PT  - JOURNAL ARTICLE
AU  - Jonathan Tiong
AU  - Ashray Rajagopalan
AU  - Joseph Jaya
AU  - Mithra Sritharan
TI  - Spontaneous rupture of a solitary oligometastatic hepatic melanoma
AID  - 10.1136/bcr-2022-252367
DP  - 2023 Feb 01
TA  - BMJ Case Reports
PG  - e252367
VI  - 16
IP  - 2
4099  - http://casereports.bmj.com/content/16/2/e252367.short
4100  - http://casereports.bmj.com/content/16/2/e252367.full
SO  - BMJ Case Reports2023 Feb 01; 16
AB  - 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.