope (GF-UE260; Olympus, Japan) and perflubutane as ultrasound contrast agent. CE-EUS showed isoenhancement during the 20-s phase (Fig. 3c) and hypoenhancement during the 120-s phase (Fig. 3d) of the peripheral rim of the mass with central non-enhancement.
Fig. 1

Computed tomography image. a Mass in the tail of the pancreas with pancreatic ductal dilation. The central mass is hyperintense on T1-weighted image (b) and hypointense on T2-weighted image (c). d Peripheral rim of the mass is hyperintense on diffusion-weighted image

Fig. 2

Endoscopic retrograde cholangiopancreatogram revealed smooth narrowing and displacement of the pancreatic duct with upstream dilatation

Fig. 3

Endoscopic ultrasonography revealed hypoechoic and homogenous heterogeneous mass (a) with central anechoic areas (b, arrow). Contrast-enhanced endoscopic ultrasonography shows isoenhancement at 20 s (c) and hypoenhancement at 120 s (d) with central non-enhancement of the peripheral rim of the mass

Cytological analysis obtained by EUS-FNA with a 22-gauge needle (Fig. 4a) revealed a large nucleus and a high nuclear/cytoplasmic ratio in the cells, with brown pigmentation (Fig. 4b). The cells were positive for Melan A and Human Melanoma Black 45 (HMB-45) and were negative for S100 on cell-block immunocytochemical analysis (Fig. 4c, d). Thus, the patient was diagnosed as having malignant melanoma.
Fig. 4

a Endoscopic ultrasound-guided fine-needle aspiration of the peripheral rim of the mass. b Cytologic results revealed a large nucleus and a high nuclear/cytoplasmic ratio in the cells, with brown pigmentation. Immunocytochemical staining with Melan A (c) and Human Melanoma Black 45 (d)

Since primary pancreatic malignant melanoma has never been reported before, we suspected metastatic malignant melanoma of the pancreas. However, intense fluorodeoxyglucose uptake was observed only in the tail of the pancreas on positron emission tomography–CT (PET-CT) (Fig. 5). Esophagogastroduodenoscopy and colonoscopy did not reveal any specific findings. The primary site could not be identified by dermatological, ophthalmological, or gynecological examination.
Fig. 5

Intense fluorodeoxyglucose uptake only in the body and tail of the pancreas (arrow)

Distal pancreatectomy was performed. Histological examination of the surgical specimen revealed malignant melanoma with central necrosis (Figs. 6, 7). The resection specimen stained for Melan A and HMB-45, but not for S100. The patient underwent interferon-alfa treatment as an adjuvant therapy. Six months postoperatively, the follow-up PET-CT showed high uptake in the left nasal cavity, left infraclavicular lymph, and peritoneum (Fig. 8). On fiber-optic laryngoscopy, a whitish mass was detected in the left nasal cavity, which was determined to be a malignant melanoma. Although melanin was unclear in the nasal cavity biopsy specimen, cell shape and immunohistochemistry findings were the same as those in the resected surgical specimen. The primary site of the malignant melanoma was the left nasal cavity, and the pancreatic mass, left infraclavicular lymph, and peritoneal lesion were metastases. Nivolumab was started; thereafter, the treatment was switched to pembrolizumab. The patient had survived for more than 2 years after the distal pancreatectomy.
Fig. 6

Resected surgical specimen showing a black–brown mass in the tail of the pancreas

Fig. 7

a Loupe image of the resection specimen. The peripheral rim of the mass has nodular components (arrows). b Tumor cells in the peripheral rim of the mass have anisokaryosis and clear nuclei with melanin production. c Center of the mass was necrotic

Fig. 8

Positron emission tomography–computed tomography image of the nasal cavity before (a) and after surgery (b). Plane computed tomography and positron emission tomography–computed tomography images after surgery revealed left infraclavicular lymph node metastasis (c, d) and a small peritoneal nodule (e, f)

Discussion

Malignant melanoma usually metastasizes to the gastrointestinal tract, and metastatic malignant melanoma usually affects multiple sites. Isolated organ metastasis is unusual; specifically, metastasis to the pancreas is extremely rare (< 1%) [6]. There are 76 cases of pancreatic metastasis from malignant melanoma reported in English (Table 1). The major primary site is cutaneous and ocular. Meanwhile, there are only three cases of pancreatic metastasis from nasal cavity malignant melanoma, including our case [9, 10]. Sometimes, the primary lesion of melanoma is difficult to identify during pretreatment evaluation. In our case, the primary site was identified by PET-CT 6 months postoperatively, even though PET-CT is only effective for detecting primary tumors or cancers of unknown primary.
Table 1

Metastatic malignant melanoma of pancreas reported in the English literature

Authors

Year of publication

Age

Sex

Case

Primary site

Location in the pancreas

Tumor size (cm)

Diagnostic modality

Surgery

Follow-up (month)

Outcome

Das Gupta et al. [21]

1964

44

Female

2

Cutaneous

Body and tail

NR

Exploratory laparotomy

No operation

2

Dead

28

Male

 

Cutaneous

Body and tail

NR

Exploratory laparotomy

DP

10

Dead

Johansson et al. [22]

1970

67

Female

1

Ocular

Head

NR

Biopsy

PD

11

Alive

Bianca et al. [23]

1991

48

Male

1

Unknown

Head

3

FNA

PD

12

Alive

Brodish et al. [24]

1993

75

Female

1

Cutaneous

Tail

5

CT

DP

12

Alive

Rütter et al. [9]

1994

55

Male

1

Unknown (1 year after surgery, melanoma detected in nasal cavity and nasopharynx)

Head

2.5

ERCP

DP

12

Alive

Sobesky et al. [25]

1997

32

Female

1

Thoracic melanoma

Diffuse infiltration

NR

ERCP, biopsy

No operation

1.5

Dead

Harrison et al. [26]

1997

NR

NR

1

NR

NR

NR

NR

NR

NR

NR

Medina-Franco et al. [27]

1999

60

Male

1

Unknown

Head

8

CT, US

PD

6

Dead

Wood et al. [19]

2001

NR

NR

8

NR

NR

NR

NR

Curative resection or palliative resection

Median 23.8

 

NR

NR

20

NR

NR

NR

NR

no operation

Median 15.2

 

Hiotis et al. [28]

2002

NR

NR

1

NR

NR

NR

NK

PD

NR

Dead

Camp et al. [29]

2002

62

Female

1

Ocular

Body

5

CT, PET-CT

DP

20

Alive

Dewitt et al. [30]

2003

33

Male

2

Unknown

Head

5

EUS-FNA

Palliative gastrojejunostomy

6

Dead

83

Female

 

Unknown

Tail

3

EUS-FNA

No operation

10

Alive

Mizushima et al. [31]

2003

51

Female

1

Cutaneous

Head

5

Biopsy

No operation

NR

NR

Nikfarjam et al. [32]

2003

45

Male

2

Ocular

Head

3

CT, MRI, PET-CT etc.

PD

6

Alive

55

Male

 

Ocular

Head, body, tail

NR

CT, PET-CT etc.

TP

7

Alive

Carboni et al. [33]

2004

55

Female

1

Cutaneous

Head

8

Biopsy

PD

4

Dead

Crippa et al. [34]

2006

36

Female

1

NR

Head

NR

NR

PD

14

Dead

Belágyi et al. [35]

2006

28

Female

1

Ocular

Body

NR

CT

Pancreatic enucleation etc.

4

Dead

Eidt et al. [36]

2007

NR

NR

4

NR

NR

8

NR

PD

76

Alive

NR

NR

 

NR

NR

5

NR

PD

30

Alive

NR

NR

 

NR

NR

7

NR

PD

12

Dead

NR

NR

 

NR

NR

5

NR

PD

25

Dead

Reddy et al. [37]

2008

NR

NR

3

NR

NR

Median size 4

NR

NR

Median 10.8

 

Dumitraşcu et al. [7]

2008

43

Female

1

Ocular

Body

2

EUS-FNA

CP

12

Alive

Lanitis et al. [38]

2010

69

Male

1

Cutaneous

Head

4.5

CT

PD

96

Alive

He et al. [39]

2010

39

Male

1

Ocular

Tail

18

CT, MRI, ERCP etc.

DP

25

Alive

Vagefi et al. [8]

2010

57

Female

1

Ocular

Tail

2.2

EUS-FNA

DP

NR

NR

Portale et al. [4]

2011

43

Female

1

Unknown

Tail

1.7

US, CT, PET-CT

DP

NR

NR

Moszkowicz et al. [40]

2011

44

Female

1

Cutaneous

Uncinate process, Cephalo-isthmic junction

1.3, 0.9

Biopsy under EUS

PD

NR

NR

Sperti et al. [41]

2011

48

Male

1

Unknown

Body

2.9

CT

DP

24

Dead

Goyal et al. [18]

2012

47

Female

5

Cutaneous

Head

3

ERCP-assisted biopsy

PD

15

Dead

73

Female

 

Cutaneous

Head

4

CT

PD

3

Dead

58

Female

 

Unknown

Head

10

CT-guided biopsy

PD

11.4

Dead

28

Female

 

Cutaneous

Head

2

PET-CT

PD

4.5

Dead

69

Male

 

Unknown

Tail

4.5

Biopsy

DP

26

Dead

Larsen et al. [2]

2013

32

Female

1

Cutaneous

Head

NR

CT

PD

228

Alive

Birnbaum et al. [5]

2013

45

Female

1

Cutaneous

Head

6

Biopsy

PD

19

Alive

Sugimoto et al. [10]

2013

46

Male

1

Nasal cavity

Body

3.3

CT, PET-CT

DP

10

Dead

Solmaz et al. [42]

2014

59

Male

1

Cutaneous

Head

3.8

Biopsy

No operation

NR

NR

Jana et al. [1]

2015

75

Male

1

Cutaneous

Head, body

2.4, 1.4, 1, 0.6

EUS-FNA

No operation

NR

NR

De Moura et al. [3]

2016

58

Female

1

Ocular

Head, neck

3.1

EUS-FNA

PD

NR

NR

Nadal et al. [43]

2016

57

Female

1

Ocular

Tail

2

EUS-FNA

NR

NR

NR

Ben Slama et al. [44]

2017

55

Female

1

Unknown

Head

5.5

CT, MRI

PD

15

Alive

Liu et al. [45]

2018

54

Male

1

Cutaneous

Head

3.1

CT

PD

6

Alive

Current

2019

67

Female

1

Nasal cavity

Body

3.5

EUS-FNA

DP

24

Alive

NR not reported, PD pancreatoduodenectomy, DP distal pancreatectomy, TP total pancreatectomy, CP central pancreatectomy

Despite technological advances, preoperative diagnosis of metastatic pancreatic tumor is sometimes difficult [11]. Metastatic lesions from malignant melanoma have hypervascularity on contrast-enhanced CT and MRI [12]. The blood supply to metastatic lesions is carried from the surrounding organs; therefore, the surrounding tissue of the large lesion receives more blood supply than the central area, resulting in rim enhancement, especially in lesions larger than 1.5 cm. The same could be said in our case, as a high-attenuation rim was revealed on enhanced CT. EUS provided us with high-quality images to examine the pancreas and nearby structures. In general, pancreatic metastases on EUS have regular margins and appear as homogenous structures that are hypoechoic compared with the surrounding pancreas [13]. In our case, EUS revealed the mass to be hypoechoic and homogenous with the central anechoic areas. Few studies have reported on CE-EUS findings of pancreatic metastatic lesion. Pancreatic metastasis of renal cell carcinoma tends to show hyperenhancement, whereas malignant melanoma may or may not show hyperenhancement [13, 14, 15]. The lack of characteristic findings makes diagnosis of metastatic malignant melanoma by CE-EUS difficult.

To confirm the diagnosis of pancreatic metastatic lesions, pathological examination is necessary. EUS-FNA plays an important role in providing cytological/histological diagnosis, and it is extremely useful in identifying pancreatic metastases. To distinguish pancreatic metastases from a primary carcinoma accurately, effective sampling and immunocytochemistry are needed [1, 3, 6]. EUS-FNA with rapid on-site evaluation provides effective sampling, because a cytopathologist can ensure that the samples are adequate for assessment [16]. Immunohistochemical analysis has been shown to be useful in identifying metastatic melanoma; the sensitivity of S100, Melan A, and HMB-45 are reported to be 97–100%, 75–92%, and 69–93%, respectively. The specificity of S100 and Melan A is reported to be 75–87% and 95–100%, respectively [17]. In our case, Melan A and HMB-45 were positive.

The prognosis of patients with malignant melanoma metastatic to the pancreas is unknown, although metastatic melanoma usually indicates poor prognosis [5]. There are few experiences with pancreatic resection for isolated pancreatic metastases, and pancreatic resection is controversial. Some studies have shown that complete surgical resection of a localized metastatic disease can prolong survival [5, 18]. However, Wood et al. [19] reported 28 patients with isolated pancreatic metastases from malignant melanoma and found that the 5-year survival rate of pancreatic resection (performed in 8 patients) was 37.5% (median survival, 23.8 months), as compared with 23% (median survival, 15.2 months) of the 20 patients treated with non-resection. It is critical that surgery should be performed only when a complete resection is possible. Therefore, exhaustive preoperative staging is needed to confirm both the absence of local invasion of the major vasculature and the absence of distant metastasis. PET scan has a high sensitivity and specificity for detecting metastasis from malignant melanoma [20]. In our case, PET-CT also had an important role; preoperative PET-CT identified the pancreatic tail mass, and the 6-month postoperative PET-CT showed high uptake in the left nasal cavity and peritoneum.

In conclusion, this unique case of isolated pancreatic metastasis from malignant melanoma was conclusively proven with EUS-FNA prior to the diagnosis of the primary lesion. Broad differential diagnoses should be considered when faced with inconclusive imaging studies of pancreatic tumors. In such cases, EUS-FNA is useful in providing a definitive diagnosis.

Notes

Acknowledgements

We are grateful to Dr. Hiroko Sugimoto from the Department of Pathology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan, for helpful discussions.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest or financial arrangement with any company.

Human rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

References

  1. 1.
    Jana T, Caraway NP, Irisawa A, et al. Multiple pancreatic metastases from malignant melanoma: conclusive diagnosis with endoscopic ultrasound-guided fine needle aspiration. Endosc Ultrasound. 2015;4:145–8.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Larsen AK, Krag C, Geertsen P, et al. Isolated malignant melanoma metastasis to the pancreas. Plast Reconstr Surg Glob Open. 2013;1:e74.PubMedPubMedCentralGoogle Scholar
  3. 3.
    De Moura DT, Chacon DA, Tanigawa R, et al. Pancreatic metastases from ocular malignant melanoma: the use of endoscopic ultrasound-guided fine-needle aspiration to establish a definitive cytologic diagnosis: a case report. J Med Case Rep. 2016;10:332.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Portale TR, Di Benedetto V, Mosca F, et al. Isolated pancreatic metastasis from melanoma. Case report. G Chir. 2011;32:135–7.PubMedGoogle Scholar
  5. 5.
    Birnbaum DJ, Moutardier V, Turrini O, et al. Isolated pancreatic metastasis from malignant melanoma: is pancreatectomy worthwhile? J Surg Tech Case Rep. 2013;5:82–4.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Pang JC, Roh MH. Metastases to the pancreas encountered on endoscopic ultrasound-guided fine-needle aspiration. Arch Pathol Lab Med. 2015;139:1248–52.PubMedGoogle Scholar
  7. 7.
    Dumitraşcu T, Dima S, Popescu C, et al. An unusual indication for central pancreatectomy—late pancreatic metastasis of ocular malignant melanoma. Chirurgia. 2008;103:479–85.PubMedGoogle Scholar
  8. 8.
    Vagefi PA, Stangenberg L, Krings G, et al. Ocular melanoma metastatic to the pancreas after a 28-year disease-free interval. Surgery. 2010;148:151–4.PubMedGoogle Scholar
  9. 9.
    Rütter JE, De Graaf PW, Kooyman CD, et al. Malignant melanoma of the pancreas: primary tumour or unknown primary? Eur J Surg. 1994;160:119–20.PubMedGoogle Scholar
  10. 10.
    Sugimoto M, Gotohda N, Kato Y, et al. Pancreatic resection for metastatic melanoma originating from the nasal cavity: a case report and literature review. Anticancer Res. 2013;33:567–73.PubMedGoogle Scholar
  11. 11.
    Yagi T, Hashimoto D, Taki K, et al. Surgery for metastatic tumors of the pancreas. Surg Case Rep. 2017;3:31.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Tsitouridis I, Diamantopoulou A, Michaelides M, et al. Pancreatic metastases: CT and MRI findings. Diagn Interv Radiol. 2010;16:45–51.PubMedGoogle Scholar
  13. 13.
    Fusaroli P, D’Ercole MC, De Giorgio R, et al. Contrast harmonic endoscopic ultrasonography in the characterization of pancreatic metastases (with video). Pancreas. 2014;43:584–7.PubMedGoogle Scholar
  14. 14.
    Fusaroli P, Spada A, Mancino MG, Caletti G. Contrast harmonic echo–endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol. 2010;8:629–34.PubMedGoogle Scholar
  15. 15.
    Yamashita Y, Kato J, Ueda K, et al. Contrast-enhanced endoscopic ultrasonography for pancreatic tumors. Biomed Res Int. 2015;2015:491782.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Yamao K, Sawaki A, Mizuno N, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future. J Gastroenterol. 2005;40:1013–23.PubMedGoogle Scholar
  17. 17.
    Ohsie SJ, Sarantopoulos GP, Cochran AJ, et al. Immunohistochemical characteristics of melanoma. J Cutan Pathol. 2008;35:433–44.PubMedGoogle Scholar
  18. 18.
    Goyal J, Lipson EJ, Rezaee N, et al. Surgical resection of malignant melanoma metastatic to the pancreas: case series and review of literature. J Gastrointest Cancer. 2012;43:431–6.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Wood TF, DiFronzo LA, Rose DM, et al. Does complete resection of melanoma metastatic to solid intra-abdominal organs improve survival? Ann Surg Oncol. 2001;8:658–62.PubMedGoogle Scholar
  20. 20.
    Rinne D, Baum RP, Hör G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer. 1998;82:1664–71.PubMedGoogle Scholar
  21. 21.
    Gupta TD, Brasfield R. Metastatic melanoma: a clinicopathological study. Cancer. 1964;17:1323–39.Google Scholar
  22. 22.
    Johansson H, Krause U, Olding L. Pancreatic metastases from a malignant melanoma. Scand J Gastroenterol. 1970;5:573–5.PubMedGoogle Scholar
  23. 23.
    Bianca A, Carboni N, Di Carlo V, et al. Pancreatic malignant melanoma with occult primary lesion. A case report. Pathologica. 1991;84:531–7.Google Scholar
  24. 24.
    Brodish RJ, McFadden DW. The pancreas as the solitary site of metastasis from melanoma. Pancreas. 1993;8:276–8.PubMedGoogle Scholar
  25. 25.
    Sobesky R, Duclos-Vallée JC, Prat F, et al. Acute pancreatitis revealing diffuse infiltration of the pancreas by melanoma. Pancreas. 1997;15:213–5.PubMedGoogle Scholar
  26. 26.
    Harrison LE, Merchant N, Cohen AM, et al. Pancreaticoduodenectomy for nonperiampullary primary tumors. Am J Surg. 1997;174:393–5.PubMedGoogle Scholar
  27. 27.
    Medina-Franco H, Halpern NB, Aldrete JS. Pancreaticoduodenectomy for metastatic tumors to the periampullary region. J Gastrointest Surg. 1999;3:119–22.PubMedGoogle Scholar
  28. 28.
    Hiotis SP, Klimstra DS, Conlon KC, et al. Results after pancreatic resection for metastatic lesions. Ann Surg Oncol. 2002;9:675–9.PubMedGoogle Scholar
  29. 29.
    Camp R, Lind DS, Hemming AW. Combined liver and pancreas resection with biochemotherapy for metastatic ocular melanoma. J Hepatobiliary Pancreat Surg. 2002;9:519–21.PubMedGoogle Scholar
  30. 30.
    Dewitt JM, Chappo J, Sherman S. Endoscopic ultrasound-guided fine-needle aspiration of melanoma metastatic to the pancreas: report of two cases and review. Endoscopy. 2003;35:219–22.PubMedGoogle Scholar
  31. 31.
    Mizushima T, Tanioka H, Emori Y, et al. Metastatic pancreatic malignant melanoma: tumor thrombus formed in portal venous system 15 years after initial surgery. Pancreas. 2003;27:201–3.PubMedGoogle Scholar
  32. 32.
    Nikfarjam M, Evans P, Christophi C. Pancreatic resection for metastatic melanoma. HPB. 2003;5:174–9.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Carboni F, Graziano F, Lonardo MT, et al. Pancreaticoduodenectomy for pancreatic metastatic melanoma. J Exp Clin Cancer Res. 2004;23:539–43.PubMedGoogle Scholar
  34. 34.
    Crippa S, Angelini C, Mussi C, et al. Surgical treatment of metastatic tumors to the pancreas: a single center experience and review of the literature. World J Surg. 2006;30:1536–42.PubMedGoogle Scholar
  35. 35.
    Belágyi T, Zsoldos P, Makay R, et al. Multiorgan resection (including the pancreas) for metastasis of cutaneous malignant melanoma. J Pancreas. 2006;7:234–40.Google Scholar
  36. 36.
    Eidt S, Jergas M, Schmidt R, et al. Metastasis to the pancreas—an indication for pancreatic resection? Langenbecks Arch Surg. 2007;392:539–42.PubMedGoogle Scholar
  37. 37.
    Reddy S, Edil BH, Cameron JL, et al. Pancreatic resection of isolated metastases from nonpancreatic primary cancers. Ann Surg Oncol. 2008;15:3199–206.PubMedGoogle Scholar
  38. 38.
    Lanitis S, Papaioannou N, Sgourakis G, et al. Prolonged survival after the surgical management of a solitary malignant melanoma lesion within the pancreas: a case report of curative resection. J Gastrointest Liver Dis. 2010;19:453–5.Google Scholar
  39. 39.
    He MX, Song B, Jiang H, et al. Complete resection of isolated pancreatic metastatic melanoma: a case report and review of the literature. World J Gastroenterol. 2010;16:4621–4.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Moszkowicz D, Peschaud F, El Hajjam M, et al. Preservation of an intra-pancreatic hepatic artery during duodenopancreatectomy for melanoma metastasis. Surg Radiol Anat. 2011;33:547–50.PubMedGoogle Scholar
  41. 41.
    Sperti C, Polizzi ML, Beltrame V, et al. Pancreatic resection for metastatic melanoma. Case report and review of the literature. J Gastrointest Cancer. 2011;42:302–6.PubMedGoogle Scholar
  42. 42.
    Solmaz A, Yigitbas H, Tokoçin M, et al. Isolated pancreatic metastasis from melanoma: a case report. J Carcinog Mutagen. 2014;5:202.Google Scholar
  43. 43.
    Nadal E, Burra P, Mescoli C, et al. Pancreatic melanoma metastasis diagnosed by endoscopic ultrasound-guided SharkCore biopsy. Endoscopy. 2016;1:E208–9.Google Scholar
  44. 44.
    Ben SS, Bacha D, Bayar R, et al. Pancreatic resection for isolated metastasis from melanoma of unknown primary. Acta Gastroenterol Belg. 2017;80:323–4.Google Scholar
  45. 45.
    Liu X, Feng F, Wang T, et al. Laparoscopic pancreaticoduodenectomy for metastatic pancreatic melanoma: a case report. Medicine. 2018;97:e12940.PubMedPubMedCentralGoogle Scholar

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Authors and Affiliations

  1. 1.Department of GastroenterologyMatsusaka Chuo General HospitalMatsusakaJapan
  2. 2.Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
  3. 3.Department of EndoscopyMie University HospitalTsuJapan
  4. 4.Department of SurgeryMatsusaka Chuo General HospitalMatsusakaJapan

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