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Previous Volume 336:1393-1394 May 8, 1997 Number 19 Next

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To the Editor: In 1960, when I was a second-year medical student, my intern at Bellevue Hospital charged me with this grave mission: "Look for the person with a glass eye and a big liver." I have spent the intervening 37 years engaged, among many other activities, in this pursuit. Imagine my sense of mission accomplished when I finally found the object of my quest in the March 20 issue of the Journal¹ — the lady with a glass right eye inserted by the ophthalmologist, who had vainly prayed that this cosmetic gesture would magically stem the spread of the recently removed malignant melanoma. This prayer took wing until the yellow bilirubin from her cancer-ridden liver stained her good left eye and ended her hopes and those of her ophthalmologist.

Robert M. Gordon, M.D.
Diagnostic Neurology Clinic of Houston
Houston, TX 77055

References

1. Kremer H. A medical mystery. N Engl J Med 1997;336:846-846. [Free Full Text]

Black as the pupil of her one good eye, malignant it grew in the one plucked out. Akin to the whale that could not be dispatched by the sharpest cold steel and that dove deep, later to return to kill. So too did this woman's melanoma hide and then return. It would be ironic if her jaundice were due to a single metastasis to the porta hepatis. An unlucky happenstance, like the single coil of harpoon line that caught old Ahab round his neck and carried him away.

Jerry M. Greene, M.D.
Veterans Affairs Medical Center
West Roxbury, MA 02132

References

1. Melville H. Moby Dick. New York: New American Library of World Literature, 1964.

The photograph of the 79-year-old woman titled "A Medical Mystery" is reproduced here (Figure 1). We received an unprecedented 2050 replies by fax and e-mail to our question, "What is the diagnosis?" Here is the answer: The patient's right eye had been removed and replaced with a glass eye three years earlier because of a malignant melanoma. The melanoma then spread to the liver and caused jaundice in her remaining eye. A total of 928 readers (45 percent) gave this answer, and another 728 readers (36 percent) gave a partially correct answer — namely, that the patient was jaundiced but had a glass eye on the right. Many readers were enthusiastic about this feature and encouraged us to repeat it. We will.

View larger version (32K): [in this window] [in a new window]   Figure 1. The Photograph to Which the Letters Refer.

 

Jerome P. Kassirer, M.D.

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