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DR . SABITA KUMARI
GUIDED BY :
DR S.DAIGAVANE ,DR S.BANAIT
Case report : Chorodial Melanoma
with secondary glaucoma in asi...
INTRODUCTION :
 Choroidal melanoma is the commonest primary
intraocular tumor but is rare in the Indian population.
 Onl...
 Blurred vision, pain, and floaters are common
symptoms, but it may be an incidental finding on
ophthalmoscopy.
 Seconda...
CASE REPORT:
A 60 years old male presented with loss of vision in right
eye and severe headache , associated with eyeache...
A darkly pigmented mass in
the retrolental space (supero-nasally)
and a detached retina were shown by
slit lamp examinati...
 The tumor mass was arising from cilio-choroidal
junction, diagnosed it as a case of choroidal melanoma.
 No metastasis ...
Results: Enucleation of the eye
was subsequently performed.
Prosthtic eye (right eye) was
implanted.
Histologic sections s...
Discussion:
Though choroidal melanoma is the commonest primary
intraocular malignancy, it has a very low incidence, only ...
In a survey of 2,111 eyes in Philadelphia , it was found that
only 2% of the eyes with choroidal melanoma had secondary
g...
The liver is the commonest site of metastasis.
The four important factors affecting the prognosis of
choroidal malignant...
In our patient the tumor measured more than 1 cm3
and
was of the spindle A type with occasional mitoses and no
scleral ex...
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Case Report : Chorodial Melanoma With Secondary Glaucoma In Asian Race.

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Dr . Sabita Kumari, Guided By : Dr. S.Daigavane , Dr. S.Banait.

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Case Report : Chorodial Melanoma With Secondary Glaucoma In Asian Race.

  1. 1. DR . SABITA KUMARI GUIDED BY : DR S.DAIGAVANE ,DR S.BANAIT Case report : Chorodial Melanoma with secondary glaucoma in asian race.
  2. 2. INTRODUCTION :  Choroidal melanoma is the commonest primary intraocular tumor but is rare in the Indian population.  Only three reports have been documented in India. Its incidence in the world is 0.02–0.06%.  The most common age group affected is between 40 and 60 years.  It presents unilaterally and is slightly more frequent in men.
  3. 3.  Blurred vision, pain, and floaters are common symptoms, but it may be an incidental finding on ophthalmoscopy.  Secondary glaucoma is an uncommon presentation.  Choroidal melanoma is rare in non-white races.  Only two reports have been documented in India and none presented with glaucoma (Manohar et al, 1991; Biswaset al, 2000).
  4. 4. CASE REPORT: A 60 years old male presented with loss of vision in right eye and severe headache , associated with eyeache and congestion in same eye since 3 months. On examination, his visual acuity was No PL in the right eye and 6/12 in the left eye; with pinhole 6/6. Anterior segment examination of right eye there was circum corneal congestion . A conjunctival naevus was present near limbus . Right eye pupil was fixed , dilated with a clear lens.
  5. 5. A darkly pigmented mass in the retrolental space (supero-nasally) and a detached retina were shown by slit lamp examination. Ocular examination of the left eye was absolutely within normal limits. The IOP in the right eye was 41.5mmHg; in the left eye it was 14.6mmHg. B-scan ultrasonography – A large dome-shaped mass along with retinal detachment. Tumor has entered up to optic disc.
  6. 6.  The tumor mass was arising from cilio-choroidal junction, diagnosed it as a case of choroidal melanoma.  No metastasis was found on evaluation.  MRI brain with contrast shows that there is e/o bilobed cottage lesion of size 2 x 1.3cm seen arising from the medial side of right orbit, lesion is hyperintense on T1 to normal vitreous, hypointense on T2, and shows enhancement.  There is e/o complete tunnel Shaped retinal detachment with subretinal haemorrhage.
  7. 7. Results: Enucleation of the eye was subsequently performed. Prosthtic eye (right eye) was implanted. Histologic sections showed Type A, elongated spindle cells with cytoplasm brown pigmentation. Nucleus appeared to be compact with Unremarkable mitotic activity. The resected end of the optic nerve was also free of tumor.
  8. 8. Discussion: Though choroidal melanoma is the commonest primary intraocular malignancy, it has a very low incidence, only 6 cases per million population /year, in the US. Moreover, black patients have less than eight times the risk of developing disease compared with white patients. The ratio of white patients to dark skinned patients who have this neoplasm is over 50:1, in most cases, the mean age at diagnosis is about 55 years, and there is slight preponderance of males (Seddon et al, 1989).
  9. 9. In a survey of 2,111 eyes in Philadelphia , it was found that only 2% of the eyes with choroidal melanoma had secondary glaucoma at the time of diagnosis. The commonest mechanism in the cases of choroidal melanoma was neovascularization of the iris (Shields et al, 1987). The second most common mechanism of secondary glaucoma is anterior displacement of the lens iris diaphragm by the tumor mass, with the development of PAS and closed-angle glaucoma (Spiereret al,1983; Shields et al, 1987): our case had glaucoma caused by this mechanism.
  10. 10. The liver is the commonest site of metastasis. The four important factors affecting the prognosis of choroidal malignant melanoma are size, cell type, scleral extension, and mitoticactivity (Yanoff and Fine, 1996). Malignant melanomas over 1 cm3 have a poor prognosis. Slightly less than 50% of ciliary body and choroidal malignant melanomas are of the spindle cell variety. These have a better prognosis than the non-spindle cell variety (epithelial, mixed or necrotic).
  11. 11. In our patient the tumor measured more than 1 cm3 and was of the spindle A type with occasional mitoses and no scleral extension Cases of primary choroidal malignant melanoma presenting with secondary glaucoma in non white patients are extremely rare. This case is all the more interesting, given its rarity and its unusual clinical presentation.

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