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Case Reports
. 2022 Jun 1:27:101607.
doi: 10.1016/j.ajoc.2022.101607. eCollection 2022 Sep.

Local recurrence of uveal melanoma and concomitant brain metastases associated with an activating telomerase promoter mutation seven years after secondary enucleation

Jacob S Heng  1 , Brittany M Perzia  1 , John H Sinard  1   2 , Renelle Pointdujour-Lim  1   3
Affiliations
Case Reports

Local recurrence of uveal melanoma and concomitant brain metastases associated with an activating telomerase promoter mutation seven years after secondary enucleation

Jacob S Heng et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To describe a case of local recurrence of uveal melanoma with concomitant brain metastases after secondary enucleation.

Observations: A 73 year-old patient presented with dizziness and gait instability. MRI of the orbits and brain showed an anophthalmic socket with an orbital implant and an associated optic nerve mass as well as multiple mass lesions in the brain. The patient's history was significant for secondary enucleation for uveal melanoma recurrence seven years prior to presentation. Histopathology of the enucleated eye revealed no signs of extrascleral extension or optic nerve invasion. Biopsy of the optic nerve mass confirmed recurrent uveal melanoma with somatic mutations in GNAQ (Q209L) and the telomerase (TERT) promoter (c.1-124C > T) found on targeted next-generation sequencing (NGS). The same mutations were found in the primary tumor in the patient's archived enucleation samples.

Conclusions: Local recurrence of uveal melanoma can occur after enucleation and is associated with an increased risk of systemic metastases. It is important for clinicians to monitor patients for local recurrence and systemic metastases even after enucleation. Genetic biomarkers may play an important role in identifying tumors at highest risk of local recurrence and metastasis. To our knowledge, this is the first case study to describe the TERT promoter mutation c.1-124C > T in the setting of recurrent uveal melanoma.

Keywords: CT, Computed tomography; Enucleation; IV, Intravenous; Local recurrence; MRI, Magnetic resonance imaging; Melanoma; Orbit; Uveal melanoma.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
(A) Fluorescein angiogram image of a large circumpapillary choroidal melanoma (B) T1 axial image of MRI orbits showing the large circumpapillary choroidal melanoma (arrows) without evidence of extraocular extension (C) H&E-stained section (4x magnification) of enucleated left eye showing large choroidal melanoma (arrows) surrounding optic nerve. (D) H&E-stained section (40x magnification) of choroidal melanoma showing both spindle and epithelioid cell types.
Fig. 2
Fig. 2
(A) T1 axial image of MRI orbits showing a mass encasing the optic nerve sheath and extending through the orbital apex (arrow). (B) T1 axial image of MRI orbits showing a large mass in the sellar region (arrow) continuous with the optic nerve sheath mass in 2A. (C) T1 axial image of MRI brain showing mass in left frontal lobe (arrow). (D) T1 axial image of MRI brain showing mass in right pons (arrow).
Fig. 3
Fig. 3
(A) H&E-stained section (4x magnification) of biopsy sample of left optic nerve mass. (B) H&E-stained section (40x magnification) of biopsy showing both spindle and epithelioid cell types. (C) Positive Melan-A immunohistochemical staining of biopsy sample (40x magnification). (D) Positive SOX10 immunohistochemical staining of biopsy sample (40x magnification).
See this image and copyright information in PMC

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