International Journal of Ophthalmic PathologyISSN: 2324-8599

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Case Report, Int J Ophthalmic Pathol Vol: 5 Issue: 4

Choroidal Nevus with Choroidal Detachment Simulating Intraocular Melanoma - Image and Pathology Studies

Chun-Ju Lin1,2*, Jane-Ming Lin1,2, Wen-Lu Chen1,2, Peng-Tai Tien1,3 and Yi-Yu Tsai1,2
1School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
2Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
3Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
Corresponding author : Chun-Ju Lin, MD
Department of Ophthalmology, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
Tel: 886-4-22052121; Ext: 1141
Fax: 886-4-22059265
Received: September 18, 2016 Accepted: October 04, 2016 Published: October 10, 2016
Citation: Lin CJ, Lin JM, Chen WL, Tien PT, Tsai YY (2016) Choroidal Nevus with Choroidal Detachment Simulating Intraocular Melanoma - Image and Pathology Studies. Int J Ophthalmic Pathol 5:4. doi: 10.4172/2324-8599.1000188


Purpose: Malignant uveal melanoma is the most common primary intraocular malignant tumors in adults. Choroidal detachment and choroidal nevus may be confused with choroidal tumors. We report a case of choroidal nevus and rhegmatogenous retinal detachment (RD) complicated with macular pucker and choroidal detachment simulating intraocular melanoma.

Method: Interventional case report.

Results: A 59-year-old woman complained of visual disturbances and superior temporal visual defect for 1 month in the left eye. Funduscopy revealed macular pucker with lower RD and an elevated lesion with pigment mottling in the nasal-lower quadrant. The optical coherence tomography (OCT) scan showed macular pucker with subretinal fluid. B scan ultrasonography showed low to moderate internal reflectivity. Fluorescein angiography demonstrated irregular pattern of mixed hypo- and hyperfluorescence in the elevated lesion and dye pooling on the posterior pole. Computed tomography (CT) revealed an intraocular enhancing mass. Positron-emission tomography/computed tomography (PET/CT) showed no abnormal 18F-fluoro-2-deoxyglucose uptake. Because the evidence of malignancy was not solid and the patient also sought to improve her vision, the small gauge vitrectomy was performed. A retinal break was found on the slope of choroidal detachment intraoperatively. Specimens were taken through the retinal break. Internal limiting membrane peeling, air-fluid exchange, focal laser around the retinal break and C3F8 tamponade were done. The postoperative magnetic resonance imaging (MRI) showed no clue of enlargement. Due to mild hyperintensity on T1-weighted imaging, choroidal melanoma was suspected by the radiologist. However, pathology showed no malignancy. The retina was attached and the retinal break was sealed on the slope during 34-month follow up.

Conclusion: Choroidal nevus and choroidal hemorrhage with detachment should be carefully differentiated from choroidal melanoma. Apart from CT and MRI, PET/CT can assess both anatomical morphology and cell metabolism in one single examination. Long term follow-up is necessary.

Keywords: Choroidal detachment; Choroidal nevus; Magnetic resonance imaging; Intraocular melanoma; Positron emission tomography/Computed tomography

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