Choroidal melanoma metastatizing to the biliary system: A diagnostic dilemma

Late Recurrence of Malignant Choroidal Melanoma Mimicking Hepatocellular Carcinoma

Late recurrence (after more than 10 years) of choroidal melanoma, though infrequent, has been documented well in Western countries. In India, however, this disease being uncommon, there is no data regarding its late recurrence. Here, we report a case of late metastatic manifestation of choroidal melanoma in the form of liver metastases in a 45-year-old man who presented with abdominal pain; metastases to liver occurred 10 years after enucleation of the right eye.

Delayed presentation of a metastatic choroidal melanoma to the liver: The latency of an elective metastatic localization

INTRODUCTION

Choroidal melanoma is the most common primary intraocular malignant tumour and the second most common type of primary malignant melanoma in the body. Biologically, cutaneuous and ocular melanoma may be considered different, in terms of both metastatic diffusion and metastatic latency. The principal target organ for metastasis of the ocular melanoma is the liver.This distinctive behaviour is also sustained by different metastatic latency, as some patients present with metastatic ocular melanoma several years after the treatment of the primary tumor.

PRESENTATION OF CASE

A 60 year-old male who had undergone left ocular enucleation for choroid melanoma 20 years ago was referred to our department with a three months history of diffuse abdominal pain, fever, weight loss and massive ascites. Abdominal ultrasonography (US) and total body computed tomography (CT) scan were performed and revealed diffuse liver metastases, associated with peritoneal carcinosis, bilateral adrenal metastases and a large mass in the left kidney compatible with another secondary localization. An ultrasound guided fine needle agobiopsy (FNA) of liver lesions was performed and the pathological findings led to the diagnosis of liver metastasis from choroidal melanoma. The patient died a few weeks later for hepatic failure.

DISCUSSION

Currently, there is no consensus regarding the optimal follow-up in terms of screening modality or time interval after the treatment of the primary ocular melanoma.

CONCLUSION

Patients with gastrointestinal symptoms and a history of choroidal melanoma should be investigated for the presence of gastrointestinal or liver metastases, although the original primary malignancy was diagnosed years before the patient's presentation.