Aggressive Presentation of Choroidal Melanoma in a Young Female

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Neuroimaging of the orbit revealed an irregular (40mm×31mm) heterogenous mass arising from the choroid, infiltrating the vitreous, extraconal fat, lacrimal gland & extending upto subtarsal region of left upper lid. (Figure 2 & 3) The patient underwent a subtotal exenteration of the left orbital contents, with resection of a large optic nerve stump. (Figure 4) An ill-defined multilobulated tumour mass (3×3×3.8 cm) was seen in the inferomedial region involving the adjacent muscle & fat. (Figure 5) The mass completely filled the globe, flattening the anterior chamber. Microscopically, the tumour cells were arranged in lobules, clusters and diffuse sheets with a mixed population of epitheloid & Spindle B cells. There was abundant melanin pigment, with melanophages infiltrating the tissues. (Figure 6) The cut end of the optic nerve also revealed tumour cells with melanocytic infiltration. The attached skin was however unremarkable. The neoplastic cells showed marked pleomorphism, with a high N:C ratio, prominent nucleoli, nuclear membrane irregularity & atypical mitoses. It was staged IIIc as per the AJCC classification.3 Immunohistochemistry showed S-100 positivity. Aggressive Presentation of Choroidal Melanoma in a Young Female