Lethal metastatic ciliary body melanoma without hepatic disease in a young girl

Abstract

AbstractPurpose To illustrate a case report of rapid metastatic death due to a ciliary body melanoma in a a young female of 19 years of age, with no hepatic metastatic disease.Methods A young algerian girl was send for conservative treatment for a ciliary body tumor of the left eye on the 19th of march 2012.This eye was blind, with a white cataract.Rubeosis iridis was present on the whole iris surface with total angle closure ,ocular pressure was 41 mm and US showed a temporal ciliary body tumor of 3.5 mm in height and 10 mm in diameter .Results An enucleation was performed on March 20th , but the patient had to be hospitalized on the same afternoon in Intensive Care Unit for drainage of bilateral pleural effusion, purely inflammatory .Full Body CT Scan has shown brain secondary foci of 3 and 5 mm on both frontal lobes.A nodular lesion of 7 mm was also present on the Fowler lung lobe.The liver was not invaded but massive mesenteric necrotic lesions with peritoneal effusion were found. Surgical biopsy of the mesenteric lesions was done in the General Surgery Unit on March 22nd showing melanoma cells.In the same time the ocular pathologists diagnosis was an epithelioid ciliary body melanoma of 10x10 mm. On April 3rd a pleurodesis was created with pleural biopsies in the Thoracic Surgery Unit.Mesothelial pleural hyperplasia without malignancy sign was diagnosed.A chemotherapy with Muphoran has been advised by oncologists and begun soon after she returned in her country where she died at the end of May .Conclusion Death by metastatic disease can also occur without detectable hepatic lesions by US or CT Scan in case of severe ciliary body melanoma.The mechanism of responsible mesenteric lesions for death in the hepatic vicinity has to be explained.