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   Table of Contents      
ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 2  |  Page : 70-71

Unsuspected malignant melanoma


Medical College, Aurangabad, India

Date of Web Publication22-Dec-2007

Correspondence Address:
D L Maria
Medical College, Aurangabad
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Maria D L, Shrivastawa S K, Datar K G, Tehra K G. Unsuspected malignant melanoma. Indian J Ophthalmol 1968;16:70-1

How to cite this URL:
Maria D L, Shrivastawa S K, Datar K G, Tehra K G. Unsuspected malignant melanoma. Indian J Ophthalmol [serial online] 1968 [cited 2019 Dec 14];16:70-1. Available from: http://www.ijo.in/text.asp?1968/16/2/70/37496

Ten percent of melanomas are dis­covered only after the enucleated eye is examined in the pathology la­boratory (KIRK AND PETTY [2] ). In more than ninety percent of such unsuspected melanomas the eye is glaucomatous and in about one fourth the tumour is markedly necrotic. Occasionally the tumour arises in a phthisical eye that has long been hind from an old injury. (HOGAN and ZIMMERMAN [1] ).

MAKLEY AND TEED[3] found that in twentyone percent of the affected eyes he media were opaque at the time of enucleation. Thus the tumour in these cases could not be visualiz­ed.

In general, heavily pigmented tumours are more malignant than amelanotic melanomas.

The following case presented in the form of proptosis with heavy chemosis, giving the picture of pan­ophthalmitis is being reported.


  Case report Top


A fifty years old Mohammadan male was admitted on 19.9.1966 with complaints of prominence of left eye since four months, pain in the eye since one month and temporal head­ache on the same side. There was a history of trauma six months back­following which there was sore eye and loss of eye-sight. (Plate 1)

Local Examination

The left eye-ball was proptosed with slight deviation to the lower nasal side with fullness in the upper outer part of the orbit. Chemosis was severe, cornea was opaque and dried with total adherent leucoma. On pal­pation the eye-ball was firm and no­dular to the feel in the tipper outer palpebral furrow. There was ten­derness on pressure.


  Investigations Top


Hxmoglobn. 12 gm/100 ml. Ery­throcyte sedimentation rate 45 mm 1st hour. Total leucocytic count 9000/c mm. V.D.R.L. negative. Urine and stool normal, screening of chest normal, X-ray Postiro-anterior and lateral views of orbit were normal.

A provisional diagnosis of pan­ophthalmitis of endogenous type was made keeping in mind the history of trauma six months back.

A course of tetracycline and locally continuous magsulph compresses were given with analgesics to re­lieve the pain. There was no im­provement in the condition and the case was reviewed again to be label­led as a lacrimal gland tumour be­cause of slight lower nasal deviation of eye ball and fullness in the upper outer palpebaral furrow. A biopsy was taken from the conjunctival side from the upper outer quadrant which showed normal lacrimal gland. Now the proptosis increased further, with increase of pain both in the temporal region and in the orbit. Now the case was labelled as an orbital tumour the nature of which could not be known and the patient was taken for exenteration with the help of general surgeon on 26-11-1966 be­cause of suspected local spread. Later, skin grafting was done on 16.12.1966 by the General Surgeon. The eye-ball with orbital tissue was sent for histopathological examina­tion which gave the diagnosis of amelanotic melanoma.

The tumour consisted of large ir­regular cells spread diffusely and ar­ranged in small groups in places in alveolar fashion. The cells varied in size and shape in different posi­tions. Some were large irregular with hyperchromatic nuclei and pro­minent nucleolus, others were spind­ley. Moderate number of tumour giant cells containing two or three nuclei were present amongst the masses of tumour cells. In places tumour cells were separated by fib­rous connective tissue stroma infil­trated with lyunphocytes. Melanin pigment was not observed.

On 1-1-1967 patient started com­plaining of numbness in the supra­orbital region and paroxysmal dry cough which made us think of secondaries. A complete haemogram was done and X-ray chest taken. Haemoglobin 10 gm/100 gm. Total leucocytic count 6200/c mm, Eryth­ed circular opaque area in the left hr. X-ray chest revealed well defin­ed circular opaque area n the left lower lobe (photo X-ray). The patient was discharged and advised to go to cancer hospital.


  Comments Top


From the clinical appearance of such a case which could be mistaken for pan-ophthalmitis, lacriminal gland tumour and orbital tumour with in­ability to do the fundus examination, because of total adherant leucoma, we should always keep in mind ma­lignant melanoma.


  Summary Top


A case of unsuspected malignant melanoma is reported. The exentera­tion was done because of progressive nature of the proptosis, pain and sus­pected local infiltration in a case simulating pan-ophthalmitis with total adherent leucoma.


  Acknowledgments Top


We are thankful to the Depart­ment of Pathology for their histo­pathological report.[3]

 
  References Top

1.
HOGAN, M. J. AND ZIMMERAMAN L.E. (1952) Ophthalmic pathology, Philedelphia W. B. Saunders Co.  Back to cited text no. 1
    
2.
KERK H. Q., AND PETTY P.W. (1956) Arch. of Ophthal. (Chicago) 56, 843-860 (1956).  Back to cited text no. 2
    
3.
MAKLEY, T. A., AND TEED R. W., Arch. of Ophthal. (Chicago) 60, 475 (1958).  Back to cited text no. 3
    


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