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   Table of Contents      
PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 7  |  Page : 1162-1163

Ciliochoroidal melanoma presenting as bleeding anterior staphyloma: Report of a case and review of literature


1 Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya (A Unit of Medical Research Foundation, Chennai), Kolkata, West Bengal, India
2 Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
3 Larson and Turbo Department of Ocular Pathology, Sankara Nethralaya, Vision Research Foundation, Chennai, Tamil Nadu, India

Date of Submission15-Sep-2018
Date of Acceptance22-Jan-2019
Date of Web Publication25-Jun-2019

Correspondence Address:
Dr. Md. Shahid Alam
Orbit Oculoplasty Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1559_18

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Keywords: Anterior staphyloma, bleeding, choroidal melanoma


How to cite this article:
Alam MS, Tongbram A, Krishnakumar S, Mukherjee B. Ciliochoroidal melanoma presenting as bleeding anterior staphyloma: Report of a case and review of literature. Indian J Ophthalmol 2019;67:1162-3

How to cite this URL:
Alam MS, Tongbram A, Krishnakumar S, Mukherjee B. Ciliochoroidal melanoma presenting as bleeding anterior staphyloma: Report of a case and review of literature. Indian J Ophthalmol [serial online] 2019 [cited 2019 Sep 18];67:1162-3. Available from: http://www.ijo.in/text.asp?2019/67/7/1162/260995



A 35-year-old Asian female presented with complaints of bleeding from the left eye for the past 10 days. There was no history of trauma and past records suggested diagnosis of left anterior staphyloma. On examination, right eye had a best corrected visual acuity of 20/20, whereas the left eye had no perception of light. The left eye examination showed a partially autoeviscerated eye with prolapse of uveal contents [Figure 1]a. Intraocular structures were indiscernible on clinical examination. A diagnosis of ruptured anterior staphyloma was made, and the patient was planned for evisceration. Intraoperatively the uveal tissue was found to be thick and adherent to the sclera, which raised doubts of intraocular malignancy and enucleation was performed instead. Histopathology revealed malignant tumor arising from the ciliochoroidal epithelium, with a mixture of spindle and epithelioid cells with intrascleral extension [Figure 1]b and [Figure 1]c. Immunohistochemistry was positive for HMB-45, which confirmed the diagnosis of ciliochoroidal melanoma. Metastatic workup (liver function tests, ultrasound neck and whole abdomen, chest X-ray, magnetic resonance imaging [MRI] orbits) was negative. At 6 months of follow-up, the patient developed hepatic metastatic nodule for which she was advised liver resection by the oncologist. She was then lost to follow up.
Figure 1: (a) External photograph showing a partially autoeviscerated eye with prolapse of uveal contents. (b) Histopathological picture of enucleated specimen showing mixed type of melanoma consisting of epithelioid and spindle cells (arrows) (25× magnification). Note area of lymphocytic infiltrate (star). (c) High-power magnification (100×) showing area of epithelioid cells. They have large nucleus with prominent nucleoli

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  Discussion Top


Uveal melanoma is the most common primary intraocular malignancy in adults, with choroid being most commonly affected.[1] Patients can present with complaints of photopsia, floaters, decreased vision, or may have pain secondary to tumor necrosis, secondary glaucoma, or inflammation or may be asymptomatic and diagnosed incidentally on routine examination.[2],[3],[4],[5] Painful blind eyes may be a harbinger for intraocular malignancy, and many such cases have been described in literature.[6],[7] Our case presented with acute bleed in a pre-existing staphyloma with prolapsed intraocular contents, which had an underlying melanoma. Such a presentation has not been described in literature.

This is the first case of underlying uveal melanoma presenting as bleeding staphyloma with spontaneously ruptured globe. A strong suspicion of intraocular malignancy should be raised. All such cases should undergo MRI and are best managed by enucleation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McLaughlin CC, Wu XC, Jemal A, Martin HJ, Roche LM, Chen VW. Incidence of noncutaneous melanomas in the U.S. Cancer 2005;103:1000-7.  Back to cited text no. 1
    
2.
Rishi P, Shields CL, Khan MA, Patrick K, Shields JA. Headache or eye pain as the presenting feature of uveal melanoma. Ophthalmology 2013;120:1946-7.e2.  Back to cited text no. 2
    
3.
Higgins TP, Khoo CT, Magrath G, Shields CL. Flat choroidal melanoma masquerading as central serous chorioretinopathy. Oman J Ophthalmol 2016;9:174-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Feng L, Zhu J, Gao T, Li B, Yang Y. Uveal melanoma in the peripheral choroid masquerading as chronic uveitis. Optom Vis Sci 2014;91:e222-5.  Back to cited text no. 4
    
5.
Hammamji K, Reich E, Arora A, Cohen VML, Sagoo MS. Visual Loss from choroidal melanoma mimicking neurological syndromes. Case Rep Neurol 2017;9:31-5.  Back to cited text no. 5
    
6.
Pereira PR, Odashiro AN, Souza Filho JP, Saraiva VS, Camoriano DG, Burnier MN Jr. Malignancy in the blind painful eye--report of two cases and literature review. Diagn Pathol 2006;21;1:45.  Back to cited text no. 6
    
7.
Sarma DP, Deshotels SJ Jr, Lunseth JH. Malignant melanoma in a blind eye. J Surg Oncol 1983;23:169-72.  Back to cited text no. 7
    


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