Choroidal nevus is a common intraocular lesion, found predominantly in Whites. This mass carries a small risk (<1%) for malignant transformation. Patients with at least three risk factors should be evaluated for possible melanoma at an experienced ocular oncology center.
Purpose: To report a case of pigmented caruncular oncocytoma that simulated malignant melanoma and discuss the associated ultrasonographic and pathologic features. Method: Case report. Results: An 81-year-old female presented with a painless caruncular mass with a smooth brown surface suspicious for melanoma. Ultrasound biomicroscopy revealed a round mass with a large central cavity, more suggestive of a cystic rather than solid lesion. Following complete surgical resection, histopathology revealed a cystadenomatous lesion composed of bland cells with copious eosinophilic cytoplasm consistent with oncocytoma that had a central blood-filled cavity. Conclusions: Oncocytoma is a benign tumor that can appear pigmented clinically and resemble melanoma. The definitive diagnosis requires histopathologic evaluation. Oncocytoma should be considered in the differential diagnosis of a pigmented caruncular mass.
This study evaluated predictors for choroidal neovascularization (CNV) associated with central serous chorioretinopathy (CSCR) based on multimodal imaging. A retrospective multicenter chart review was conducted on 134 eyes of 132 consecutive patients with CSCR. Eyes were classified as per the multimodal imaging-based classification of CSCR at baseline into simple/complex CSCR and primary episode/recurrent/resolved CSCR. Baseline characteristics of CNV and predictors were evaluated with ANOVA. In 134 eyes with CSCR, 32.8% had CNV (n = 44) with 72.7% having complex CSCR (n = 32), 22.7% having simple (n = 10) and 4.5% having atypical (n = 2). Primary CSCR with CNV were older (58 vs. 47, p = 0.00003), with worse visual acuity (0.56 vs. 0.75, p = 0.01) and of longer duration (median 7 vs. 1, p = 0.0002) than those without CNV. Similarly, recurrent CSCR with CNV were older (61 vs. 52, p = 0.004) than those without CNV. Patients with complex CSCR were 2.72 times more likely to have CNV than patients with simple CSCR. In conclusion, CNV associated with CSCR was more likely in complex CSCR and older age of presentation. Both primary and recurrent CSCR are implicated in CNV development. Patients with complex CSCR were 2.72 times more likely to have CNV than patients with simple CSCR. Multimodal imaging-based classification of CSCR supports detailed analysis of associated CNV.
A healthy 67-year-old man presented to the ocular oncology service with a 3-day history of acute-onset blurred vision and mild tenderness of his left eye. He denied notable ocular history aside from a recently documented elevated intraocular pressure (IOP) of 36 mm Hg OS and shallow anterior chamber (AC). Laser peripheral iridotomy had been performed but failed to deepen the AC. Subsequently, a choroidal mass was discovered, and he was referred for our opinion.On examination, refractive error was +3.00 D OU, and best-corrected visual acuity was 20/25 OD and 20/40 OS. Results of examination in the right eye were unremarkable, and IOP was 17 mm Hg. Examination of the left eye revealed elevated IOP of 26 mm Hg while the patient was taking dorzolamide/timolol. The AC was shallow, and episcleral vessels were congested. Ophthalmoscopic examination and wide-angle scanning laser ophthalmoscopy (Figure 1A) documented a ring-shaped peripheral ciliochoroidal mass accompanied by shallow serous retinal detachment inferiorly. Globe transillumination revealed an undefined mottled choroidal shadow inferiorly. B-scan ultrasonography (Figure 1B) and ultrasound biomicroscopy suggested an echolucent ciliochoroidal elevation without intrinsic vascular pulsations. Magnetic resonance imaging of the orbits confirmed the ring-shaped ciliochoroidal elevation with nonenhancement of the mass. Doppler ultrasonography showed normal flow parameters without evidence of a dural-cavernous fistula. Serous choroidal detachment B Choroidal detachment with folds A Figure 1. A, Wide-angle fundus photograph demonstrating peripheral choroidal elevation, most prominent superotemporally, and numerous choroidal folds. B, B-scan ultrasonography showing extensive choroidal detachment. WHAT WOULD YOU DO NEXT? A. Perform fine-needle aspiration biopsy B. Perform plaque radiotherapy C. Treat with oral corticosteroids D. Proceed with sclerotomies, ie, creation of scleral windows Clinical Review & Education
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