PMC3526915_01
External photographs showing anterior segment of the eye. (A) Initial visit. A raised choroidal mass can be seen behind the lens. (B) Six weeks after first visit. The choroidal mass behind the lens has expanded to push the lens upward. (C) Three months after the first visit. The eye had a mature cataract, the anterior chamber has disappeared, and iris rubeosis is severe. (D) Seven months after the first visit. The tumor showed extraocular extensions through the sclera into the subconjunctival space.
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Ophthalmoscopy revealed a raised choroidal mass behind the lens (Figure 1A) and exudative retinal detachment in the lower retina of the right eye. Six weeks after our initial examination, the choroidal mass behind the lens had expanded to push the lens upward (Figure 1B), and corrected visual acuity was reduced in regard to light perception. Three months later, the right eye had a mature cataract, the anterior chamber had disappeared, and iris rubeosis was severe (Figure 1C). Seven months after the first visit, the tumor showed extraocular extensions through the sclera into the subconjunctival space (Figure 1D).
Histopathology findings of enucleated eye. (A) Macroscopic appearance. The eye had a massive choroidal tumor with exudative retinal detachment and multiple extraocular extensions into the orbit through the sclera. (B) Higher magnification of representative histological section showing spindle type A, spindle type B, and epithelioid cells, as well as cells with karyokinesis. Upper left: spindle type A cells. Upper right: epithelioid cells. Lower left: spindle type B cells. Lower right: cells presenting karyokinesis (arrow). (C) Necrosis of tumor cells. (D) Direct extraocular extension through the sclera (arrow).
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Macroscopic observations showed that the enucleated eye had a massive choroidal tumor along with exudative retinal detachment and multiple extraocular extensions into the orbit through the sclera (Figure 2A). We diagnosed the tumor as a mixed cell melanoma, because the tumor cells consisted of spindle type A, spindle type B, and epithelioid cells (Figure 2B). The intraocular portion showed marked necrosis that indicated rapid growth of the tumor and karyokinesis (Figure 2B and C). The tumor had directly invaded the sclera (Figure 2D) and extended through the scleral emissarium vessels, but had not invaded the optic disc.