Liver metastases from uveal melanoma

P. Sánchez-Pobre, E. Pérez Martín¹, G. López Alonso¹, S. Sáenz-López, P. Martínez-Montiel,
I. Fernández and J. A. Solís Herruzo

Services of Digestive Diseases and ¹Pathology. Hospital Universitario 12 de Octubre. Madrid, Spain

      

      

An 82-year-old woman with a history of enucleation of the right eye one year previously due to a choroid melanoma was attended in our hospital because of anorexia, weight loss and vomiting. Physical examination revealed jaundice, ascites and hepatomegaly. The consistency of the liver was firm, the surface was irregular and its edge reached the right iliac crest. Laboratory data showed: serum bilirubin, 6.1 mg/dl; GGT, 533 IU/L; alkaline phosphatase, 704 IU/L; AST, 87 IU/L; ALT, 90 IU/L; CA 19.9, 105 UI/ml; CA12.5, 201 UI/ml, alpha fetoprotein and carcinoembryonic antigen were in normal ranges. Abdominal ultrasound disclosed hepatomegaly with multiple hypoechogenic areas suggesting infiltration of the liver parenchyma. Laparoscopy showed an enlarged liver with nodulated surface and dark grey colour (Fig. 1). Liver biopsy demonstrated that the liver architecture was preserved, and hepatocellular plates were normal. On one edge of the liver biopsy specimen there were nests of intrasinusoidal, atypical, pigmented cells (Fig. 2). These neoplastic cells belonged to two different types: spindle (Fig. 3a) or epithelioid (Fig. 3b).

Uveal melanoma is the most common primary intraocular malignant tumor in adults. The incidence of this tumor is 6/1.000.000/year in the United States and Europe (1). Despite early diagnosis, the 10-year survival is only 59% (2). This poor prognosis is ascribed to the presence of asymptomatic metastasis at diagnosis. In comparison with the melanoma of the skin that spreads through lymphatic route uveal melanoma tends to favour hematogenous spread, since eye lacks lymphatic drainage. Because metastasis are frequent and appear in early stages of the disease, annual control of the liver function should be done. Once confirmed that the tumor has disseminated, median survival time is of just 2 to 7 months. However, this survival time can be increased following resection of the affected liver segment and chemotherapy (3,4).

References

1. Mc Lean IW, Burnier MN Jr, Zimmerman LE, Jakobiec FA. Malignant melanoma of the uveal tract. In: Rosai J, Sobin LH, eds. Tumors of the eye and ocular anexa. Atlas of tumor pathology. Washington: Armed Forces Institute of Pathology, 1994. p. 161-94.

2. Mc Lean IW. The biology of hematogenous metastasis in human uveal melanoma. Virchow's Arch 1993 (A); 422: 433-7.

3. Zimmerman LE, Mc Lean IW. 1984. Do growth and onset of symptoms of uveal melanomas indicate subclinical metastasis? Ophthalmology 1991; 685-91.

4. Sato T, Babazono A, Shields JA, Shields CL, De Porter P, Mastrangelo MJ. Time to systemic metastasis in patients with posterior uveal melanoma. Cancer Invest 1997; 15: 95-105.

5. Salmon RJ, Levy C, Plancher C, et al. Treatment of liver metastasis from uveal melanoma by combined surgery-chemoterapy. Eur J Surg Oncol 1998; 24: 127-30.