PET-CT 意外发现十二指肠晚期黑色素瘤转移:病例报告

Ovidiu-Angel Matei, L. Matei
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引用次数: 0

摘要

一名 62 岁的白种女性患者在接受皮肤黑色素瘤初步切除术和右腹股沟淋巴结切除术三年后出现高烧症状,被送往普福尔茨海姆赫利奥斯医院接受进一步医学评估。PET-CT 扫描时意外发现十二指肠降段和胰腺头部有可疑肿块。上部内窥镜检查和超声波检查显示,十二指肠降部有一个 30 毫米的肿瘤肿块,肿瘤已浸润胰头,并造成胰环梗阻。内镜活检证实肿瘤细胞带有黑色素颗粒,Melan-A/SOX10 染色阳性,表明存在转移性恶性黑色素瘤。重要的是,肿瘤没有显示 BRAF 基因突变。术后对这些额外染色进行了评估,结肠镜检查未发现任何肿瘤。术后,医生强烈建议患者接受手术切除,患者表示同意。普福尔茨海姆赫利俄斯医院普外科为患者实施了保留幽门的胰十二指肠切除术。在手术切除的Whipple标本中,肿块为5 x 4厘米大,实性,溃疡。组织学上,肿瘤浸润十二指肠各层及其周围组织。免疫细胞化学和电子显微镜检查结果证实了恶性黑色素瘤的诊断,与右大腿皮肤标本一致。因此,十二指肠病变是源于右大腿皮肤黑色素瘤的转移性皮肤黑色素瘤。患者术后恢复良好,13 天后出院。随后,她接受了伊匹单抗(Ipilimumab)和尼维鲁玛(Nivoluma)的免疫治疗,在5个月的随访期间,对患者进行了密切监测,未发现复发情况。患者的病史始于三年前的皮肤切除术,...........。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
PET-CT Incidental Finding of Duodenum Late Melanoma Metastasis: A Case Report
Three years post-primary resection of a skin melanoma with right inguinal lymphadenectomy, a 62-year old Caucasian female patient presented with high grade fever episodes and was admitted to Helios Hospital Pforzheim for further medical evaluation. A suspicious mass was unexpectedly discovered in the descending duodenum and head of pancreas during PET-CT scan. Upper endoscopic examination with ultrasonography revealed a 30 mm tumor mass originating from the descending part of the duodenum, which had infiltrated the head of pancreas and caused/resulted in loop obstruction. Endoscopic biopsy confirmed the presence of neoplastic cells with melanin granules and positive for Melan-A/SOX10 staining, indicating the presence of a metastatic malignant melanoma. Importantly, the tumor showed no BRAF-Mutation. These additional staining was evaluated postoperatively, and colonoscopy did not reveal any tumors. After this procedure, the patient was strongly recommended to undergo surgical resection, to which the patient agreed. A pylorus preserving pancreaticoduodenectomy was performed at the Department of General Surgery at Helios Hospital Pforzheim. In the surgically resected Whipple specimen, the mass was 5 x 4 cm large, solid and ulcerated. Histologically the tumor infiltrated all duodenal layers and the tissue around them. Immunocytochemistry and electronic microscopy findings confirmed the diagnosis of malignant melanoma consistent with the skin specimen from the right thigh. Herefore, the duodenal lesion was a metastasizing skin melanoma originating from the skin melanoma in the right thigh. The postoperative course of the patient was favorable, therefore she was discharged from the hospital after 13 days. Subsequently, she underwent immunotherapy with Ipilimumab and Nivoluma, and no recurrence was identified during the close monitoring of the patient in the 5-month follow-up period. The patient’s medical history began three years prior with resection of a skin ...........
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