GIANT MALIGN OCULAR MELANOMA TREATED BY SELECTIVE ARTERIAL EMBOLIZATION AND EXENTERATION. CASE REPORT

  • Daniela STANA Emergency University Hospital Bucharest, Ophthalmology Departament
  • O. GRAMESCU Emergency University Hospital Bucharest, Ophthalmology Departament
  • G. SIMION Emergency University Hospital Bucharest, Ophthalmology Departament
  • Ana Maria DASCALU “Carol Davila“ University of Medicine and Pharmacy Bucharest

Abstract

Although rare, uveal melanoma is the most frequent primary malign tumor of the eye in adult population. If discovered in early phase, several conservative therapies are available, which can help the patient to preserve the eye and even the visual function: brachytherapy, proton beam radiotherapy, stereotactic radiotherapy, laser ablation or endo photocoagulation and limited resection of the tumor. In up to 40% of cases, enucleation is required due to tumoral increased size, while exenteration is required only exceptionally, in loco-regional advanced tumors. The paper presents the case of a patient diagnosed with ocular melanoma 12 years ago but refused surgery. She returns with a giant tumoral mass, complete disorganization of the eyeball and extensive extraocular lateral invasion, but no metastatic disease. Selective arterial embolization under angiographic control followed by exenteration were performed, with no local or at distance recurrence in a 2-year follow-up period. The disease course was favorable, despite many risk factors for poor prognosis. The patient is still checked regularly for metastatic disease, which remain a high risk for the following 10-15 years. Conclusions: Angiographic embolization may reduce the intraoperative risk of hematogenous dissemination and improve survival in regionally advanced ocular melanomas. The case was challenging due to increased size of the tumor, yet the predominantly lateral extension, spearing the orbital bones and intraconal space were positive factors for favorable outcome.

References

1. Nichols EE, Richmond A, Daniels AB. Disparities in Uveal Melanoma: Patient Characteristics. Semin Ophthalmol 2016; 31(4): 296-303.
2. Costache M, Dumitru AV, Pătraşcu OM, et al. A challenging case of ocular melanoma. Rom J Morphol Embryol 2015; 56(2 Suppl): 817-822.
3. Kaliki S, Shields C. Uveal melanoma: relatively rare but deadly cancer. Eye 2017; 31: 241-257.
4. Kaliki S, Shields CL, Shields JA. Uveal melanoma: estimating prognosis. Indian J Ophthalmol 2015; 63(2): 93-102.
5. Munzenrider JE. Uveal melanomas. Conservation treatment. Hematol Oncol Clin North Am 2001; 15(2): 389-402.
6. Sikuade MJ, Salvi S, Rundle PA, Errington DG, Kacperek A, Rennie IG. Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma. Eye(Lond) 2015; 29(9): 1194-1198.
7. Tarlan B, Kıratlı H. Uveal Melanoma: Current Trends in Diagnosis and Management. Turk J Oph-thalmol 2016; 46(3): 123-137.
8. Dogrusöz M, Jager M, Damato B. Uveal Melanoma Treatment and Prognostication. Asia-Pacific Journal of Ophthalmology 2017; 6(2): 186-196.
9. Lukenda A, Dotlic S, Vukojevic N, et al. Expression and prognostic value of putative cancer stem cell markers CD117 and CD15 in choroidal and ciliary body melanoma. Journal of Clinical Pathology 2016; 69: 234-239.
10. Ndulue JK, Mashayekhi A, Shields CL. Ciliary Body Seeding after Pars Plana Transvitreal Fine-Needle Aspiration Biopsy of Choroidal Melanoma. J Ophthalmic Vis Res 2020;15(2): 252-255
11. Straatsma BR, Diener-West M, Caldwell R, Engstrom RE; Collaborative Ocular Melanoma Study Group. Mortality after deferral of treatment or no treatment for choroidal melanoma. Indian J Oph-thalmol 2018; 66(10): 1395-1400.
12. Savlovschi C, Serban D, Andreescu C, Dascalu A, Pantu H. Economic analysis of medical management applied for left colostomy. Chirurgia (Bucur) 2013; 108(5): 666-669.
13. Yang J, Manson DK, Marr BP, Carvajal RD. Treatment of uveal melanoma: where are we now? Ther Adv Med Oncol 2018; 10: 1758834018757175.
14. Amaro A, Gangemi R, Piaggio F, et al. The biology of uveal melanoma. Cancer Metastasis Rev 2017; 36(1): 109-140.
15. Pfeffer U. Uveal Melanoma. Cancers (Basel) 2019; 11(12): 1986.
16. Şavlovschi C, Comandaşu M, Şerban D. Specifics of diagnosis and treatment in synchronous colorectal cancers (SCC). Chirurgia (Bucur) 2013; 108(1): 43-45.
17. Cooper C, Murali R, Doubrovsky A, et al. Synchronous and metachronous malignancies in patients with melanoma: a clinicopathologic study highlighting the role of fine-needle biopsy cytology and potential diagnostic pitfalls. Melanoma Research 2010: 20(3): 203-211.
18. Eschelman DJ, Gonsalves CF, Sato T. Transhepatic therapies for metastatic uveal melanoma. Semin Intervent Radiol 2013; 30(1): 39-48.
19. Kiss L, Kiss R, Porr PJ, et al. Pathological evidence in support of total mesorectal excision in the management of rectal cancer. Chirurgia (Bucur) 2011; 106(3): 347-352.
20. Savlovschi C, Serban D, Trotea T, Borcan R, Dumitrescu D. Post-surgery morbidity and mortality in colorectal cancer in elderly subjects. Chirurgia (Bucur) 2013; 108(2): 177-179.
21. Rowcroft A, Loveday BPT, Thomson BNJ, Banting S, Knowles B. Systematic review of liver directed therapy for uveal melanoma hepatic metastases. HPB (Oxford) 2020; 22(4): 497-505.
22. Savlovschi C, Brănescu C, Serban D, et al. Amyand’s hernia-a clinical case. Chirurgia (Bucur) 2010; 105(3): 409-414.
23. Dumitrescu D, Savlovschi C, Borcan R, et al. Clinical case-voluminous diaphragmatic hernia-surgically acute abdomen: diagnostic and therapeutical challenges. Chirurgia (Bucur) 2011; 106(5): 657-660.
24. Puippe G, Pfammatter T, Schaefer N: Arterial Therapies of Non-Colorectal Liver Metastases. Visze-ralmedizin 2015; 31: 414-422.
25. Villegas V, M, Monagas M, Campbell J, Murray T, G, Serrano L. Selective Intra-Arterial Embolization for Advanced Extra scleral Uveal Melanoma. Ocul Oncol Pathol 2018; 4: 44-47.
Published
2020-09-30