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Cardiac Metastasis From Uveal Melanoma
References 1 Tai DYH, El-Bilbeisi H, Tewari S, et al. A study of consecutive autopsies in a medical ICU: a comparison of clinical cause of death and autopsy diagnosis. Chest 2001; 119:530 – 536 2 Roosen HJ, Frans E, Wilmer A, et al. Comparison of premortem clinical diagnoses in critically ill patients and subsequent autopsy findings. Mayo Clin Proc 2000; 75:562– 567 3 Twigg SJ, McCrirrick A, Sanderson PM. A comparison of postmortem findings with post hoc estimated clinical diagnoses of patients who die in a United Kingdom intensive care unit. Intensive Care Med 2001; 27:706 –710 4 Mokhtari M, Couvelard A, Combes A, et al. Do autopsies of ICU patients reveal clinically undetected findings [abstract]? Am J Respir Crit Care Med 2001; 163:A801 5 Moore GW, Hutchins GM. The persistent importance of autopsies [editorial]. Mayo Clin Proc 2000; 75:557–558 6 Inoue K, Yoshioka K, Kawahito Y. Is the discordance rate of malignancy still high? Arch Intern Med 1999; 159:1013
Cardiac Metastasis From Uveal Melanoma To the Editor: In the August 2000 issue of CHEST, Rosario and coworkers1 presented an interesting case of cardiac metastasis from intraocular melanoma. This patient suffered from syncope attacks resulting from endocardial and left ventricular metastasis and died during cardiac surgery. We agree with the authors, in that clinically detected cardiac metastasis from uveal melanoma is very rare. In addition to their report, we are aware of only two other case reports2,3 of cardiac metastases from uveal melanoma that were symptomatic and eventually lethal. A 69-year-old man died of cardiac arrest following atrioventricular block and atrial fibrillation; at autopsy, cardiac metastases were found to involve the atrioventricular node and left and right bundle branches.2 A 74-year-old woman died after biopsy of ruptured myocardium weakened by myocardial metastasis.3 Studies based on autopsy series indicate, however, that cardiac metastasis from uveal melanoma is not uncommon. Of patients who die of disseminated uveal melanoma, 19 to 24% have macroscopic cardiac metastasis at autopsy.4,5 Patients with cardiac metastasis also have widespread metastasis in general.4 Because patients with disseminated intraocular melanoma are generally elderly and many of them have other cardiovascular diseases that may obscure symptoms of cardiac metastasis, its frequency may be clinically underestimated. Rosario and colleagues1 have very prudently alerted clinicians to the possibility of cardiac involvement in uveal melanoma. Teemu Ma¨ kitie, MD Tero Kivela¨ , MD Helsinki University Central Hospital Helsinki, Finland Correspondence to: Teemu Ma¨ kitie, MD, Department of Ophthalmology, Helsinki University Central Hospital, Haartmaninkatu 4 C, PL 220, FIN-00029 HUS, Helsinki, Finland; e-mail: [email protected]
References 1 Rosario RT, DiMaio DJ, Lapham RL, et al. Metastatic ocular melanoma to the left ventricle inducing near-syncope attacks in an 84-year-old woman. Chest 2000; 118:551–553 2 Matturri L, Nappo A, Varesi C, et al. Metastasi cardiache di
melanoma maligno. Pathologica 1993; 85:97–102 3 Ruiz RS, El Harazi S, Albert DM, et al. Cardiac metastasis of choroidal melanoma. Arch Ophthalmol 1999; 117:1558 –1559 4 Ma¨ kitie T, Kivela¨ T. Cardiac metastasis from uveal melanoma. Arch Ophthalmol 2001; 119:139 –140 5 Jensen OA. Malignant melanomas of the uvea in Denmark 1943–1952: a clinical, histopathological, and prognostic study. Acta Ophthalmol 1963; 75(suppl):1–220 To the Editor: We thank you for the interesting comments. It is also our belief that any patient with cardiovascular symptoms and disseminated intraocular melanoma (or any other metastatic tumor) should have an imaging procedure investigating the cardiac anatomy. Regarding the other two case reports mentioned by you,1,2 at the time of submission of our manuscript (September 21, 1999), we were of course not aware of the article2 published in November 1999. Although we knew about the other case report,1 which was published in Italian in 1993 and in which intramyocardial metastases (not left ventricular pedunculated mass as in our case report) were found at autopsy in two patients with malignant melanoma, we did not know that the primary tumor location was ocular because the article abstract, as it is given in PubMed, does not mention it. We still maintain our original statement that at the time of submission of our article, this was the first case report of metastatic ocular melanoma presenting as a left ventricular pedunculated intracavitary mass intermittently obstructing the left ventricular outflow tract. Eddy Barasch, MD University of Texas Houston Medical School Houston, TX Correspondence to: Eddy Barasch, MD, University of Texas Houston Medical School, 6431 Fannin, PO Box 20708, Houston, TX 77225
References 1 Matturri L, Nappo A, Varesi C, et al. Metastasi cardiache di melanoma maligno. Pathologica 1993; 85:97–102 2 Ruiz RS, El Harazi S, Albert DM, et al. Cardiac metastasis of choroidal melanoma. Arch Ophthalmol 1999; 117:1558 –1559
Some More Historical Notes on Adamantiades-Behc¸ et’s Disease To the Editor: I read with interest the review article (August 2000) on intracardiac thrombus in Behc¸ et’s disease by Mogulkoc et al1 and the historical comments (February 2001) by Cheng.2 I would like to add some more comments from the historical point of view. Although the first description of the disease was reported by Hippocrates in the fifth century bc in ancient Greece, this originally endemic and epidemic disease became less significant and was forgotten, due to sporadic appearance in the course of time.3 The first description in contemporary times was made by the Greek ophthalmologist Benedict Adamantiades (1875–1962) in 1931.4 He described the case of a 20-year-old man observed for 3 years, with recurring ocular involvement (hypopyon iritis), scrotal ulcerations, aphthous stomatitis, and relapsing skin manifestations (pyodermitis). Six years later, the disease was described for the second time, independently from Adamantiades, by the Turkish dermatologist Hulusi Behc¸ et (1889 to 1948).5 In CHEST / 120 / 6 / DECEMBER, 2001
2115
Cardiac Metastasis From Uveal Melanoma To the Editor: In the August 2000 issue of CHEST, Rosario and coworkers1 presented an interesting case of cardiac metastasis from intraocular melanoma. This patient suffered from syncope attacks resulting from endocardial and left ventricular metastasis and died during cardiac surgery. We agree with the authors, in that clinically detected cardiac metastasis from uveal melanoma is very rare. In addition to their report, we are aware of only two other case reports2,3 of cardiac metastases from uveal melanoma that were symptomatic and eventually lethal. A 69-year-old man died of cardiac arrest following atrioventricular block and atrial fibrillation; at autopsy, cardiac metastases were found to involve the atrioventricular node and left and right bundle branches.2 A 74-year-old woman died after biopsy of ruptured myocardium weakened by myocardial metastasis.3 Studies based on autopsy series indicate, however, that cardiac metastasis from uveal melanoma is not uncommon. Of patients who die of disseminated uveal melanoma, 19 to 24% have macroscopic cardiac metastasis at autopsy.4,5 Patients with cardiac metastasis also have widespread metastasis in general.4 Because patients with disseminated intraocular melanoma are generally elderly and many of them have other cardiovascular diseases that may obscure symptoms of cardiac metastasis, its frequency may be clinically underestimated. Rosario and colleagues1 have very prudently alerted clinicians to the possibility of cardiac involvement in uveal melanoma. Teemu Ma¨ kitie, MD Tero Kivela¨ , MD Helsinki University Central Hospital Helsinki, Finland Correspondence to: Teemu Ma¨ kitie, MD, Department of Ophthalmology, Helsinki University Central Hospital, Haartmaninkatu 4 C, PL 220, FIN-00029 HUS, Helsinki, Finland; e-mail: [email protected]
References 1 Rosario RT, DiMaio DJ, Lapham RL, et al. Metastatic ocular melanoma to the left ventricle inducing near-syncope attacks in an 84-year-old woman. Chest 2000; 118:551–553 2 Matturri L, Nappo A, Varesi C, et al. Metastasi cardiache di
melanoma maligno. Pathologica 1993; 85:97–102 3 Ruiz RS, El Harazi S, Albert DM, et al. Cardiac metastasis of choroidal melanoma. Arch Ophthalmol 1999; 117:1558 –1559 4 Ma¨ kitie T, Kivela¨ T. Cardiac metastasis from uveal melanoma. Arch Ophthalmol 2001; 119:139 –140 5 Jensen OA. Malignant melanomas of the uvea in Denmark 1943–1952: a clinical, histopathological, and prognostic study. Acta Ophthalmol 1963; 75(suppl):1–220 To the Editor: We thank you for the interesting comments. It is also our belief that any patient with cardiovascular symptoms and disseminated intraocular melanoma (or any other metastatic tumor) should have an imaging procedure investigating the cardiac anatomy. Regarding the other two case reports mentioned by you,1,2 at the time of submission of our manuscript (September 21, 1999), we were of course not aware of the article2 published in November 1999. Although we knew about the other case report,1 which was published in Italian in 1993 and in which intramyocardial metastases (not left ventricular pedunculated mass as in our case report) were found at autopsy in two patients with malignant melanoma, we did not know that the primary tumor location was ocular because the article abstract, as it is given in PubMed, does not mention it. We still maintain our original statement that at the time of submission of our article, this was the first case report of metastatic ocular melanoma presenting as a left ventricular pedunculated intracavitary mass intermittently obstructing the left ventricular outflow tract. Eddy Barasch, MD University of Texas Houston Medical School Houston, TX Correspondence to: Eddy Barasch, MD, University of Texas Houston Medical School, 6431 Fannin, PO Box 20708, Houston, TX 77225
References 1 Matturri L, Nappo A, Varesi C, et al. Metastasi cardiache di melanoma maligno. Pathologica 1993; 85:97–102 2 Ruiz RS, El Harazi S, Albert DM, et al. Cardiac metastasis of choroidal melanoma. Arch Ophthalmol 1999; 117:1558 –1559
Some More Historical Notes on Adamantiades-Behc¸ et’s Disease To the Editor: I read with interest the review article (August 2000) on intracardiac thrombus in Behc¸ et’s disease by Mogulkoc et al1 and the historical comments (February 2001) by Cheng.2 I would like to add some more comments from the historical point of view. Although the first description of the disease was reported by Hippocrates in the fifth century bc in ancient Greece, this originally endemic and epidemic disease became less significant and was forgotten, due to sporadic appearance in the course of time.3 The first description in contemporary times was made by the Greek ophthalmologist Benedict Adamantiades (1875–1962) in 1931.4 He described the case of a 20-year-old man observed for 3 years, with recurring ocular involvement (hypopyon iritis), scrotal ulcerations, aphthous stomatitis, and relapsing skin manifestations (pyodermitis). Six years later, the disease was described for the second time, independently from Adamantiades, by the Turkish dermatologist Hulusi Behc¸ et (1889 to 1948).5 In CHEST / 120 / 6 / DECEMBER, 2001
2115