Massive infarction of ocular tissues complicating a necrotic uveal melanoma

Brannan, S; Browne, B H; Clark, Barry

doi:10.1038/eye.1998.77

Cited by 8 publications

(12 citation statements)

References 6 publications

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“…The 6 patients with spontaneously necrotic uveal melanomas in our study exhibited similar clinical presentations to those in previous studies [1,2,3,4,5,6]. All of them presented with pain as a common clinical finding in addition to acute changes in vision, inflammation of the sclera and episclera [7], and raised intraocular pressure.…”

Section: Discussionsupporting

confidence: 67%

“…The tumor cells were postulated to provoke a T-cell and B-cell response, with the T cells injuring the vessel endothelium and leading to thrombosis, infarction, and necrosis [8]. In both Brannan et al's [4] and Reese et al's [8] work, the idea was that either inflammation or secondary glaucoma occurred first, followed by ischemic necrosis of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Brannan et al [4] discussed 2 potential mechanisms of infarction with associated ocular necrosis. In the first mechanism, the tumor mass in the posterior segment raises the intraocular pressure, leading to an acute angle closure, vascular compromise, and ischemia of the ocular contents.…”

Section: Discussionmentioning

confidence: 99%

“…Vasculitis in the anterior ciliary arteries, central retinal artery, and choriocapillaries supported Brannan et al's hypothesis. Vasculitis provides a potential explanation for the infarction of both the anterior and posterior choroid, which typically avoid vascular compromise due to vessel anastomoses [4]. …”

Section: Discussionmentioning

confidence: 99%

“…Another study of 334 ciliary body and choroidal tumors showed that patients with necrotic tumors were more likely to present with episcleritis or scleritis than those without tumor necrosis [3]. Other studies have shown that patients with necrotic uveal melanomas may present with conjunctivitis, orbital inflammation [4], pain, and hyphema [5]. Individual case studies of spontaneously necrotic uveal melanomas have reported periorbital swelling and inflammation [6], vitreous hemorrhage, raised intraocular pressure [5], and occasionally uveal effusion [1], ophthalmoplegia, and proptosis [6].…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Necrosis of Choroidal Melanoma

2014

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Background/Aims: The purpose of this study was to examine the clinical presentations and pathological features of spontaneously necrotic choroidal melanomas. Methods: The clinical and histological features of patients who underwent enucleation for uveal melanoma from 1989 to 2012 at Emory University and were found to have spontaneously necrotic choroidal melanomas were retrospectively analyzed. Results: A total of 6 cases were identified. All cases had 90-100% tumor necrosis and also exhibited marked ischemic necrosis of the iris and ciliary body; 5 of 6 cases exhibited marked ischemic necrosis of the retina. The tumor consisted of melanoma ghost cells often surrounded by a zone of pigmented macrophages. Thrombi were not found in any of the cases. All of the tumors in our cases were centered around the equatorial choroid and 2 extended into the ciliary body. One of the cases exhibited a wedge-shaped infarct in a lateral aspect of the tumor. In most of the cases, microscopic areas of intact tumor cells were present in the peripheries of the tumors. Conclusions: Spontaneous necrosis may occur in uveal melanoma. We believe that this occurs secondary to tumor hypoxia in the center of the tumor, followed by secondary inflammation, generalized ischemia and finally complete tumor necrosis.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spontaneous Necrosis of Choroidal Melanoma

2014

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Spontaneous acute scleritis and scleral necrosis in choroidal malignant melanoma

Bhagat

Ramaesh

Wharton

et al. 1999

Eye

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Spontaneous Necrosis of a Large Choroidal Melanoma: Unusual Presentation in a 49-Year-Old Male

et al. 2019

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Spontaneous intraocular haemorrhage can occur due to underlying malignancies, such as choroidal melanoma.• Choroidal melanomas usually demonstrate a solid dome-or mushroom-shaped low-to-medium reflective lesion with a regular internal acoustic structure on ultrasound (US), often with subretinal fluid at the margins. Colour Doppler US frequently shows pulsatile blood flow at the base of the melanoma. None of these features were observed in the case presented. • Rapid growth can occur in monosomy 3 and/or BAP1 mutant melanoma, leading to tumour necrosis, haemorrhage and secondary glaucoma. Novel Insights• A massive vitreous haemorrhage can obscure the underlying diagnosis of a large choroidal melanoma.• Atypical large choroidal melanomas can occur without any of the above-mentioned characteristics on US.• Rapid expansive growth of a choroidal melanoma does not necessarily equate a "high risk" uveal melanoma but can occur also in spindle cell melanomas with disomy 3 and in the absence of somatic BAP1 mutations. AbstractPurpose: To demonstrate a case of massive vitreous haemorrhage obscuring the underlying diagnosis of a large mixed-cell choroidal melanoma which had undergone spontaneous necrosis. Case Report: A 49-year-old man in good general health suddenly lost vision in his right eye due to an extensive vitreous haemorrhage 1 day after a workout at the gym. He reported good vision prior to that without any symptoms of flashes, floaters, or shadows. He was referred to the vitreoretinal department of a tertiary eye hospital, where he presented with a drop in vision to light perception Spontaneous Necrosis of a Large Choroidal Melanomaonly in the right phakic eye. Pars plana vitrectomy was performed in the right eye, which revealed intraoperatively massive retinal ischemia and choroidal haemorrhage, but no obvious tumour mass that could have been biopsied. The vitrectomy cassette specimen was sent for histopathology, where "ghost-like" melanoma cells were identified. The eye was subsequently enucleated, revealing an extensively necrotic and haemorrhagic choroidal melanoma of mixed cell type with only small viable tumour foci at the base and almost complete lysis of the detached retina. Conclusion: Some uveal melanomas (UMs) undergo spontaneous necrosis due to rapid growth, with the centre of the tumour outstripping its established blood supply in the "watershed area" of the eye, and becoming hypoxic with associated necrosis of intraocular structures. Such UMs are often associated with haemorrhage and/or inflammation and usually cause significant destruction of ocular tissues, resulting in enucleation as the only treatment option.

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Massive infarction of ocular tissues complicating a necrotic uveal melanoma

Cited by 8 publications

References 6 publications

Spontaneous Necrosis of Choroidal Melanoma

Spontaneous Necrosis of Choroidal Melanoma

Spontaneous acute scleritis and scleral necrosis in choroidal malignant melanoma

Spontaneous Necrosis of a Large Choroidal Melanoma: Unusual Presentation in a 49-Year-Old Male

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