Uveal melanoma with diffuse bone marrow involvement

Sheng-Yen Hsiao and Tsai-Yun Chen

A 76-year-old man received left eye enucleation resulting from ablepsia in May 2013. A pathological review suggested a malignant melanoma of the choroid body with staging of T2b (panel A); white quadrangle in A, original magnification, ×200 (panel B). The patient visited an oncology outpatient department for persistent low back pain and asthenia for more than 1 month in September 2013. For malignant melanoma surveillance, unexpectedly, a whole-body 18F-fluorodeoxyglucose-positron emission tomography revealed increased 18F-fluorodeoxyglucose uptake over the whole cervical-thoracic-lumbar spine, sacrum, pelvic bone, bilateral proximal femoral bone, and bilateral scapular bone (panel C). Liu’s stain of a peripheral blood smear revealed leukoerythroblastosis and circulating tumor cells with abundant cytoplasm and bizarre nucleus (panel D, arrow). Bone marrow study demonstrated nonhematopoietic cells with prominent nucleus arranged in clusters (panel E, arrow). Immunohistochemical analysis was positive for S-100 and human melanoma black 45, thus identified as metastatic melanoma. After confirmed diagnosis, the patient died of respiratory failure secondary to pneumonia 2 months later.

Uveal melanoma with bone marrow involvement is very rare. However, similar clinical pictures have been reported in patients with cutaneous melanoma. An interesting finding of this case is the presentation as hematologic malignancy in positron emission tomography scan and blood smear.


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