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Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma
Published on: January 25, 2015
DELAYED-ONSET BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION ASSOCIATED WITH GASTRIC ADENOCARCINOMA
Rosa Dolz-Marco1, Ferran Vilaplana, Roberto Gallego-Pinazo
1*Unit of Macula, University and Polytechnic Hospital La Fe, Valencia, Spain; †Retics Oftared, Prevention, Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology, Institute of Health Carlos III, Madrid, Spain; ‡Vitreous Retina Macula Consultants of New York, New York, New York; §Centro de Oftalmologia Barraquer, Barcelona, Spain; ¶LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; **Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; and ††Department of Ophthalmology, New York University School of Medicine, New York, New York.
Purpose:
To report an unusual case of delayed-onset bilateral diffuse uveal melanocytic proliferation in a patient with a remote history of gastric adenocarcinoma 17 years earlier.
Methods:
Case report of a patient with bilateral diffuse uveal melanocytic proliferation including comprehensive systemic and ocular examinations.
Results:
A 78-year-old man presented with a history of progressive bilateral vision loss during the 4 previous years associated with fever of unknown origin. He underwent total gastrectomy 17 years earlier as a treatment for gastric adenocarcinoma. Funduscopic examination revealed multiple subretinal pigmented and nonpigmented lesions involving the posterior pole of both eyes. These lesions showed early hyperfluorescence on fluorescein angiography, producing a giraffe pattern. Spectral-domain optical coherence tomography showed intraretinal and subretinal fluid with multiple hyperreflective mounds involving the retinal pigment epithelium. Treatment with the intravitreal anti-vascular endothelial growth factor agent, ranibizumab, produced anatomical improvement in both eyes but visual improvement in just the right eye.
Conclusion:
Although delayed-onset bilateral diffuse uveal melanocytic proliferation may occur, it is important to rule out a second malignancy. To the knowledge of the authors, this is the first report of delayed-onset bilateral diffuse uveal melanocytic proliferation associated with gastric adenocarcinoma. Treatment with intravitreal anti-vascular endothelial growth factor therapy warrants further evaluation.
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