Monday, April 19, 2010

The Answer is Cancer

These are two separate patients with the same disease. The other finding is hepatomegaly. When scanned, a liver mass is found. The patient, unfortunately, has dementia. His estranged daughter says, "Well, he had some sort of minor surgery years ago, but he never told me what it was for."

Challenge: One unifying diagnosis connects the reason for the prior surgery, the current presentation now, and the liver mass. The median survival for this patient is 4.4 months; the five-year survival is 3%.

Note: I got this case idea from a morning report during a preliminary medicine interview.

Image shown under Fair Use.


Anonymous said...

I can't think of a reason for unilateral scleral icterus other than a false eye or subconjunctival hemorrhage. The answer to this should be really good.

Craig Chen said...

yes! you are entirely right - this is unilateral scleral icterus...and its from a false eye! and since the answer is cancer...ocular melanoma is the most likely culprit (it probably sent mets to liver prior to enucleation)
The Answer is Cancer

This patient had ocular melanoma many years ago; his eye was enucleated and replaced with a prosthetic eye. Ocular melanoma tends to metastacize to the liver. Here, he is presenting with unilateral scleral icterus and a hepatic mass; the prosthetic eye is the non-icteric eye.

Sources: Morning report at UCI preliminary medicine; UpToDate;