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LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 2  |  Page : 172-3

Prolapsed intraocular aspergilloma masquerading as malignant melanoma



Correspondence Address:
Philip A Thomas


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Source of Support: None, Conflict of Interest: None


PMID: 15283231

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How to cite this article:
Thomas PA, Geraldine P. Prolapsed intraocular aspergilloma masquerading as malignant melanoma. Indian J Ophthalmol 2004;52:172

How to cite this URL:
Thomas PA, Geraldine P. Prolapsed intraocular aspergilloma masquerading as malignant melanoma. Indian J Ophthalmol [serial online] 2004 [cited 2020 Apr 7];52:172. Available from: http://www.ijo.in/text.asp?2004/52/2/172/14596

Dear Editor,

The interesting report by Bajaj et al .,[1] describing an intraocular aspergilloma that masqueraded as malignant melanoma, serves to illustrate the fact that a proliferative mass arising out of an infection or infestation may masquerade as a malignant process and lead to confusion in diagnosis. A lesion in the posterior pole of the eye due to the helminth Toxocara species masquerading as a retinoblastoma is another such example.[2] Hence, it is imperative that laboratory investigations, such as histopathology, and other diagnostic tests be performed to substantiate the clinical diagnosis, particularly where this has an important bearing on management.

The authors have stated that histopathological examination of sections of the excised mass stained by the methenamine silver stain revealed "septate, acute angle branching fungal hyphae, confirming the diagnosis of aspergilloma". In this respect, it is relevant to remember the experimental study by McGuire et al .[3] comparing endophthalmitis due to Pseudallescheria boydii (now known by its anamorphic name Scedosporium apiospermum ) and Aspergillus fumigatus . In their animal model of endophthalmitis, they found that the angles of branching of both P. boydii (mean angle 47o) or A. fumigatus (mean angle 43o) hyphae were indistinguishable. In their view, a diagnosis of an Aspergillus infection could not be made on the basis of visualising dichotomously branching septate hyphae in biopsy specimens. Arthur et al .[4] recently reported the occurrence of keratouveitis due to the fungus Scedosporium prolificans in association with the longterm intraocular retention of a contact lens; the hyphae of this fungus, which are very similar to Aspergillus hyphae, were found completely covering the lens. Hence, Bajaj et al .[1] could have designated the mass in their report as an "intraocular fungal ball" rather than an "intraocular aspergilloma", especially since culture was not done.



 
  References Top

1.
Bajaj MS, Pushker N, Kulkarni A, Kashyap S, Purohit A. Prolapsed intraocular aspergilloma masquerading as malignant melanoma. Indian J Ophthalmol 2003;51:255-57.  Back to cited text no. 1
[PUBMED]    
2.
Parke DW II, Shaver RP. Toxocariasis. In : Pepose JS, Holland GN, Wilhelmus KR, editors. Ocular Infection and Immunity . Ist ed: St. Louis: Mosby, 1996. pp. 1225-35.  Back to cited text no. 2
    
3.
McGuire TW, Bullock JD, Elder BL, Funkhouser JW. Fungal endophthalmitis. An experimental study with a review of 17 human ocular cases. Arch Ophthalmol 1991; 109:1289-96.  Back to cited text no. 3
[PUBMED]    
4.
Arthur S, Steed LL, Apple DJ, Peng Q, Howard G, Escobar-Gomez M. Scedosporium prolificans keratouveitis in association with a contact lens retained intraocularly over a long term. J Clin Microbiol 2001;39:4579-82.  Back to cited text no. 4
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