Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4044-4051
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4044
Distant metastasis in choroidal melanoma with spontaneous corneal perforation and intratumoral calcification: A case report
Tso-Wen Wang, Hung-Wei Liu, Youn-Shen Bee
Tso-Wen Wang, Youn-Shen Bee, Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
Hung-Wei Liu, Department of Pathology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
Youn-Shen Bee, Yuh-Ing Junior College of Health Care and Management, Kaohsiung 807, Taiwan
Youn-Shen Bee, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Wang TW reviewed the literature and contributed to manuscript drafting; Liu HW performed the pathological diagnosis, edited the manuscript, and contributed to developing the figures; Bee YS contributed to the surgical treatment of the patient, critical revision of the article for important intellectual content, and final approval of the article; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Youn-Shen Bee, MD, PhD, Associate Professor, Doctor, Surgeon, Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan. ysbee@vghks.gov.tw
Telephone: +886-7-3468217 Fax: +886-7-3468054
Received: June 11, 2019
Peer-review started: June 19, 2019
First decision: September 23, 2019
Revised: September 30, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: December 6, 2019
Processing time: 179 Days and 8.2 Hours
Abstract
BACKGROUND

Uveal melanoma is the most common primary intraocular malignancy in adults, but its incidence is low in Asian populations. Spontaneous corneal perforation and intratumoral calcification are rare presentations of choroidal melanoma (CM) , and reports regarding these presentations have been limited. Even after complete surgical treatment, the prognosis of CM patients is usually poor if distant metastasis is present. We here present a case of CM with unique presentations and early distant metastasis to the liver.

CASE SUMMARY

A 63-year-old Asian woman presented to our hospital with complaint of pain and brownish discharge from her left eye for 3 d. Imaging studies revealed intratumoral calcification within the left eye with eyeball rupture. Enucleation of the left eye was performed and pathological examination confirmed the diagnosis of CM. Systemic surveillance revealed no metastatic diseases. However, the patient was lost to follow-up 3 mo after surgery. At 1.5 years after the operation, she presented to our emergency department with complaint of dull epigastric pain that radiated to the back for 1 d. Imaging studies revealed a large mass at the upper abdomen abutting the pancreatic neck and body as well as several nodular lesions in the liver. Fine needle biopsy was performed and findings confirmed liver and pancreatic metastases.

CONCLUSION

This case highlights the importance of continued follow-up of patients with CM.

Keywords: Uveal melanoma; Choroidal melanoma; Corneal perforation; Calcification; Enucleation; Liver metastasis; Case report

Core tip: Although early metastasis of choroidal melanoma is rare, large primary tumor size, advanced stage and extraocular extension of choroidal melanoma increased the risk of metastasis. At initial diagnosis of choroidal melanoma, systemic surveillance can allow early detection of metastatic disease. Even after complete surgical excision, patients should be advised about the importance of continued follow-up monitoring, including physical examination, liver function testing, liver ultrasonography, and positron emission tomography-computed tomography scan or magnetic resonance imaging of the abdomen. Unfortunately, current treatment for metastatic disease is limited and the prognosis is usually poor.