Presentation
Choroidal mass noted on exam. In office ultrasound features are concerning for melanoma. Patient has increasing neurovascular glaucoma in the right eye resulting in severe pain.
Patient Data
There is a mass at the level of the posteroinferior right optic globe. The mass exhibits T1 hyperintensity which is best appreciated on the T1 fat-saturated images. There is no obvious extraoccular extension of the mass.
Left optic globe unremarkable. Optic nerves, obstructive muscles, lacrimal glands, orbital fat, optic
foramina, optic chiasm and bony orbital margins are unremarkable.
Case Discussion
This is a case of an choroidal melanoma. The patient underwent enucleation of the right eye. Gross pathology consisted of a right eye with the optic nerve intact. On transillumination, there was a shadow extending from the optic nerve to ciliary body inferotemporally. The globe was opened obliquely from the 2:00 to 8:00 position. A dark brown/tan choroidal mass was noted. Histopathologically, the mass consisted of epithelioid and spindle cell type melanoma with pockets of necrosis and pigment-laden macrophages. The overlying retina was atrophic and adherent to the choroidal surface. There was intrascleral extension of the tumor surrounding blood vessels. There were 0-1 mitotic figures noted in high power field. The BRAF staining is positive throughout the tumor. The specimen was sent for BRAF analysis, which was negative for BRAF V600E or V600K mutations.
The patient did well post-operatively but was eventually lost to follow-up.