Metastatic ocular melanoma to the kidney 20 years after initial diagnosis

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  • NOTIA

    ULO

    ACMe es ome 0 yewi ion 2no ss wex aledthe intaof 8.e

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    Acer treated with external beam radiotherapy pre-sented with intermittent gross hematuria. His his-torennohahisscauplabwiT

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    CASE REPORT

    ALLy was notable for having undergone leftucleation in 1984 for confined, ocular mela-ma. He had not required adjuvant therapy andd no evidence of disease recurrence. As a part ofhematuria evaluation, a computed tomographyn was obtained demonstrating a 3.5-cm, rightper pole, enhancing, cystic mass (Fig. 1). Hisoratory and metastatic evaluations were other-se negative.he mass was approached using pure laparo-pic techniques and appeared to be grossly cysticintraoperative inspection. Given that the lesion

    was quite endophytic, the renal hilum was dis-sected out and temporarily clamped with laparo-scopic bulldog clamps. Themass was then resectedwith a margin of normal tissue. The collecting sys-tem was closed with a running 2.0 Vicryl suture,and a series of capsular sutures were placed to re-approximate the edges of the defect over a Surgicelbolster. The total ischemic time was 32 minutes.No complications occurred, and the patient recov-eredwell postoperatively. Rigorous follow-up eval-uations revealed no evidence of disease recurrence.Pathologically, the gross specimen appeared

    dark purple andwell circumscribed, measuring 4.0

    m the Departments of Urology and Pathology, Vanderbiltiversity Medical Center, Nashville, Tennesseeddress for correspondence: Brian M. Levin, M.D., Depart-nt of Urology, Vanderbilt University Medical Center, A-1302

    FIGURE 1. Computed tomography scan demonstratingcystic tumor located in upper pole of right kidney.METASTATIC OCULAR MELAYEARS AFTER INI

    BRIAN M. LEVIN, FOUAD I. BO

    ABSTRtastatic tumors are the most common malignancitastatic ocular melanoma to the kidney occurring 2th gross hematuria. He had undergone left enucleatt required adjuvant therapy. A right upper pole macised laparoscopically. Pathologic examination revekidney is rare. A high index of suspicion must be maa nonrenal malignancy. UROLOGY 66: 658.e1165

    etastatic tumors are themost commonmalig-nancies of the kidney, far outnumbering pri-

    ry renal neoplasms. Most renal metastases areltifocal and associated with widespread nonre-l metastases.1 To our knowledge, we report thest case of isolated renal metastasis secondary toular melanoma occurring 20 years after initialgnosis and treatment.

    CASE REPORT

    71-year-old man with a history of prostate can-cmrevno

    dical Center North, Nashville, TN 37232-2765. E-mail:an.m.levin@vanderbilt.eduubmitted: October 29, 2004, accepted (with revisions): March005

    2005 ELSEVIER INC.RIGHTS RESERVEDMA TO THE KIDNEY 20L DIAGNOSIS

    S, AND S. DUKE HERRELL

    Tf the kidney. We report a rare case of isolatedars after diagnosis. A 71-year-old man presented0 years previously for ocular melanoma and hadas identified on computed tomography and wasmetastatic melanoma. Metastatic melanoma to

    ined in any patient with a renal mass and a history12, 2005. 2005 Elsevier Inc. 3.0 cm 3.5 cm. The microscopic specimenealed a confined, completely excised mela-ma. Hematoxylin-eosin staining demonstrated

    0090-4295/05/$30.00doi:10.1016/j.urology.2005.03.035 658.e11

  • spplastatin

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    cines have demonstrated favorable improvementsin overall and disease-free survival rates.69 Giventhat this patients disease recurred with a singlemetastatic deposit and he had no other signs ofdisease, he has received no adjuvant immunother-apy.Although metastatic melanoma to the kidney

    typically causes multifocal lesions, in this case itpresented as a solitary mass.1 Therefore, a highindex of suspicion must be maintained in any pa-tient with a renal mass and a prior history of non-renal malignancy. This is particularly true for ocu-lar melanoma, which may metastasize after aprolonged disease-free interval.10

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    FIGcaint

    65indled melanoma cells with scattered intracyto-smic melanin (Fig. 2). Immunohistochemicalins were positive for HMB45, S100, and vimen-, confirming malignant melanoma.

    COMMENT

    utopsy series have shown that 7% to 12% oftients dying of cancer have renal metastases,king it one of the most common sites of meta-tic disease.24 The most common primary tu-rs, in decreasing order of frequency, are lung,east, and skin (melanoma) and tumors of thenitourinary, gastrointestinal, and gynecologiccts. In patients dying of malignant melanoma,e kidneywas involved in 24% to 50% of cases.5 Ineview of a large series of patients with metastaticular melanoma, the liver was the most commontial site of metastasis, with no cases of renal in-lvement.6imilar to renal cell carcinoma, melanoma is anmunologically active disease. Various formsof sys-ic immunotherapy, including bacille Calmette-rin, interferon-alpha, and allogenic tumor vac-

    URE 2. Hematoxylin-eosin stain showing cytologi-lly bland, spindled melanoma cells with scatteredracytoplasmic melanin pigment.8.e12REFERENCES1. Choyke PL, White EM, Zeman RK, et al: Renal metas-es: clinicopathologic and radiologic correlation. Radiology2: 359363, 1987.2. Pollack HM, BannerMP, and AmendolaMA: Other ma-ant neoplasms of the renal parenchyma. Semin Roentgenol: 260274, 1987.3. Bracken RB, Chica G, Johnson DE, et al: Secondaryal neoplasms: an autopsy study. South Med J 72: 8067, 1979.4. Klinger ME: Secondary tumors of the genitourinaryct. J Urol 65: 144153, 1951.5. Stein BS, and Kendall AR: Malignant melanoma of theitourinary tract. J Urol 132: 859868, 1984.6. Veronesi U, Adamas J, Aubert C, et al: A randomizedl of adjuvant chemotherapy and immunotherapy in cuta-us melanoma. N Engl J Med 307: 913916, 1982.7. Kirkwood JL, Strawderman MH, Ernstoff MS, et al: In-feron alfa-2b adjuvant therapy of high-risk resected cutane-s melanoma: the Eastern Cooperative Oncology Group trialT 1684. J Clin Oncol 14: 717, 1996.8. Hsueh EC, Gupta RK, Qi K, et al:Correlation of specificmune responses with survival in melanoma patients withtant metastases receiving polyvalent melanoma cell vac-e. J Clin Oncol 16: 29132920, 1998.9. Morton DL, Ollila DW, Hsueh EC, et al: Cytoreductivegery and adjuvant immunotherapy: a new managementadigm formetastatic melanoma. CACancer J Clin 49: 101, 1999.0. Lorigan JG, Wallace S, and Mavligit GM: The preva-ce and location of metastases from ocular melanoma: im-ng study in 110 patients. AJR Am J Roentgenol 157: 12791, 1991.UROLOGY 66 (3), 2005

    METASTATIC OCULAR MELANOMA TO THE KIDNEY 20 YEARS AFTER INITIAL DIAGNOSISCASE REPORTCOMMENTREFERENCES

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