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Lai YS, Shatriah I, Lo YL, Koh KL, Kogilavaani J. A Choroidal Melanoma With Ciliary Body Involvement in a Young Female. Cureus 2024; 16:e56955. [PMID: 38665711 PMCID: PMC11044094 DOI: 10.7759/cureus.56955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Choroidal melanoma with ciliary body involvement is rare, especially in young adults and Asians. Here, we report the case of a young, healthy Chinese woman who complained of decreased vision in the left eye for one week. Her ocular examination and imaging were suggestive of choroidal melanoma involving the ciliary body. The patient underwent enucleation of the left eye. Close monitoring was needed, as the involvement of the ciliary body in choroidal melanoma is associated with a high risk of metastasis.
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Affiliation(s)
- Yen Sheong Lai
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
| | - Ismail Shatriah
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Yee Lin Lo
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
| | - Koon Ling Koh
- Department of Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
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Abdel-Aty A, Linderman WL, Kombo N, Sinard J, Pointdujour-Lim R. Necrotic Uveal Melanoma Mimics Orbital Cellulitis: A Review. Ocul Oncol Pathol 2022; 8:1-8. [PMID: 35356597 PMCID: PMC8914239 DOI: 10.1159/000515558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/28/2021] [Indexed: 02/03/2023] Open
Abstract
Background Uveal melanoma is the most common primary intraocular malignancy in adults, often resulting in painless vision loss. We report a case of necrotic uveal melanoma presenting with orbital inflammation mimicking orbital cellulitis and present a comprehensive review of the literature and tabulation of reported cases. Summary Our review found 44 published reports of spontaneously necrotic uveal melanoma involving 55 patients. Of these reports, 26 patients (47%) presented with orbital cellulitis. Presenting symptoms of necrotic uveal melanoma with orbital cellulitis included proptosis (82.8%), pain (80.7%), vision loss (61.5%), and restricted extraocular movements (46.2%). Key Messages Uveal melanoma can rarely mimic orbital cellulitis. Autoinfarction and tumor necrosis causes secondary orbital inflammation. Intraocular malignancy must remain in the differential for patients with orbital inflammation and vision loss.
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Affiliation(s)
- Ahmad Abdel-Aty
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Wendy L. Linderman
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Sinard
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA,*Renelle Pointdujour-Lim,
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Mehta A, Singh M, Banerjee N, Jain C, Kakkar N, Gupta P. Aseptic orbital cellulitis: A master masquerade of intraocular malignancy. Eur J Ophthalmol 2020; 31:NP1-NP4. [PMID: 32321305 DOI: 10.1177/1120672120919343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sudden and extensive growth of intraocular tumors like retinoblastoma and choroidal melanoma may result in the clinical presentation of sterile or aseptic orbital cellulitis. In such masquerading situations, ocular and orbital imaging plays a significant role. The treatment with steroids may provide a rapid recovery from the aggressive orbital inflammation. However, a high index of suspicion is vital for apt diagnosis and timely management.
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Affiliation(s)
- Aditi Mehta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirmalya Banerjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Jain
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Li AL, Kang JY, Berry DE, Patel KB, Hendrick AM. Necrotic uveal melanoma presenting as orbital cellulitis with intraocular hemorrhage: A case report. Am J Ophthalmol Case Rep 2019; 16:100557. [PMID: 31650085 PMCID: PMC6804517 DOI: 10.1016/j.ajoc.2019.100557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/21/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose To report a case of necrotic uveal melanoma presenting as orbital cellulitis with an intraocular hemorrhage. Observations A 61 year-old non-verbal male presented with a two-week history of right eyelid swelling and erythema unresponsive to antibiotics. In addition to these signs of orbital cellulitis, he presented with an opaque media precluding fundus visualization. He was later found to have a collar-button shaped mass consistent with uveal melanoma on B scan ultrasonography during an exam under anesthesia. The patient underwent enucleation with histopathology confirming a necrotic uveal melanoma. Conclusion and Importance This case demonstrates how necrotic uveal melanoma can present as orbital cellulitis and the importance of keeping the diagnosis on the differential.
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Affiliation(s)
- Alexa L Li
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Julia Y Kang
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Duncan E Berry
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Krishna B Patel
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew M Hendrick
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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Singh P, Sen S, Banerjee M, Meel R. Choroidal melanoma masquerading as orbital cellulitis. BMJ Case Rep 2018; 11:11/1/e227486. [PMID: 30567222 DOI: 10.1136/bcr-2018-227486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Orbital cellulitis is the most common subset of orbital inflammatory disease. We describe a patient with necrotic choroidal melanoma who presented with orbital cellulitis. MRI revealed a mass lesion suggesting intraocular melanoma with no extrascleral extension. There was no metastasis on positron emission tomography-CT scan. Enucleation with orbital implant was performed. Histopathological analysis of the specimen revealed intraocular necrotic melanoma with very few recognisable melanoma cells. The necrotic subtype is more commonly associated with extrascleral extension, distant metastasis and poorer prognosis than other melanoma types. Sterile orbital cellulitis may rarely be a manifestation of ocular tumours in adults, and a high index of suspicion should be maintained to rule out the same.
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Affiliation(s)
- Pallavi Singh
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sagnik Sen
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mousumi Banerjee
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rachna Meel
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Oh LJ, Dunn H, Cherepanoff S, Giblin M. Orbital Cellulitis and Secondary Angle Closure: A Rare Presentation of Choroidal Melanoma. Ocul Oncol Pathol 2018; 4:130-133. [PMID: 30320095 DOI: 10.1159/000477546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/15/2017] [Indexed: 11/19/2022] Open
Abstract
We describe a case of choroidal melanoma initially presenting with orbital cellulitis, fulminant conjunctival swelling, and secondary angle closure. Despite treatment with intravenous antibiotics, the patient's condition did not improve. With further investigations including ultrasound scan and magnetic resonance imaging, a high-density lesion was found within the globe. Characteristic imaging findings suggested a malignant origin and the lesion was found to be a melanoma on histopathological analysis.
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Affiliation(s)
- Lawrence J Oh
- Save Sight Institute, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Hamish Dunn
- University of Sydney, Sydney, NSW, Australia.,Concord Hospital, Sydney, NSW, Australia
| | - Svetlana Cherepanoff
- Save Sight Institute, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Michel Giblin
- Save Sight Institute, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
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Orbital cellulitis. Surv Ophthalmol 2018; 63:534-553. [DOI: 10.1016/j.survophthal.2017.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/12/2022]
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Nair AG, Kaliki S, Kamal S. Protocol-based management in orbital retinoblastoma. Orbit 2017; 37:78-79. [PMID: 29053031 DOI: 10.1080/01676830.2017.1383449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Akshay G Nair
- a Ophthalmic Plastic Surgery and Ocular Oncology Services , Advanced Eye Hospital & Institute , Navi Mumbai , Maharashtra , India
| | - Swathi Kaliki
- b The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute , Hyderabad , Telangana , India
| | - Saurabh Kamal
- c Oculoplasty and Ocular Oncology Services , EyeHub Hospital , Faridabad , Haryana , India
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Wang LC, Kim JW, Rao NA. Coexisting Phacoanaphylaxis and Choroidal Melanoma: An Unusual Intraocular Inflammation. Ocul Immunol Inflamm 2017; 26:1278-1282. [PMID: 28960124 DOI: 10.1080/09273948.2017.1347693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To describe an unusual case of panuveitis in coexisting choroidal melanoma and phacoanaphylaxis. METHODS Clinical records of the patient with intraocular melanoma and pathologic findings of the affected eye were reviewed. Composition of inflammatory infiltrates involving the tumor and lens was evaluated immunohistochemically. RESULTS Histologically, tumor showed a choroidal mixed cell type malignant melanoma with infiltration of inflammatory cells. The globe also showed typical features of phacoanaphylaxis, characterized by disruptions of the lens capsule with zonal granulomatous inflammation. The inflammatory infiltration revealed the predominant presence of both cytotoxic T cells and histiocytes in phacoanaphylaxis and intra-tumoral inflammation. CONCLUSIONS The current clinico-pathologic case report suggests that a long standing intraocular melanoma can present with phacoanaphylaxis. The immunophenotype of the inflammatory infiltrates at both sites, lens and the tumor, is similar, cytotoxic T cells and histiocytes, favoring a common immune inflammatory process directed at the tumor and the lens.
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Affiliation(s)
- Lei-Chi Wang
- a Department of Ophthalmology and Pathology, USC Roski Eye Institute , Keck School of Medicine of the University of Southern California , Los Angeles , California , USA.,b Department of Pathology and Laboratory Medicine , Taipei Veterans General Hospital , Taipei , Taiwan.,c School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Jonathan W Kim
- a Department of Ophthalmology and Pathology, USC Roski Eye Institute , Keck School of Medicine of the University of Southern California , Los Angeles , California , USA
| | - Narsing A Rao
- a Department of Ophthalmology and Pathology, USC Roski Eye Institute , Keck School of Medicine of the University of Southern California , Los Angeles , California , USA
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Nalcaci S, Palamar M, Yaman B, Akalin T, Mentes J. Choroidal malignant melanoma with no extraocular extension presenting as orbital cellulitis. Orbit 2016; 35:285-7. [PMID: 27463451 DOI: 10.1080/01676830.2016.1176216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This report describes a patient with choroidal malignant melanoma presenting as orbital cellulitis without extraocular tumor extension. It is an interventional case report with histopathologic correlation. A 68-year-old male presented with a 3-day history of painful hyperemia and swelling in the right eye. The examination showed edematous eyelids, mechanical ptosis and chemosis with conjunctival injection. B-scan ultrasonography showed a mass with medium level echogenicity that filled the vitreous cavity. Magnetic resonance imaging showed a solid choroidal mass with hemorrhagic and inflammatory changes with no obvious extraocular extension. Due to these suggestive findings of choroidal melanoma the right eye was enucleated. A spindle cell choroidal melanoma including intense pigmentation and necrosis was confirmed by histopathological examination. Although rare; choroidal melanoma may present as orbital cellulitis, particularly when the tumor is necrotic.
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Affiliation(s)
- Serhad Nalcaci
- a Department of Opthalmology , Ege Universitesi Tip Fakultesi , Izmir , Turkey
| | - Melis Palamar
- a Department of Opthalmology , Ege Universitesi Tip Fakultesi , Izmir , Turkey
| | - Banu Yaman
- b Department of Pathology , Ege Universitesi Tip Fakultesi , Izmir , Turkey
| | - Taner Akalin
- b Department of Pathology , Ege Universitesi Tip Fakultesi , Izmir , Turkey
| | - Jale Mentes
- a Department of Opthalmology , Ege Universitesi Tip Fakultesi , Izmir , Turkey
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Abstract
Orbital cellulitis is a medical emergency requiring multidisciplinary team involvement. Early diagnosis and intervention is imperative to avoid serious complications. This article provides an evidence-based approach to the assessment and management of patients with orbital cellulitis.
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Affiliation(s)
- Nikul Amin
- Specialist Registrar in Ear, Nose and Throat Surgery, University Hospital Lewisham, London SE13 6LH
| | - Irfan Syed
- Consultant Ear, Nose and Throat Surgeon, University Hospital Lewisham, London
| | - Sarah Osborne
- Consultant Ophthalmologist, Moorfields Eye Hospital, London
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