Presymptomatic diagnosis of bronchogenic carcinoma associated with bilateral diffuse uveal melanocytic proliferation.
A 62-year-old man presented with bilateral diffuse uveal melanocytic proliferations (BDUMP) and painful flexor contractures of the fingers of both hands. All these features were considered paraneoplastic but extensive and repeated investigations revealed no underlying malignancy. Oral steroids and orbital radiotherapy were ineffective. The diagnosis was confirmed by trans-scleral biopsy of the right choroid. Rapidly progressive cataracts were treated by phacoemulsification. Severe exudative retinal detachment with rubeosis and neovascular glaucoma in the left eye were treated successfully by partial choroidectomy. Fifteen months after presentation, investigations detected a 22 mm, poorly differentiated adenocarcinoma, which was resected without complication. The ocular tumours in both eyes regressed, without improvement in vision of Light Perception, and the palmar fasciitis also improved. The patient remained free of tumour recurrence until sudden death from myocardial infarction five years after he first presented.
Sen
Julia
J
St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, Merseyside, UK. juliasen@jsen.freeserve.co.uk
Clewes
Adrian R
AR
Quah
Say-Aun
SA
Hiscott
Paul S
PS
Bucknall
Roger C
RC
Damato
Bertil E
BE
D002283:Carcinoma, Bronchogenic / Q000175:diagnosis* / Q000601:surgery; D002386:Cataract / Q000473:pathology; D049109:Cell Proliferation; D015862:Choroid Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D005208:Fasciitis / Q000473:pathology; D005384:Finger Joint / Q000473:pathology; D005451:Fluorescein Angiography; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000000981:diagnostic imaging / Q000473:pathology*; D018918:Phacoemulsification; D011013:Pneumonectomy; D012163:Retinal Detachment / Q000473:pathology; D014463:Ultrasonography