Large Ciliary Body Melanoma with Pseudocysts: a case report

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Dr.Roger Harrie

Moran Eye Center, University of Utah, USA

: Int J Ophthalmic Pathol

Abstract

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Statement of the problem: A 20 year-old woman presented with chronic floaters OS. Examination revealed visual acuity of 20/2O OD and 20/25 OS with intraocular pressures of 14mm OU, and a normal slit-lamp examination. The right fundus examination was unremarkable and the left found a peripheral deeply homogenously pigmented intraocular lesion inferiorly (Figure A). Ultrasonography showed a highly reflective lesion measuring 9.88mm in thickness by 11.06mm by 10.75mm in basal dimensions. The reflectivity was not consistent with melanoma and the differential diagnosis included melanocytoma, retinal pigment epithelial adenoma, and medulloepithelioma. The purpose of this report is to demonstrate the value of standardized A-scan echography in the differentation of an intraocular tumor. Methodology: The Eyecubed Standardized A-scan was used to determine the internal reflectivity pattern of the lesion. Findings: An ultrasound exam showed a lesion measuring 15.73mm in thickness by 16.43mm by 15.94mm in basal dimensions. The rapid growth was concerning for a malignant melanoma, but the high reflectivity on A-scan was most consistent with a melanocytoma or a retinal pigment epithelial adenoma. The eye was enucleated and pathology described a large ciliary body mass. Microscopy revealed a melanocytoma with pseudocysts, cells with heavily pigmented cytoplasm with small nuclei without dysplastic features, and pigment-laden macrophages. Conclusions and significance: The reflectivity of this melanocytoma by standardized A-scan was consistent with multiple pseudocysts on pathological evaluation. This echographic pattern guided the differential diagnosis.

Biography

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Roger Harrie is director of the ophthalmic ultrasound department at the University of Utah Moran Eye Center. He has written two textbooks on ophthalmic ultrasound, several book chapters, and numerous articles in peer reviewed journals. He has been a senior instructor in ophthalmic ultrasound courses at the American Academy of Ophthalmology annual meeting.