Mucinous cystic neoplasms (MCNs) can occur in the pancreas and liver. Classically, these cystic lesions are lined by columnar mucinous epithelium with underlying ovarian-type stroma. It has been proposed that cysts with ovarian-type stroma and nonmucinous epithelium be considered separate entities in both the pancreas and liver. Using a series of 104 pancreatic and 32 hepatic cases, we aimed to further characterize the epithelium present in MCNs. Mucinous epithelium was defined as pancreatic intraepithelial neoplasia-like columnar cells with pale pink/clear apical mucin. Epithelial cells ranging from flat to cuboidal to short columnar without obvious mucin or goblet cells were classified as nonmucinous/biliary epithelium. A mixture (at least 5%) of mucinous and nonmucinous/biliary epithelium was noted in 81%. Almost half (47%) of the cases had abundant (>50%) nonmucinous/biliary epithelium. Of the 71 cases with ≤50% nonmucinous/biliary epithelium, 8 cases demonstrated high-grade dysplasia (7 pancreas, 1 liver) and 14 demonstrated invasive adenocarcinoma (11 pancreas, 3 liver). Conversely, of the 58 cases with >50% nonmucinous/biliary epithelium, not a single case of high-grade dysplasia (P=0.007) or invasive carcinoma (P<0.001) was identified. In summary, nonmucinous/biliary epithelium frequently occurs in MCNs of the pancreas and liver. As mucinous and nonmucinous/biliary epithelia often occur together, there does not appear to be enough evidence to regard cases with predominantly nonmucinous/biliary epithelium as separate entities. Our findings suggest that mucinous change is a "progression" phenomenon in MCNs of the pancreas and liver, and only when abundant mucinous epithelium is present is there a risk of progression to malignancy.
The aim of this study was to report a case of metastatic uveal melanoma in which radioembolized nodular liver metastases decreased in size while infiltrative sinusoidal metastases progressed, leading to jaundice without obstruction of the biliary ducts.The relevant clinical features, imaging, and histopathologic findings of this case are reviewed.A 61-year-old Caucasian male with a history of uveal melanoma of the left eye status post plaque brachytherapy developed numerous liver metastases. After progression on systemic therapies, he underwent palliative radioembolization. Despite some radiographic improvement in the liver metastases, he developed hyperbilirubinemia without biliary tract obstruction or signs of liver failure. A biopsy of radiographically normal liver demonstrated extensive sinusoidal infiltration with melanoma.Distinct angiographic and histopathologic growth patterns of metastatic uveal melanoma differ in their amenability to radioembolization. Sinusoidal infiltration may lead to hyperbilirubinemia in the absence of overt obstruction or liver failure.
Abstract Intraocular teratomas are rare neoplasms with only three previously reported cases. We present the fourth case of intraocular teratoma and the second associated with sacrococcygeal teratoma. While the nature of the association between intraocular teratomas and sacrococcygeal teratomas is unclear it suggests a need for careful ophthalmologic follow-up of infants with congenital sacrococcygeal teratomas.
Melanoma is commonly known to metastasize to the gastrointestinal tract (GIT) with a predilection for the small bowel (SB). Early signs of melanoma in the GIT are iron deficiency anemia and abdominal pain with later findings including overt gastrointestinal bleeding (GIB), obstruction or intussusception. This case highlights a common presentation of metastatic melanoma requiring multiple endoscopic modalities for diagnosis. An 81 year-old male with a history of metastatic melanoma to the brain presented at an outside hospital with bright red blood per rectum. Initial work-up included an esophagoduodenoscopy (EGD) revealing non-erosive gastritis and a colonoscopy remarkable for large amounts of blood coming from the SB. A nuclear medicine tagged RBC scan did not localize a source of bleeding. He underwent a video capsule endoscopy (VCE), showing multiple non-bleeding SB arteriovenous malformations (AVMs), which he was transferred to our tertiary care center for further intervention and management. Due to report of SB AVMs, he underwent an antergrade single balloon enteroscopy revealing a 3 cm infiltrative, ulcerative, easily friable mass in the mid-jejunum (Figure A). Biopies were taken and pathology was consistent with metastatic melanoma (Figure B). Diagnosis and treatment of SB metastatic melanoma resolves the presenting complications but more importantly is associated with prolonged survival1. A randomized prospective study showed higher diagnostic yield of VCE compared to push enteroscopy (50% and 24% respectively) for obscure GIB. This paper cites other studies that collaborate this finding2. In this study, VCE did not miss lesions detected by enteroscopy while enteroscopy missed lesions detected by VCE in 26% of patients. Thus it is surprising that the large sized melanoma was not identified after a VCE, but instead identified with pursuant enteroscopy. This case illustrates the importance of using multiple endoscopic modalities, even in diagnosing lesions commonly presenting in the GIT, as no single modality is highly sensitive to evaluate for SB bleeding. As in our case, diagnosis of metastatic melanoma in the SB will potentially lead to further surgical treatments and increased survival.Figure 1Figure 2
