This is the case of a 58-year-old white Hispanic woman with a history of uveal melanoma in her right eye (Fig.1).
She was admitted to the hospital with jaundice and abdominal pain for 10 days.
On admission, laboratory tests were obtained (a complete blood count was within normal limits, amylase: 136 U/L, total bilirubin: 6.37 mg/dL with a direct fraction of 5.30 mg/dL).
Cross-sectional, abdominal computed tomography (CT) with contrast, showed a low-attenuating lesion localized in the pancreatic head (measuring 4 × 3 cm) and a thinner section of the distal bile duct suspicious for compression).
After a multidisciplinary meeting, our patient was scheduled for EUS-FNA.
EUS showed a solid, heteroechoic with predominantly hypoechoic areas, well-defined lesion with regular contours (measuring 3.1 × 2.6 cm), localized between the head and neck of the pancreas (Fig.2).
There was no vascular or lymph node invasion identified.
EUS-FNA was performed with a 22G needle using the fanning technique.
In the cytology specimens (Fig.3), the cells presented have a discohesive dispersed pattern, with marked variation in size and shape including epithelioid and spindle-shaped cells with plasmacytoid and round nuclei.
The nuclear chromatin is clumping and irregular with excessive parachromatin clearing, there are single or multiple macronucleoli, and abundant cytoplasm with deep brownish-black granules obscuring the cell details.
The background shows necrosis and hemorrhage.
Our patient underwent right orbital exenteration and followed by duodenopancreatectomy (the Whipple procedure), without any complications (Fig.4).
The surgical specimen showed undifferentiated cells, with extended disposition of brown pigment, infiltrating the pancreas and the serosa of the duodenal wall.
Immunohistochemistry was positive for Melan-A, HMB45, vimentin, S-100 protein and negative for cytokeratin, all consistent with metastatic malignant melanoma.
At the moment, our patient is receiving adjuvant chemotherapy at an outside oncology clinic.