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
|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.