Primary mucosal melanoma of the maxillary sinus with spontaneous rupture of liver metastasis.
Shusuke Okamura, Wataru Fukami, Risa Tanaka et al.
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Case in brief
A 60-year-old woman presented with intraperitoneal bleeding from spontaneous rupture of a liver metastasis. Transcatheter arterial embolization controlled the bleeding, and biopsy confirmed metastatic melanoma. The primary tumor was identified in the maxillary sinus and was a mucosal melanoma. The liver metastases had appeared over a short period and progressed rapidly. Contrast-enhanced CT obtained immediately before rupture showed poor but heterogeneous tumor enhancement and a tortuous, dilated vessel traversing the lesion; three-dimensional CT angiography identified it as a tumor-feeding artery.
What made this case unusual
The pre-rupture CT showed a tortuous, dilated intratumoral feeding artery, thought morphologically more consistent with a pre-existing hepatic vessel altered by tumor progression than with a newly formed tumor vessel.
Diagnostic / clinical pearl
In a patient with liver metastasis, a tortuous, dilated intratumoral vessel on pre-rupture CT may signal tumor fragility and possible impending rupture.
Why it matters
This case highlights spontaneous rupture as a potentially life-threatening complication of metastatic liver tumors, particularly in the setting of rapid tumor progression.