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Spontaneous rupture of a solitary oligometastatic hepatic melanoma
  1. Jonathan Tiong1,2,
  2. Ashray Rajagopalan2,
  3. Joseph Jaya2 and
  4. Mithra Sritharan2
  1. 1Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
  2. 2Surgery, Monash Health, Clayton, Victoria, Australia
  1. Correspondence to Dr Jonathan Tiong; jonathan.tiong{at}


A mid-50s woman presented with acute right upper quadrant pain 1-day post second cycle of pembrolizumab. She has a significant history for two concurrent malignancies: a solitary oligometastatic hepatic melanoma (NRAS mutant) of unknown primary diagnosed 2 months prior, and a 10-year history of breast carcinoma with pulmonary metastases on palliative chemotherapy. Multiphase CT scan demonstrated active venous bleeding without active arterial bleeding. The patient received two units of packed red blood cells, followed by selective transcatheter arterial embolisation (TAE) of the right hepatic artery branches to segment 7 and 8. Spontaneous rupture of solitary liver metastases are exceedingly rare. TAE is a safe and effective treatment choice in patients with spontaneous rupture. Given progressive tumour burden, changes in management with a different immunotherapy agent can be considered.

  • Radiology (diagnostics)
  • Hepatic cancer
  • Gastrointestinal surgery

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  • Contributors JT was involved in conceptualisation, drafting, editing and finalising the manuscript. AR was involved in editing. JJ was involved in conceptualisation. MS was involved in conceptualisation and finalising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.