Abstract
Cystic hepatic metastases arising from malignant melanoma are extremely rare, with the few such cases reported in the literature to date describing indeterminate imaging findings, being focused more on computed tomography. To the best of our knowledge, there is no prior report describing contrast-enhanced ultrasound findings of a solitary cystic liver metastasis from a primary rectal melanoma. We herein describe a case of a 41-year-old patient with a rectal melanoma, in whom the first manifestation of disease was a solitary complex cystic liver metastasis incidentally detected by ultrasound. On admission, our patient was free of specific symptoms and his laboratory test was normal. In this setting, contrast-enhanced ultrasound showed some distinctive features that helped us to make the correct diagnosis, confirmed subsequently by FNAC examination, thus allowing to provide the correct management for our patient. Although cystic metastases are rare, knowledge of CEUS imaging findings will be invaluable for radiologists and other medical subspecialties that may face such cases in the future in helping to provide adequate management for affected patients.
Riassunto
Metastasi epatiche di tipo cistico secondarie a melanoma maligno sono estremamente rare; ad oggi, i pochi casi riportati in letteratura descrivono reperti di imaging aspecifici, focalizzandosi quasi esclusivamente sul ruolo della Tomografia Computerizzata. Per quanto a nostra conoscenza, non ci sono precedenti lavori in letteratura che descrivano reperti eco-contrastografici di casi di metastasi cistiche solitarie epatiche a partenza da melanomi primitivamente rettali. Di seguito, descriviamo il caso di un paziente di 41 anni con melanoma rettale, nel quale la prima manifestazione clinica di malattia è stato il riscontro diagnostico di una lesione epatica cistica complex di natura metastatica, rilevata incidentalmente ad un esame ecografico di routine. Al momento del ricovero, il paziente era asintomatico e con profilo laboratoristico nella norma. In questo caso, l’eco-contrastografia ha mostrato caratteristiche semeiologiche peculiari che hanno permesso una corretta diagnosi presuntiva, confermata successivamente da un esame FNAC, consentendo un corretto management del paziente. Sebbene le metastasi cistiche rappresentino un’eventualità rara, riconoscerne i reperti CEUS è indispensabile sia per i radiologi sia per qualunque altro specialista che possa trovarsi ad affrontare tali casi in futuro, fornendo loro un valido strumento per la corretta gestione di questo tipo di pazienti.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification. The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.
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Corvino, A., Catalano, O., Corvino, F. et al. Rectal melanoma presenting as a solitary complex cystic liver lesion: role of contrast-specific low-MI real-time ultrasound imaging. J Ultrasound 19, 135–139 (2016). https://doi.org/10.1007/s40477-015-0182-1
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DOI: https://doi.org/10.1007/s40477-015-0182-1