Massive bleeding of ruptured metastatic hepatic melanoma treated by transarterial embolization

A rare case of ruptured liver metastases from a laryngeal cancer

Rupture of a metastatic liver tumor associated with laryngeal cancer is a very rare complication with no previous case in the literature. We present a case of ruptured liver metastases which was treated conservatively. Dynamic contrast-enhanced computed tomography demonstrated active extravasation and discontinuity of liver capsule. When the patient came to our hospital from the external medical center, we did not see active extravasation on control computed tomography. This case highlights the role of radiologic imaging in the diagnosis and follow-up of ruptured hepatic metastases.

Large Hemorrhagic Extrascleral Ciliary Body Melanoma Recurrence Treated With Transarterial Embolization and Coiling Followed by Exenteration

A 59-year-old male patient who suffered from a systemically metastasized, large extrascleral uveal melanoma recurrence of the left eye presented with active hemorrhage from the tumor. He had undergone proton beam irradiation for an epithelioid ciliary body melanoma 4 years before presentation and was lost to follow-up. Magnetic resonance angiography showed vascularization of the lesion via the ophthalmic and maxillary artery. Selective transarterial embolization of the tumor was conducted with polyvinyl alcohol microparticles followed by coiling of the supplying arteries. The bleeding stopped after 2 days and the tumor started to become necrotic. As tumor removal was the primary wish of the patient at this point in time, exenteration was carried out a week later without significant blood loss, intraoperative or postoperative complications. Socket healing was adequate, and the patient reported improved quality of life. He refused systemic palliative treatment and died 3 months after the intervention.

Intratumoral Hemorrhage of Liver Metastasis from a Rectal Neuroendocrine Tumor

A 56-year-old healthy woman was referred to our hospital for abdominal pain. Contrast-enhanced computed tomography (CT) showed a 14-cm-diameter liver tumor with intratumoral hemorrhage. We performed emergent transcatheter arterial embolization. She was referred to hepatic surgeon (M.M.) for resection. Preoperative colonoscopy showed an elevated lesion measuring 2 cm in diameter that was pathologically diagnosed as a rectal neuroendocrine tumor (NET). We performed low anterior resection of the rectum, followed by extended right hepatectomy for all hepatic lesions. Intratumoral hematoma was observed in the largest hepatic lesion (size: 150 mm×100 mm). Microscopy also indicated NET G2. We pathologically diagnosed a liver tumor from a rectal NET that bled spontaneously.

Hemoperitoneum Secondary to Rupture of a Hepatic Metastasis from Small Cell Lung Cancer during Chemotherapy: A Case with a Literature Review

A 65-year-old man was diagnosed with small cell lung cancer with multiple liver metastases. Three days after initiating chemotherapy, he experienced abdominal discomfort with hypotension. Computed tomography revealed a ruptured liver metastasis and the presence of hemorrhagic ascites. Transcatheter arterial embolization to the appropriate hepatic artery in concomitant with supportive therapies successfully stabilized his condition. Unlike with hepatocellular carcinoma, the rupture of a liver metastasis and associated hemoperitoneum is very rare in patients with lung cancer. We comprehensively reviewed the literature and found 10 similar cases with this serious condition. Physicians should therefore be aware of the risk of hemoperitoneum caused by ruptured liver metastases in patients with lung cancer.

Ruptured hepatic metastases of cutaneous melanoma during treatment with vemurafenib: an autopsy case report

BACKGROUND

The spontaneous rupture of hepatic metastases is rare compared to that of primary hepatic tumors. In addition, vemurafenib, a selective inhibitor of the mutant BRAF protein or gene product, has been reported to be extremely effective in patients with metastatic melanoma who harbor a BRAF V600E mutation.

CASE PRESENTATION

A 44-year-old female had previously undergone surgery for resection of a malignant melanoma in the lower right leg. Four years later, hepatic metastases became apparent, and transcatheter arterial embolization (TAE) was performed. Then she underwent treatment with vemurafenib. The size of the hepatic metastases markedly decreased. Two months later, they enlarged rapidly and ruptured, requiring emergency TAE. However, the patient developed hemorrhagic shock and died of renewed intra-abdominal bleeding on the 26th postoperative day.

CONCLUSIONS

This is a rare case of ruptured hepatic metastases of malignant melanoma during treatment with vemurafenib. Postmortem examination and immunohistochemical analysis indicated reactivation of the mitogen-activated protein kinase pathway in the metastatic tumor, suggesting secondary resistance to vemurafenib as the possible underlying mechanism.

Complete resection of isolated hepatic metastatic uveal melanoma with a notably long disease-free period: A case report and review of the literature

Although uveal melanoma frequently metastasizes to the liver, cases with a large solitary lesion with spontaneous intratumoral hemorrhage and necrosis are rarely encountered. Here, we report a case of metastatic hepatic melanoma that occurred in a 45-year-old Chinese male. The patient complained of the feeling of a full stomach for a month. Ten years earlier, the patient had undergone left ocular enucleation and artificial eye implantation at a different hospital. Postoperative pathology revealed choroidal melanoma without intrascleral or vascular involvement. Abdominal magnetic resonance imaging and computed tomography scan revealed a solitary lesion measuring 12 cm in diameter. A whole-body F-18-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography scan demonstrated a large solitary nodule with increased FDG uptake. Computed tomography angiography revealed that the huge mass had partially ruptured and was bleeding spontaneously. For diagnostic and therapeutic purposes, right hepatectomy was performed and histological examination revealed that the tumor was metastatic melanoma.

Management of bleeding liver tumors

Liver tumors bleed rarely; management has changed radically during the last 20years, advancing from emergency surgery with poor results to multidisciplinary management. The first steps are the diagnosis and control of bleeding. Abdominopelvic CT scan should be performed as soon as patient hemodynamics allow. When active bleeding is visualized, arterial embolization, targeted as selectively as possible, is preferable to surgery, which should be reserved for severe hemodynamic instability or failure of interventional radiology. When surgery is unavoidable, abbreviated laparotomy (damage control) with perihepatic packing is recommended. The second step is determination of the etiology and treatment of the underlying tumor. Adenoma and hepatocellular carcinoma (HCC) are the two most frequently encountered tumors in this context. Liver MRI after control of the bleeding episode generally leads to the diagnosis although sometimes the analysis can be difficult because of the hematoma. Prompt resection is indicated for HCC, atypical adenoma or lesions at risk for degeneration to hepatocellular carcinoma. For adenoma with no suspicion of malignancy, it is best to wait for the hematoma to resorb completely before undertaking appropriate therapy.

Spontaneous rupture of hepatic metastasis from small cell neuroendocrine carcinoma of maxillary sinus

BACKGROUND

Small cell neuroendocrine carcinoma of the maxillary sinus, a rare malignant tumor, has a poor prognosis because of its high incidence of metastasis. Moreover, metastatic cancer-induced hepatic rupture, characterized by hemoperitoneum, is infrequent, although several lines of evidences have reported that a wide variety of other neoplasms can cause this usually fatal manifestation.

CASE PRESENTATION

We now present the first case of a 49-year-old man with spontaneous rupture of hepatic metastasis from small cell neuroendocrine carcinoma of the maxillary sinus and ultimately resulted in massive intraperitoneal bleeding, which was successfully controlled by subsequent surgery (partial hepatectomy). The postoperative clinical manifestation of the patient was uneventful. He was discharged on the 16th day after operation and without any complication.

CONCLUSIONS

Small cell neuroendocrine carcinoma of the maxillary sinus is very scarce and unfortunately has a poor prognosis. It has potential to cause spontaneous metastatic rupture which can elicit fatal hemorrhage. Emergency surgery is effective, although the long-term outcome is still unsatisfactory.