Year : 1968 | Volume
: 16 | Issue : 2 | Page : 70--71
Unsuspected malignant melanoma
DL Maria, SK Shrivastawa, KG Datar, KG Tehra
Medical College, Aurangabad, India
D L Maria
Medical College, Aurangabad
|How to cite this article:|
Maria D L, Shrivastawa S K, Datar K G, Tehra K G. Unsuspected malignant melanoma.Indian J Ophthalmol 1968;16:70-71
|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 2020 Jul 6 ];16:70-71
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  ). 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  ).
MAKLEY AND TEED 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.
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)
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.
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.
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.
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.
We are thankful to the Department of Pathology for their histopathological report.
|1||HOGAN, M. J. AND ZIMMERAMAN L.E. (1952) Ophthalmic pathology, Philedelphia W. B. Saunders Co.|
|2||KERK H. Q., AND PETTY P.W. (1956) Arch. of Ophthal. (Chicago) 56, 843-860 (1956).|
|3||MAKLEY, T. A., AND TEED R. W., Arch. of Ophthal. (Chicago) 60, 475 (1958).|