A 72-year-old man presented to the Ophthalmology Department complaining of a one-month history of left eye loss.
The patient had been treated for prostate carcinoma 10 years prior with radiotherapy without relapse at the time of the study.
The visual acuity in the right eye (OD) was 5/10 and in the left eye of no light perception.
Intraocular pressure was 18 mmHg in the RE and 12 mmHg in the LE.
A thick smear showed ++ nuclear cataract in both eyes.
In the eye fundus of the RE there were no alterations, but in the left eye it was not appreciated by a hemovitreous.
Ultrasound showed a lobulated lesion occupying 4/5 of the vitreous chamber.
The hypothesis of CM or metastatic lesion was raised and screening for primary lesion was performed.
Toco-abdominal CT and liver tests were normal.
PET/CT was performed, which was positive in the eye (SUVmax: 7.2), liver (SUVmax: 5.7) and right lung hilium (SUVmax: 3.5).
After PET/CT, we reviewed abdominal CT, without identifying liver lesions, only a dubious nodular alteration of the poorly defined density and difficult to interpret due to its small size, not accessible for ultrasound or CT biopsy.
A magnetic resonance imaging (MRI) of the liver was performed, but it was ruled out due to the small size of the lesion.
Enucleation was decided due to the need for pathological anatomy to confirm the diagnosis prior to chemotherapy.
The severity of the disease, type of surgery and no possibility of visual recovery in the affected eye were reported.
Histopathology showed a large MC (17*17 mm) of spindle cells and immunohistochemical study showed intense cytoplasmic positivity for MELAM-A and HMB45.
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The patient, who at the end of the diagnostic process presented with CACS-1 (quality of life according to the Eastern Cooperative Oncology Group scale) for loss of vision, started palliative treatment with dacarbacin at a dose of 850 weeks.
In June 2011, it was reassessed presenting hepatic radiological progression, not detected on CT, but on PET/CT.
In June 2011, she started second-line treatment with ipilimumab (3 mg/kg every 3 weeks - 4 doses), with conservation of the general condition (EC), completing treatment without side effects.
Liver progression was again detected (at week 12 and 16 of treatment, as stipulated by the ipilimumab assessment protocol) identified on CT and PET/CT.
In November 2011, she started the third line of treatment with fotemustine at 75 mg/m2 with induction doses, for conservation of the general condition, without completing the treatment planned until the radiological evaluation planned, due to general deterioration.
He died in February 2012 (11 months after diagnosis).
