PMC5437443_01
a The patient in April 2013 with a prolapsed, bleeding tumor mass. b Details of the tumor mass with temporal skin socket. c Details of the temporal part of the mass. d The patient in July 2013 with an enlarged tumor mass and bleeding. e The patient in September 2013 before external Co60 radiotherapy. f The patient in October 2013 after external Co60 radiotherapy.
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F1
The heroin abusing, homeless male who had never been treated before reported a 2-year history of a prolapsed, dark colored mass from his eye (Fig. 1a-c). In October 2013, his general status was very poor (Fig. 1d-f).
a Axial orbital computed tomography of the orbital prolapsed mass without infiltration of the skull. b-d Sagittal computed tomography of the mass infiltrating the orbital cone.
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F2
Computed tomography confirmed a solid mass 20 x 20 cm prolapsing from the orbit (Fig. 2).
a Microscopic picture of the tumor composed of epithelioid melanocytes (star), with large areas of necrosis (arrow). b Immunohistochemical detection of some prognostic factors expressed in the tumor (high proliferation index Ki67 [positive nuclei, arrows]). c Diffuse strong cytoplasmic positivity of apoptosis-inducing factor. d Few cyclin D1-positive nuclei (arrows). e Odd p53-positive nucleus (arrow). Hematoxylin and eosin. x200 (a). Immunoperoxidase, diaminobenzidine, x200/400 (b-e).
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F3
Histopathological examination of the biopsy specimen showed malignant melanoma of the epitheloid type G2-3 with necrotic spaces, S100+, HMB45+, MelanA+, cyclin D1 -, p53-, Bcl2+ 20%, Ki67+ 30%, with poor prognosis (Fig. 3).