Partial hepatectomy for primary hepatic melanoma: a report of two cases and review of the literature
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Partial hepatectomy for primary hepatic melanoma: a report of two cases and review of the literature Yuhua Zhang, Zhiming Hu, Weiding Wu, Jie Liu, Defei Hong and Chengwu Zhang*
Abstract Malignant melanoma is an extremely aggressive cancer arising from melanocytes, associated with the development of metastases in up to 20% of patients. Although the liver is a frequent metastatic site of malignant melanoma, primary hepatic melanoma (PHM) is rare. The treatment of PHM is controversial, and the prognosis for affected patients remains poor. We present two PHM patients who underwent partial hepatectomy at our institution and review the clinical and pathological data from these cases. Our results suggest that it is difficult to make a preoperative diagnosis of PHM without pathological results. For patients with resectable PHM, surgical resection is a potentially curative treatment. Keywords: Primary hepatic melanoma, Diagnosis, Surgery, Prognosis
Background The American Cancer Society estimated that in 2012, 76,250 new cases of melanoma were diagnosed in the United States and 9,180 patients died from the disease [1]. Ninety percent of all melanomas are of cutaneous origin [2]. Although the liver is a frequent site of metastases from melanomas, primary hepatic melanoma (PHM) is rare. In this report, we present two patients with PHM who underwent partial hepatectomy in our institution and review the literature addressing this topic. Case presentation Case 1
A 60-year-old male presented with a 1-month history of upper abdominal discomfort. Physical examination found no palpable lymph nodes, scars or pigmented patches. The abdomen was soft with no tenderness and no palpable liver or spleen. There was no history of an excised pigmented lesion or history of eye surgery. Liver function tests did not show signs of liver injury (alanine aminotransferase: 25 U/L, aspartate transaminase: 39 U/L, albumin: 36.4 g/L). The tumour markers * Correspondence: [email protected] The hepatobiliary, Pancreatic and Minimal Invasive Surgery Department, Zhejiang Provincial People’s Hospital, 158# Shangtang Road, Hangzhou, Zhejiang 310014, China
alpha-fetoprotein (AFP) (3.49 μg/L), carcinoembryonic antigen (2.04 μg/L), carbohydrate antigen 19 to 9 (12.8 U/mL) as well as complete blood count (red blood cells: 4.82 × 1012/L, white blood cells: 7.37 × 109/L, platelets: 223 × 109/L) were all in the normal range. Abdominal ultrasonography revealed a mass in the right lobe of the liver with liquid at its centre. Computed tomography (CT) showed a 14 × 14 cm mixed-attenuation mass with a pseudocapsule and central low attenuation in the right lobe of the liver (Figure 1A). Magnetic resonance imaging (MRI) demonstrated an isointense high-signal lesion in the right lobe of the liver on T1-weighted imaging (T1W1), with mixed low- and high-signal intensity on T2-weighted imaging (T2W1) (Figure 1B). The mass showed peripheral enhancement with a contrast agent during the arterial and portal ve
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