Adenocarcinoma of retinal pigment epithelium.

Abstract

SUMMARY This report describes a 41-year-old man with an intraocular tumour misinterpreted clinically as choroidal melanoma. The fluorescein angiographic features were not fully characteristic of uveal malignancy, and indeed histopathology revealed the diagnosis of adenocarcinoma of the retinal pigment epithelium. It is suggested that, in cases with the fundus and angiographic findings described here, the rare possibility of adenocarcinoma of retinal pigment epithelium should be kept in mind. Of particular interest were the changing pathological findings in the various parts of the tumour, which paralleled the fluorescein angiographic pattern.Adenocarcinoma of the retinal pigment epithelium is a very rare neoplasm which is notoriously difficult to diagnose clinically and has always prompted enucleation because of its resemblance to choroidal melanoma. '-1 This report describes the case of a male patient who underwent enucleation for a retinal mass that looked like a melanoma and seemed to grow during a follow-up period of one year. The angiographic characteristics were not fully suggestive of melanoma, and indeed the histopathological studies revealed the tumour to be an adenocarcinoma of the retinal pigment epithelium. In such a rare condition, where reports on individual patients constitute the main source of knowledge of the tumour characteristics, it seems worthwhile to publish our case, both for what it illustrates and for the areas of ignorance it exposes. Case reportA 41-year-old male was admitted for investigation following the diagnosis of an intraocular tumour in his left eye. The initial symptoms had appeared six months before admission, when he complained of metamorphopsia and disturbances of visual acuity in his left eye.Ocular examination revealed an entirely normal right eye with 20/20 visual acuity. In his left eye the vision was 20/40, the intraocular pressure was normal, and no anterior segment abnormalities were present, Corrcspondcncc to Victor Godcl, MD,

Things that go bump in the light. The differential diagnosis of posterior uveal melanomas

“…Extrascleral extension has been reported only once in association with a posterior staphyloma 109 in the more recently reported cases. 101,102,[110][111][112][113][114] Although the number of cases studied is relatively few, adenomas and adenocarcinomas appear to occur mainly in women. 109 Clinically, adenomas and adenocarcinomas are indistinguishable and have frequently been mistaken for malignant melanomas.…”

Adenocarcinoma of the Retinal Pigment Epithelium

“…Finger et al 3 described a darkly pigmented subretinal tumor accompanied by inflammation that was suspected of being an adenocarcinoma of the RPE. In several published cases, RPE carcinomas were darkly pigmented, 2,3,5,6 but in others, including our case, they were clinically nonpigmented 1,4,7,9 and did not exhibit significant uveitis. 6,7 Tumors have been located at the posterior pole 1,4-7 as well as anterior to the equator.…”

Diagnostic Surprise in an Evisceration Specimen

“…5 If a RPE adenoma or adenocarcinoma is diagnosed, the chances of secondary metastasis may be low. 6 Correspondingly, we have not found any evidence of an occult primary or secondary lesion in our patient as yet.…”