Halenda Kevin M, Kudchadkar Ragini R, Lawson David H, Kies Darren D, Zhelnin Kristen E, Krasinskas Alyssa M, Grossniklaus Hans E
Emory University School of Medicine, Atlanta, Ga., USA.
Departments of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Ga., USA.
Ocul Oncol Pathol. 2016 Apr;2(3):160-5. doi: 10.1159/000442950. Epub 2015 Dec 24.
The aim of this study was to report a case of metastatic uveal melanoma in which radioembolized nodular liver metastases decreased in size while infiltrative sinusoidal metastases progressed, leading to jaundice without obstruction of the biliary ducts.
The relevant clinical features, imaging, and histopathologic findings of this case are reviewed.
A 61-year-old Caucasian male with a history of uveal melanoma of the left eye status post plaque brachytherapy developed numerous liver metastases. After progression on systemic therapies, he underwent palliative radioembolization. Despite some radiographic improvement in the liver metastases, he developed hyperbilirubinemia without biliary tract obstruction or signs of liver failure. A biopsy of radiographically normal liver demonstrated extensive sinusoidal infiltration with melanoma.
Distinct angiographic and histopathologic growth patterns of metastatic uveal melanoma differ in their amenability to radioembolization. Sinusoidal infiltration may lead to hyperbilirubinemia in the absence of overt obstruction or liver failure.
本研究旨在报告一例转移性葡萄膜黑色素瘤病例，其中经放射性栓塞治疗后，结节状肝转移灶缩小，而浸润性窦状转移灶进展，导致出现黄疸且无胆管梗阻。
回顾该病例的相关临床特征、影像学及组织病理学表现。
一名61岁的白种男性，有左眼葡萄膜黑色素瘤病史，曾接受斑块近距离放射治疗，出现多处肝转移。在全身治疗进展后，他接受了姑息性放射性栓塞治疗。尽管肝转移灶在影像学上有一定改善，但他出现了高胆红素血症，且无胆道梗阻或肝功能衰竭迹象。对影像学表现正常的肝脏进行活检显示有广泛的黑色素瘤窦状浸润。
转移性葡萄膜黑色素瘤不同的血管造影和组织病理学生长模式对放射性栓塞治疗的敏感性不同。在无明显梗阻或肝功能衰竭的情况下，窦状浸润可能导致高胆红素血症。
