Korean J Gastroenterol.  2024 Apr;83(4):163-166. 10.4166/kjg.2024.011.

Metastatic Melanoma of the Common Bile Duct Presented with Dyspepsia

• Cetiner OF
• Dundar HE
• Kantarcioglu-Coskun S
• Torun S
• Tokmak S

• KMID: 2555650
• DOI: http://doi.org/10.4166/kjg.2024.011

Abstract

Malignant melanoma (MM) is an aggressive tumor that can metastasize to any organ, but biliary tract metastasis is scarce. We describe a very rare case of MM metastasis to the common bile duct (CBD), presented with only dyspeptic symptoms. The patient had mildly elevated alkaline phosphatase and gamma-glutamyl transferase levels. Magnetic resonance cholangiopancreatography demonstrated a dilated common bile duct with a distal stricture. The MM diagnosis was established with the ampulla of Vater biopsy specimens obtained by endoscopic retrograde cholangiopancreatography (ERCP), and the patient’s symptoms were resolved after biliary stenting. Both primary CBD cancer and other cancer types like MM that metastasize to CBD can cause obstruction and can be manifested only by dyspeptic symptoms. MM metastasis to CBD can cause obstruction manifested only by dyspeptic symptoms without obstructive jaundice. ERCP can be employed as a promising option for treatment and diagnosis. New-onset dyspeptic symptoms in patients with a history of MM should be investigated thoroughly, especially in the context of biliary metastasis.

Keyword

Malignant melanoma; Common bile duct; Metastasis; Endoscopic retrograde cholangiopancreatography; Biopsy

Figure

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  Fig. 1 Magnetic resonance cholangiopancreatography (MRCP) image of the dilated common bile duct (12 mm) and the distal stricture (red arrow).

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  Fig. 2 Endoscopic retrograde cholangiopancreatography (ERCP) images of the ampulla of Vater mucosa, which was irregular, fragile, and nodular.

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  Fig. 3 Clusters of atypical cells epithelioid appearance in the lamina propria, ×4, and ×20, Hematoxylen & Eosin (A, B), adequate IgG4 positive plasma cells were not present ×10, IgG4 (C), tumor cells stained positive with MelanA and SOX10, ×10 and ×20, respectively (D, E), tumor cells showed no immunostaining with PanCK ×10 (F).

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