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Finding malignant change in a necrotic choroidal melanocytoma: a clinical challenge
  1. M Kurli1,2,
  2. P T Finger1,3,
  3. T Manor1,
  4. S A McCormick2,
  5. H E Grossniklaus4
  1. 1New York Eye Cancer Center, New York, USA
  2. 2The New York Eye and Ear Infirmary, New York, USA
  3. 3New York University School of Medicine, and New york Eye and Ear Infirmary, New York, USA
  4. 4Emory University School of Medicine, Atlanta, GA, USA
  1. Correspondence to: Paul T Finger MD, The New York Eye Cancer Center, 115 East 61st Street, New York City, NY 10021, USA; pfingereyecancer.com

https://doi.org/10.1136/bjo.2004.060038

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    Melanocytic intraocular tumours can grow as to exceed their vascular supply, become necrotic, and induce inflammation. They present with atypical signs and become a diagnostic challenge. We present a case of a large melanocytic intraocular tumour that offered an atypical presentation, unexpected cytology, and finally diagnostic histopathology.

    Case report

    A 37 year old white woman presented with a painful right eye and vision loss. Exam ination showed no light perception, a relative afferent pupillary defect, a shallow anterior chamber, and an intraocular pressure of 58 mm Hg. Dense vitreous haemorrhage and tumour obscured her fundus.

    Three dimensional ultrasonography revealed vitreous haemorrhage, a total retinal detachment, and a large choroidal mass (fig 1A, B). Computed tomography and magnetic resonance imaging (MRI) of the orbits showed a 2 cm intraocular mass with a collar-button extension (arrow) consistent with a choroidal melanoma (fig 1C).

    Figure 1

     (A) B-scan ultrasound demonstrated a large intraocular tumour with scleral thickening and retrobulbar oedema. There was almost no intrinsic vascularity noted within the tumour. No …

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