Metastatic melanoma of the gallbladder diagnosed by EUS-guided FNA

Accepted Manuscript Metastatic melanoma of the gallbladder diagnosed by EUS-guided fine-needle aspiration Filippo Antonini, Luigi Acito, Stefano Sisti, Lucia Angelelli, Giampiero Macarri PII:

S0016-5107(16)00165-6

DOI:

10.1016/j.gie.2016.02.015

Reference:

YMGE 9837

To appear in:

Gastrointestinal Endoscopy

Received Date: 30 October 2015 Accepted Date: 11 February 2016

Please cite this article as: Antonini F, Acito L, Sisti S, Angelelli L, Macarri G, Metastatic melanoma of the gallbladder diagnosed by EUS-guided fine-needle aspiration, Gastrointestinal Endoscopy (2016), doi: 10.1016/j.gie.2016.02.015. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Metastatic melanoma of the gallbladder diagnosed by EUS-guided fine-needle aspiration Filippo Antonini, Luigi Acito1 , Stefano Sisti2, Lucia Angelelli3, Giampiero Macarri

Department of Gastroenterology, A.Murri Hospital, Polytechnic University of Marche, Fermo, Italy Medical Oncology, A.Murri Hospital, Fermo, Italy

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Pathological Anatomy and Histopathology, Department of Biomedical Sciences and Public Health,

Polytechnic University of Marche, Ancona, Italy Medical Oncology, Mazzoni Hospital, Ascoli Piceno, Italy

Financial support: None.

Corresponding author: Filippo Antonini, MD

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Potential competing interests: None

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UOC Gastroenterologia ed Endoscopia Digestiva Università Politecnica delle Marche

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Ospedale “A.Murri” 63900 – Fermo

E-mail: [email protected]

Telephone: +39.0734.6252249 Fax: +39.0734.6252252

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A 73-year-old woman with a history of malignant cutaneous melanoma (BRAF wild type) of the groin, excised 4 years previously, was referred for further characterization of an asymptomatic gallbladder mass discovered during follow-up on abdominal US (confirmed on CT scan). Blood tests showed mild elevation of gamma glutamyltransferase, erythrocyte sedimentation rate, and

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carcinoembryonic antigen. EUS confirmed a 30-mm irregular mass rising from the gallbladder wall and extending into the lumen (A). A EUS-guided fine-needle aspiration (EUS-FNA) of the lesion was performed in a single pass, changing the position of the echo-endoscope to safely target the

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solid tissue only without going through the gallbladder lumen (B). The procedure was uneventful. Adequate tissue specimen was obtained for cytopathological assessment and proved to be metastatic

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melanoma with BRAF mutation (C, D, H&E x100). Further investigations also revealed metastasis to the urinary bladder. The patient was started on BRAF inhibitor Vemurafenib with rapid response. In this case EUS-FNA enabled diagnosis of still limited metastatic disease involving an unusual location and provided tissue for repeated genetic testing that was crucial to address the

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following treatment.

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