PMC5291549_01
(A) Positron emission tomography-computed tomography (PET-CT) shows fluorodeoxyglucose (FDG) uptake in the liver. (B) Hematoxylin and eosin (H&E) stained sections of a metastatic liver lesion. H&E demonstrates dark brown pigmentation (circle) consistent with metastatic melanoma. FDG = fluorodeoxyglucose, H&E = hematoxylin and eosin, PET-CT = positron emission tomography-computed tomography.
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F1
The liver lesion remained stable until August of 2013, when she had progression on positron emission tomography-computed tomography (PET-CT) (Figure 1), for which she underwent a wedge resection with harvest of tumor infiltrating lymphocytes in November of 2013. The pathology of the resected liver lesion confirmed metastatic melanoma (Figure 1).
Molecular analysis of the metastatic liver lesion. Sequencing of exon 5 of guanine nucleotide-binding protein alpha-11 (GNA11) revealed the mutation of glutamine (CAG; Q) to leucine (CTG; L) at codon 209 (Q209L) in the patient's tumor.
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F2
A GNA11 mutation was detected in codon 209, exon 5 of the gene that would change the encoded amino acid from glutamine to leucine (Q209L) (Figure 2).
Magnetic resonance imaging (MRI) of the brain shows no evidence of uveal lesions.
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F3
As GNA11 mutations have been reported in uveal melanoma frequently, extensive ophthalmology exams and a magnetic resonance imaging (MRI) of the brain were performed, which revealed no evidence of uveal melanoma (Figure 3).