27906105 Visualization

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