S1571 Isolated Melanoma to Pancreas in the Context of Myeloproliferative Neoplasm: A Rare Occurrence
Notice bibliographique
Résumé
Introduction: Isolated metastatic melanoma to the pancreas is a rare occurrence, representing less than 1 percent of metastatic melanoma. Case Description/Methods: A healthy 69 year old female presented to her family physician with a pigmented lesion on her left lateral arm which had changed in colour and size over 9 months; a deep shave biopsy revealed melanoma. Subsequent local excision and axillary lymph node biopsy were negative. Her melanoma was staged at IB. She had no clinical evidence of recurrence in follow-up 9 months later. 11 months after treatment, she presented with abdominal pain radiating to her back and associated nausea. Outpatient blood work revealed a new leukocytosis of 22 x 109/L with 82% neutrophils and new normocytic anemia (hemoglobin 105 g/L). C-reactive protein levels were elevated (99.11 mg/L). CA 19-9 levels were normal. A CT of her abdomen and pelvis revealed a large, heterogenous, low-density, 6.3 x 4.5 cm mass arising from the pancreas suspicious for primary pancreatic malignancy or lymphoma. There was no evidence of metastatic disease. The patient was referred to both hematology and HPB surgery, who subsequently referred her to gastroenterology for urgent endoscopic ultrasound-guided biopsy for tissue diagnosis of this pancreatic mass (Figure 1). The pathology was consistent with metastatic melanoma and molecular profiling revealed a pathogenic NRAS mutation (c.181C >A;p.Q61K). There was no evidence of BRAF (including V600E/K) or KIT mutations. The patient concurrently had a bone marrow biopsy and aspirate which were negative for lymphoma. However, she did have TET2 positive myeloproliferative neoplasm that was identified postmortem. Her metastatic melanoma mass was not amenable to resection, and the patient was referred to medical oncology. Unfortunately, she deteriorated quickly and was deemed too frail to receive palliative chemotherapy. She was referred to palliative care and passed away several days later. Discussion: This case highlights a rare finding in isolated melanoma metastasis to the pancreas that may have been accelerated by the patient being immunocompromised by a concurrent myeloproliferative neoplasm. A high index of suspicion must be raised in patients with abdominal symptoms and melanoma history, particularly if they have an underlying immunocompromised state, as the therapeutic window for these patients is narrow. Referral for biopsy, typically endoscopic ultrasound-guided, is critical in this population to establish the diagnosis and guide management.Figure 1.: On EUS in the pancreatic body, a 7cm mass was visualized with some anechoic internal foci, suggestive of possible areas of necrosis. (a) The mass was in close proximity to the splenic artery and vein. Three passes were made into the lesions with a 22G FNB needle and good strands of tissue were obtained. (b)
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».