Choroidal malignant melanoma with no extraocular extension presenting as orbital cellulitis

This report describes a patient with choroidal malignant melanoma presenting as orbital cellulitis without extraocular tumor extension. It is an interventional case report with histopathologic correlation. A 68-year-old male presented with a 3-day history of painful hyperemia and swelling in the right eye. The examination showed edematous eyelids, mechanical ptosis and chemosis with conjunctival injection. B-scan ultrasonography showed a mass with medium level echogenicity that filled the vitreous cavity. Magnetic resonance imaging showed a solid choroidal mass with hemorrhagic and inflammatory changes with no obvious extraocular extension. Due to these suggestive findings of choroidal melanoma the right eye was enucleated. A spindle cell choroidal melanoma including intense pigmentation and necrosis was confirmed by histopathological examination. Although rare; choroidal melanoma may present as orbital cellulitis, particularly when the tumor is necrotic.     

Choroidal melanoma with disc and retinal neovascularization

A 23-year-old white woman presented with a large superior choroidal mass with a secondary inferior serous detachment of the retina. Clinical and angiographic examination revealed extensive inferior, peripheral retinal vascular occlusion associated with peripheral retinal and disc neovascularization. The fellow eye was normal. Histologic examination confirmed that the choroidal mass was a malignant melanoma.     

Bilateral atypical nodular posterior scleritis

PURPOSE: To evaluate ocular features of nodular posterior scleritis simulating choroidal melanoma. METHODS: A 60-year old woman presented with blurred vision in her right eye of two weeks duration. On examination she had a mild right-globe proptosis with an episcleral nodular mass as well as a large elevated nonpigmented choroidal mass involving the nasal quadrant. RESULTS: A and B-scan ultrasonography showed a medium to high-reflective solid choroidal mass. MRI demonstrated a bi-convex mass in the medial aspect of the right globe with signal characteristics compatible with choroidal melanoma. Biopsy of the extraocular lesion demonstrated chronic inflammatory cell infiltrate suggestive of posterior scleritis. She responded to corticosteroid therapy. On evaluation 41 months later she was noted to have a similar choroidal mass in the left eye. CONCLUSIONS: The physician should be aware of the clinical manifestations and diagnostic hall marks of nodular posterior scleritis in order to differentiate this inflammatory process from choroidal melanoma.     

Supraciliary hemangiopericytoma

A 10-year-old black girl complaining of pain and decreased vision in the left eye was found to have a smoothly elevated ciliochoroidal mass involving the superonasal quadrant of the left eye. The mass appeared circumscribed and uniformly dense by computed tomography. The tumor was hyperintense to vitreous and cerebral white matter on T1-weighted magnetic resonance imaging but was hypointense to vitreous and hyperintense to white matter on T2-weighted magnetic resonance imaging. Results of gross examination of the enucleated eye showed a sharply circumscribed, tan, intraocular mass arising equatorially. Results of histopathologic examination showed a well-vascularized spindle cell proliferation with a sinusoidal pattern characteristic of hemangiopericytoma. This is the third reported case of intraocular hemangiopericytoma and the first in a pediatric patient.     

Metastatic adenocarcinoma with rupture through the bruch membrane simulating a choroidal melanoma

PURPOSE: To report a case of adenocarcinoma metastatic to the choroid with rupture through the Bruch membrane, thus, simulating a choroidal melanoma. METHODS: Interventional case report. Evaluation in a university-based clinic, including a complete eye examination, fluorescein angiography, and ultrasonography; oncological evaluation; and eventual enucleation with histopathological study, including immunohistochemical stains. RESULTS: A 62-year-old Hispanic female presented with visual loss, right eye, of short duration because of a choroidal mass with retinal detachment. Ultrasonography showed a dome-shaped lesion with an eccentric collar-button projection and medium internal reflectivity, which suggested a choroidal melanoma. Initial systemic evaluation was negative. Severe pain necessitated enucleation, RE, and histopathology of the choroidal mass demonstrated an adenocarcinoma. Further examination revealed a left, upper lobe, nonsmall cell lung carcinoma. CONCLUSION: Metastatic choroidal tumors may present, although rarely, with collar-button configurations.     

Red lesions of the iris, choroid, and skin secondary to metastatic carcinoma of the thyroid: a review

An 83-year-old man was seen with a history of bilateral progressive loss of vision of 1 month's duration. On examination, there was a reddish, nodular lesion adjacent to the right side of the nose. Slit-lamp examination revealed a reddish iris mass in the left eye. Ophthalmoscopic examination revealed two orange choroidal lesions in the right eye and a large subretinal hemorrhage in the posterior pole with a central reddish vascular lesion in the left eye. An excisional biopsy of the skin lesion was performed. A diagnosis of metastatic follicular thyroid carcinoma was made according to the histopathologic findings and immunohistochemistry. The patient had no known history of thyroid malignancy and a metastatic survey revealed widespread metastasis. The patient had a total thyroidectomy followed by two series of radioactive iodine ablation. The iris lesion completely resolved and the choroidal lesions in the right eye showed partial regression during the follow-up period. Ocular and skin metastasis secondary to thyroid carcinoma is uncommon. In a review of English literature we found reports of 12 clinically well-documented cases of choroidal metastasis and two cases of iris metastasis. Our case and review of the previous cases reveal that reddish/orange color is a commonly observed feature of the uveal metastasis of thyroid carcinoma. Although ocular and skin metastases from thyroid carcinoma are rare, this possibility should be considered in the differential diagnosis of reddish-colored iris and choroidal masses as well as reddish nodular lesions of the scalp, face, and neck.     

Choroidal folds associated with a sellar mass

We report a case with progressive visual loss whose ophthalmic examination revealed bilateral optic atrophy and choroidal folds in the left eye. Neuroimaging demonstrated a sellar mass compressing the optic chiasm and the left optic nerve was to be stretched. We assume the traction created on the optic nerve by the mass stretched the optic nerve and caused the choroidal folds.     

Clinical Course of a Presumed Metastatic Uveal Melanoma to the Contralateral Choroid

Abstract

We present the ultrasound and optic coherence tomography follow-up of a presumed choroidal metastasis from a contralateral melanoma. A 53-year-old male was diagnosed with uveal melanoma with extraescleral extension in his left eye. A year later, the fundus examination revealed a flat, gray-green, pigmented choroidal lesion in the right eye. The ultrasonography showed a mass, almost flat, and all these findings were compatible with a choroidal melanocytic lesion with risk factors for growth. One month later, melanocytic skin lesions appeared on the scalp, as well as small tumors. Three months later, an ultrasonography on B scan showed a growth of the tumor size. The patient developed a progressive deterioration and died. Three possibilities can explain the occurrence of a choroidal pigmented tumor in the contralateral eye: first, bilateral primary choroidal melanomas; second, both choroidal tumors are metastatic in origin from an unknown primary melanoma; and third, the contralateral tumor is a metastatic tumor from the primary choroidal melanoma.     

Just another metastatic carcinoid tumour to the uveal tract

We describe the clinic, image, and histopathologic features of a well differentiated neuroendocrine carcinoma (carcinoid tumour) metastatic to choroid and ciliary body in a 52-year-old Mexican Mestizo man. The ophthalmologic examination showed an inferior choroidal mass accompanied by exudative retinal detachment. Ultrasound B-Scan study revealed a diffuse thickened choroid with overlying serous retinal detachment, ultrasound A-Scan revealed a high internal reflectivity solid lesion. Ultrasound biomicroscopy (UBM) evidenced a dome shaped ciliary body mass, presumptive diagnosis was uveal tract metastatic disease. Scleral flap choroidal incisional biopsy was performed. Microscopic evaluation demonstrated a hypercellular lesion replacing choroid, composed by cohesive oval-round cells with finely granular chromatin arranged in organoid pattern. Immunohistochemical reactions were Pankeratin AE1/AE3 (+), Cytokeratin CK5/6 (+), Chromogranin A (+), Ki67 (20%), typical well differentiated neuroendocrine carcinoma (carcinoid tumour) was diagnosed. Patient had a mediastinal carcinoid diagnosed 3?years earlier. Metastatic cancer to the eye is perhaps the leading cause of intraocular tumour, despite this fact metastases are rarely seen by the ophthalmologist while the patient is alive. Intraocular metastasis should be considered in the presence of ciliary body or/and choroidal amelanotic or pigmented mass and serous retinal detachment in a patient with history of carcinoid tumor, althought its low frequency (2.2%).     

A case of pulmonary tuberculosis presenting with a choroidal tuberculoma

A 17-year-old woman was referred because of a choroidal mass, with marked decrease in vision, in her left eye. Her medical history was negative. However, preliminary examination revealed a positive skin tuberculin test (PPD) and a chest x-ray picture of pulmonary tuberculosis. Bronchoscopy documented the diagnosis. Findings of other systemic investigations were negative. Fluorescein angiographic findings were compatible with the clinical diagnosis of a choroidal tuberculoma. A regimen of antituberculous medications was started, and both the choroidal and the pulmonary lesions gradually subsided. To our knowledge this is the first reported case of nonmiliary tuberculosis that presented solely with a choroidal lesion.     

Clinicopathologic correlation of choroidal folds: secondary to massive cranioorbital hemangiopericytoma.

A 55-year-old woman developed marked choroidal folds in the right eye secondary to a massive tumor in the right orbit. The patient underwent a modified exenteration with debulking of the tumor, thus providing the opportunity to do a clinicopathologic correlation on the choroidal folds. Histopathologically, the orbital tumor proved to be an unusually aggressive malignant hemangiopericytoma. Microscopic examination of the globe showed that the apices of some of the folds were directed toward the retina, whereas the apices of other folds were directed toward the choroid. In contrast to popular concepts, the retinal pigment epithelium was intact at the crests of the folds toward the retinal side, while the retinal pigment epithelium was atrophic in the valleys toward the choroid.     

Contralateral blindness from chiasmal extension of unsuspected choroidal melanoma

An 80-year-old woman with a prior diagnosis of age-related macular degeneration in her left eye had rapidly progressive visual loss in her right eye. Orbital MRI revealed a mass involving the left optic nerve and chiasm, interpreted by a radiologist as optic nerve sheath meningioma. Further review of the MRI revealed a mass inside the left eye, characteristic of choroidal melanoma, with apparent extension through the optic nerve to the chiasm and adjacent tissues. Orbital biopsy revealed mixed cell-type melanoma. This case demonstrates that unsuspected choroidal melanoma can invade the optic nerve and chiasm, causing contralateral visual loss. Contralateral blindness as the initial complaint from an unsuspected choroidal melanoma is extremely unusual if not unique.     

A case of choroidal melanocytoma mimicking a choroidal melanoma

A 17-year-old young girl was seen by us with complaints of progressive, painless decreasing vision in one eye for the last 4 years. No other supporting history could be elucidated. On examination, a large choroidal mass was found. Since the features were suggestive of malignant melanoma of the choroid, an enucleation of the eye was performed. Subsequently, histopathological examination of the enucleated eye revealed findings consistent with melanocytoma of the choroid. This case is unique in that the patient was of relatively young age and the tumor was huge compared to previous such reports.     

Successful treatment of a large choroidal abscess in an immunocompetent child

BACKGROUND: We report the case of a systemically well 4-year-old Aboriginal boy who developed a choroidal abscess after being poked in the left eye with a blunt object. CASE REPORT: This boy presented with redness and reduced vision in the left eye after a blunt object was poked into his eye by his sibling. He was noted to have a choroidal mass which finally manifested as a choroidal abscess. RESULTS: His initial visual acuity was 6/60, and dilated fundus examination demonstrated a localised solid-appearing choroidal elevation involving the posterior pole, including the macula. An ultrasound of the eye revealed a choroidal haematoma with an atypical appearance, whose height was 8 mm with a base of 12 mm x 10 mm. The lesion failed to resolve, and eventually resulted in orbital cellulitis that did not respond to intravenous and topical antibiotic treatment. He then went on to achieve complete visual recovery after successful management by transcleral incision, drainage and systemic antibiotic therapy. CONCLUSION: Choroidal abscess has been described in patients who are debilitated, immunocompromised or suffer with systemic disease such as cystic fibrosis or endocarditis. This case represents a unique report of staphylococcal choroidal abscess in a healthy child that completely resolved after transcleral drainage and systemic antibiotics.     

Endogenous bacterial endophthalmitis masquerading as an intraocular tumor

A 40-year-old female patient referred for a possible intraocular tumor was found to have an endogenous bacterial endophthalmitis in her right eye. Fundus examination revealed an amelanotic dome shaped choroidal mass and an exudative retinal detachment. Enhanced Depth Imaging-Optical Coherence Tomography (EDI-OCT), fundus autofluorescence (FAF) and ultrasounds were suggestive of a possible choroidal melanoma. A multimodal imaging approach and a thorough anamnesis were instrumental in establishing the correct diagnosis.     

Role of Spectralis HRA+OCT Spectral Domain Optical Coherence Tomography in the Diagnosis and Management of Fungal Choroidal Granuloma

Objective: To report the usefulness of inverted scan technique using Spectral domain Optical Coherence Tomography (OCT) in inflammatory fungal chorioretinitis

Design: Case Report - Interventional

Methods: We present a 53 year old female with sudden painful blurring of vision in left eye. Ocular examination revealed retinochoroiditis.OCT using the inverted scan technique showed a choroidal mass lesion. Polymerase chain reaction was positive for panfungal genome. She was treated with systemic fluconazole.

Results: Symptoms improved and the choroidal mass was diminished in size after one week of therapy.

Conclusions: Inverted OCT scan technique is useful in the diagnosis and management of choroidal inflammatory mass lesion.     

Choroidal osteoma with CNVM – Successful treatment with intravitreal Bevacizumab

Twenty-seven years old healthy woman presented with complaints of sudden painless blurred vision in right eye for 1 week. On examination, visual acuity was 20/30 in the right eye and 20/20 in left eye. Fundus examination OS was normal; OD demonstrated a flat, opaque, yellowish parapapillary choroidal lesion with grayish membrane associated with minimal subretinal fluid suggestive of a CNVM in the center. B-scan ultrasonography revealed findings consistent with a choroidal osteoma. Fundus fluorescein angiography of the right eye revealed a relatively well-defined area of hyperfluorescence that increased in size and intensity in the later phases suggestive of active extrafoveal CNVM. Optical coherence tomography confirmed the extrafoveal CNVM with subfoveal fluid. She was treated with intravitreal Bevacizumab OD. At the 2 weeks visit, vision OD improved to 20/20. The FFA and OCT revealed a resolved CNVM. Intravitreal Bevacizumab may be an effective alternative in the management of CNVM secondary to choroidal osteoma.     

Intravitreal bevacizumab in the management of choroidal neovascular membrane secondary to choroidal osteoma

PURPOSE. To describe a patient with choroidal neovascular membrane (CNVM) secondary to choroidal osteoma treated successfully with intravitreal bevacizumab. METHODS. Case report. A 25-year-old healthy woman presented with complaints of sudden painless decrease in vision in the left eye (OS) of 1 month duration. On examination, visual acuity was 20/20 in the right eye (OD) and counting fingers at 1.5 meters OS. Slit lamp examination was unremarkable. Fundus examination OD was normal; OS demonstrated a flat, opaque, yellowish parapapillary choroidal lesion with adjacent subfoveal grayish membrane associated with minimal subretinal fluid suggestive of a CNVM. B-scan ultrasonography revealed findings consistent with a choroidal osteoma. Fundus fluorescein angiography (FFA) of the left eye revealed a relatively well-defined area of hyperfluorescence that increased in size and intensity in the later phases suggestive of active subfoveal CNVM. Optical coherence tomography (OCT) confirmed the subfoveal CNVM with altered foveal contour and distortion of foveal architecture. A diagnosis of subfoveal CNVM associated with choroidal osteoma was made. The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 mL OS and repeated 6 weeks later. RESULTS. At the 4-month visit, vision OS improved to 20/125. The FFA and OCT revealed a resolved CNVM. CONCLUSIONS. Intravitreal bevacizumab may be an effective alternative in the management of CNVM secondary to choroidal osteoma. Larger series of such cases need to be studied to further validate our findings.     

Choroidal malignant melanoma with early vitreous seeding

Primary choroidal malignant melanoma with extension through the overlying retina is a rarely reported entity, and to our knowledge actual seeding of the vitreous has never been reported. The pathologic findings in a 41-year-old woman who presented with a large amelanotic subretinal mass near the optic disc of the right eye are discussed. Fundus examination preoperatively revealed a concentration of discrete, fleshy, oval to round, vitreous bodies of varying size, limited to the area overlying the mass. Histopathology of this tumor revealed a spindle cell posterior choroidal melanoma with marked atrophy of the overlying retina. At the apex, the retina was discontinuous and melanoma cells extended into the overlying vitreous. Some of the cells surrounded asteroid bodies overlying the tumor, altering their clinical appearance. This behavior, while only involving a small fraction of the tumor cells, may imply a more aggressive tumor.     

Mesectodermal leiomyoma exclusively involving the posterior choroid

PURPOSE: To report a mesectodermal leiomyoma of the posterior choroid. DESIGN: Observational case report. METHODS: A 23-year-old man was referred to us because of a progressive blurred vision in his left eye. Ophthalmologic examination revealed the presence of a 12 x 10 x 7.2-mm amelanotic choroidal mass in his left posterior pole. Fluorescein angiography, A-scan ultrasonography, and B-scan echography findings were suggestive for a diagnosis of choroidal amelanotic melanoma. These clinical features prompted us to enucleate the left eye. RESULTS: Histopathological and immunohistochemistry examinations established a definitive diagnosis of mesectodermal leiomyoma of the posterior choroid. CONCLUSION: This case represents the first report describing the occurrence of an intraocular mesectodermal leiomyoma that may exclusively involve the posterior choroid.