Choroidal Mass Research Articles

Nodular posterior scleritis mimicking melanotic choroidal melanoma: A diagnostic dilemma.

To report a case of atypical nodular posterior scleritis mimicking as a melanotic choroidal melanoma. Descriptive case report. A 38-year-old female presented with sudden onset diminution of vision, severe pain and redness in her right eye. She was diagnosed to have choroidal melanoma in her left eye one year ago and underwent enucleation. On examination, conjunctiva was injected in right eye with cells in anterior vitreous face (AVF). Fundus examination revealed a large pigmented choroidal mass temporal to macula with exudative retinal detachment. Systemic evaluation and multimodal imaging ruled out the possibility of a choroidal melanoma or metastasis, with a presumptive diagnosis of nodular posterior scleritis. Three cycles of intravenous methyl prednisolone (IVMP) with a tapering dose of oral corticosteroids showed drastic improvement in symptoms with resolution of choroidal mass - further confirming the diagnosis. In cases of choroidal mass with an inflammatory component, a trial of steroids is worthwhile to prevent clinical misjudgement and devastating treatment outcomes including enucleation.

Disappearing choroidal mass: Ophthalmic manifestations of a Presumed Kikuchi-Fujimoto disease.

to report our findings in a patient with presumed Kikuchi-Fujimoto disease. report of clinical findings, fundus images, OCT, and ultrasonography. a 19-year-old female patient who presented with an unusual form of symptoms that fit a disease called Kikuchi-Fujimoto disease (KFD). A large choroidal mass was observed in the posterior pole, a month later the mass was completely gone. large choroidal masses can occur in patients with Kikuchi-Fujimoto disease, these do not warrant treatment as they are self-limiting.

CHOROIDAL OSTEOMA IN AN INFANT

Purpose: To describe a case of choroidal osteoma with macular involvement in an infant that was treated with transpupillary thermotherapy. Methods: A case report. Results: An 11-month-old infant presented for retinopathy of prematurity follow up examination and was found to have a three disc-diameter round, orange, subretinal, slightly elevated lesion with well-defined margins in the superior macula of the left eye. B-scan ultrasonography showed a slightly elevated, highly reflective choroidal mass with acoustic shadowing. A diagnosis of choroidal osteoma was made. Six months later, repeat examination under anesthesia (EUA) showed the lesion to be increasing in size and encroaching on the fovea. Given demonstrated growth and the risk of central vision loss, the patient was treated with transpupillary thermotherapy (TTT). Subsequent EUAs, over a period of four months, have shown complete decalcification with no subsequent growth. Conclusion: Choroidal osteomas are benign lesions that can be sight threatening if located in the macula. TTT in this case resulted in complete regression of a sight threatening extrafoveal choroidal osteoma at four month follow up.

Plasma Circulating Tumor DNA to Assist in the Diagnose of Unknown Primary Malignancy Underlying Choroidal Metastases.

Management of suspected choroidal metastases requires diagnostic imaging and an invasive, sometimes intraocular, biopsy to determine the primary malignancy. This multistep process takes time which may impact morbidity and mortality. Retrospective review of one case. A 56-year-old woman presented with bilateral amelanotic choroidal masses suspicious for metastases of unknown origin. Plasma circulating tumor DNA revealed EGFR, PTEN, SMAD4, a profile consistent with non-small cell lung cancer. Subsequent radiographic imaging and scapular biopsy revealed lung adenocarcinoma and genetic profile concordant with the liquid biopsy. Patient was started on EGFR-inhibitor, Osimertinib1, with measurable systemic and ocular response. Plasma circulating tumor DNA revealed the genetic profile of the primary malignancy underlying choroidal metastases of unknown origin; aiding in the prompt diagnosis and detecting the driver mutation which guided management with targeted therapy.

Choroidal amelanotic mass with vermiform margins, vision loss, and extreme fatigue.

To describe a case of a previously healthy middle-aged male with an atypical choroidal mass and fatigue. Case report. A 56-year-old Caucasian male presented with decreased vision in the right eye (OD) and a choroidal amelanotic mass OD with subretinal fluid. He received bevacizumab (1.25 mg/0.05 mL) injections by multiple providers without improvement in vision and with tumor progression. Visual acuity was 20/400 OD and 20/25 left eye (OS). The anterior segment was unremarkable in both eyes (OU). He was referred with suspected diagnosis of choroidal melanoma, metastasis, or osteoma. On examination, a choroidal amelanotic tumor with vermiform margins measuring 12 mm in base and 1.8 mm in thickness was seen OD. Smaller satellite lesions were noted inferiorly. Fundus OS was normal. Infectious evaluation was unrevealing and angiotensin-converting enzyme, lysozyme, and chest x-ray were normal. Fine-needle aspiration biopsy was declined by the patient. Given the clinical suspicion of choroidal sarcoidosis with characteristic tumor color, vermiform margins, and presence of satellite lesions, oral corticosteroids 60 mg/day for 2 months were started, followed by sub-Tenons triamcinolone acetonide (40mg/1 mL) injection three months later and urgent rheumatologic evaluation. He self-discontinued the oral corticosteroids and the tumor progressed by the next follow-up. Oral corticosteroids were restarted at 80mg/day. 16 months after his presentation to us, he experienced fatigue with electrocardiogram findings of third-degree heart block from sarcoidosis. He received an intracardiac defibrillator and 80 mg/day of corticosteroids with plans to initiate methotrexate for stronger immunosuppression. Understanding the numerous manifestations of ocular and systemic sarcoidosis is crucial. Choroidal sarcoidosis characteristically exhibits vermiform margins. Close follow-up and systemic monitoring is necessary in patients presenting with ocular signs of sarcoidosis. The diagnosis of choroidal sarcoidosis can be challenging. Features including vermiform tumor margins, satellite lesions, and choroidal infiltration on OCT are suggestive of choroidal sarcoidosis. All patients with ocular sarcoidosis should be monitored for systemic involvement. In this case, the ocular manifestation guided the diagnosis and eventually the treatment of cardiac sarcoidosis.

Coexistence of choroidal melanoma and rhegmatogenous retinal detachment: a case report and literature review

Introduction and importance: The simultaneous occurrence of rhegmatogenous retinal detachment (RRD) and choroidal melanoma is extremely rare, and diagnosis of choroidal melanoma in RRD patients is challenging. As a result, choroidal masses in RRD patients tend to be overlooked, resulting in delayed treatment. The authors report a rare case presenting with simultaneous choroidal melanoma and RRD, and the authors review the related literature. Case presentation: A 45-year-old Thai man who presented with inferior RRD and choroidal elevation in the left eye was examined using fundoscopy and ultrasonography. The presumptive diagnosis was simultaneous RRD and haemorrhagic choroidal detachment (CD). Vitrectomy and external drainage were attempted but were unsuccessful in draining fluid from the presumed haemorrhagic CD. Although the retina was reattached, the choroidal elevation remained unchanged. After being lost to follow-up, the patient returned later with severe proptosis in the left eye. MRI findings suggested a presumptive diagnosis including choroidal melanoma and choroidal metastasis, which choroidal melanoma was later confirmed through histopathological examination after exenteration. Clinical discussion: Important clinical clues were provided for distinguishing between choroidal melanoma and haemorrhagic CD in cases of coexisting RRD. Conclusions: In the differential diagnosis of RRD with suspicious choroidal elevation, the possibility of the presence of choroidal melanoma should be considered. In particular, in cases where haemorrhagic CD fails to drain during surgery, the possibility of underlying choroidal melanoma should be investigated.

RESOLUTION OF CHOROIDAL METASTASIS AND ASSOCIATED SUBRETINAL EXUDATION OF METASTATIC CUTANEOUS MELANOMA 15 DAYS AFTER TREATMENT WITH COMBINED TARGETED THERAPY.

To report a case of metastatic cutaneous melanoma to the choroid with rapid and complete resolution of associated choroidal elevation and subretinal fluid after initiation of combined targeted therapy. We describe a case of a 41-year-old man diagnosed with a metastatic cutaneous melanoma to the choroid of his right eye, for which treatment with dabrafenib/trametinib was initiated. A 41-year-old man with a past medical history of a BRAF V600E/V600E2/V600D mutated invasive superficial spreading cutaneous melanoma presented with acute metamorphopsia and blurred vision in his right eye. Examination revealed a best-corrected visual acuity (BCVA) of 20/22 and 2 elevated choroidal lesions temporal to the fovea with subretinal exudation to the fovea on fundoscopy. On repeat examination 3 days later, his vision had further decreased to 20/50 with an increase of subretinal fluid. Treatment with BRAF/MEK-inhibitor dabrafenib/trametinib was initiated, with complete resolution of the choroidal masses and subretinal exudation and improvement of the BCVA to 20/22 after only 15 days. Follow-up 8 weeks after start of therapy showed stable fundoscopic and tomographic findings, with further improvement of BCVA to 20/17 and no ocular side effects. A case of metastatic cutaneous melanoma to the choroid with choroidal elevation and subretinal exudation to the fovea, for which treatment with dabrafenib/trametinib was initiated. Rapid and complete resolution of choroidal metastasis and the associated subretinal exudation after initiation of combined targeted therapy was seen, without any ocular side effects.

Testosterone-Induced Central Serous Chorioretinopathy Mimicking a Choroidal Mass.

To describe a case of supplemental testosterone-induced central serous chorioretinopathy (CSCR) mimicking a choroidal mass in a 63-year-old male. Case report. A 63-year-old male patient on self-prescribed supplemental testosterone with CSCR mimicking a choroidal mass. A 63-year-old male presented with new onset vision loss, subretinal fluid, and choroidal mass in his left eye. Intravenous fluorescein angiography showed an enhancing choroidal mass involving the fovea. B scan ultrasonography revealed diffuse choroidal thickening. Given concern for a diffuse uveal melanoma, the lesion was biopsied showing non-diagnostic rare, atypical melanocytes. Four months after initial presentation, the patient was diagnosed with polycythemia vera. Fourteen months after diagnosis, he admitted to testosterone supplementation. Upon cessation of the testosterone supplement, the lesion progressively flattened to a chorioretinal scar with subretinal fluid resolution, and the return of normal choroidal thickness over the next 14 months. Testosterone supplementation has been linked to erythrocytosis and polycythemia vera. In the retina, testosterone supplementation has been linked to CSCR and both central and branch retinal artery and vein occlusions. This case demonstrates the importance of inquiring about all prescribed and over the counter medications in patients presenting with retinal lesions of unknown origin.

Solitary choroidal mass: A diagnostic dilemma

Abstract We report a case of 46-year-old male who had progressive visual loss in right eye for 1 month, preceded by pain. He had visual acuity of hand movement at presentation and examination revealed a choroidal mass lesion in the superior quadrant with exudative retinal detachment. Systemic workup was inconclusive. Fluorescein angiography revealed speckled fluorescence contrary to hypo fluorescence of choroiditis, and the presence of T sign on B-scan led us to the diagnosis of nodular posterior scleritis (NPS). The patient was treated with oral steroids and visual acuity recovered to 6/6. NPS can present as a choroidal mass resembling granuloma; careful workup and investigations can diagnose the entity and result in good treatment outcome.

Bilateral choroidal mass: Are we dealing with tuberculosis?

Abstract A 27 year old female was undergoing treatment for suspected viral meningitis in medicine department and referred for eye examination for decrease in vision in left eye. Fundus examination showed multiple bilateral choroidal mass with a normal anterior segment. Fundus fluorescein angiography (FFA) was confirmatory for bilateral choroidal granuloma and with a provisional diagnosis of miliary tuberculosis, High-resolution computed tomography (HRCT) thorax and contrast-enhanced magnetic resonance imaging (CEMRI) brain was done which revealed miliary mottling in both lungs with vertebral involvement and ring lesions with focal asymmetric enhancement respectively. A diagnosis of bilateral multifocal choroiditis with choroidal tubercular granuloma was established following a positive Mantoux report. Hence, unilateral or bilateral mass lesions should not be missed as a possibility of tubercular granuloma with or without systemic presentation in Indian subcontinent.

Surgical Treatment of a Large Choroidal Melanoma

Purpose: We report successful eyeball-preserving management of a patient with a large choroidal melanoma. We combined partial lamellar sclerouvectomy (PLSU) with ruthenium (Ru)-106 plaque brachytherapy.Case summary: A 48-year-old woman with a history of asthma visited our clinic with a chief complaint of gradual loss of vision at the nasal side of her right eye (best-corrected visual acuity 0.6). Fundus examination revealed a mushroom-shaped, dark choroidal mass 17.1 mm (basal diameter) × 14.2 mm (apical height). There was no evidence of distant metastasis. To remove the tumor while preserving the eyeball, we combined PLSU and simultaneous Ru-106 plaque brachytherapy with the patient under hypotensive general anesthesia. At 6 weeks postoperatively, trans pars plana vitrectomy with silicone oil injection was performed to remove the vitreous hemorrhage and treat the retinal detachment. Intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) (0.05 mL, 1.25 mg) was injected every 2 months to prevent the development of radiation retinopathy. No residual tumor, recurrence, or distant metastasis was noted during follow-up of 2 years. The patient was stable with no ocular complications at her last visit (2 years postoperatively).Conclusions: Contrary to what we expected and despite the surgical difficulties, PLSU combined with Ru-106 plaque brachytherapy is a useful eyeball-preserving strategy even when encountering a very large choroidal melanoma (diameter > 16 mm and apical height > 10 mm). Such a melanoma was previously believed to be treatable only via enucleation.

Choroidal Mass in a Patient with Undiagnosed Pulmonary Langerhans’ Cell Histiocytosis

ABSTRACT Background Langerhan cell histiocytosis (LCH), although not a common cause, should be kept in the differential diagnosis for a patient that presents with a choroidal mass. Case presentation A 28-year-old female presented with a 4-day history of vision loss and associated pain in her right eye. Examination and investigations A dilated fundus examination revealed a deep subretinal, orange, mottled lesion with associated serous retinal detachment. Ultrasonography demonstrated a solid mass at the posterior pole. Fluorescein angiography revealed corresponding, small, punctate, hyperfluorescent areas with leakage and pooling in the late phase outlining the subretinal fluid. Optical coherence tomography confirmed the choroidal elevation and subretinal fluid. In addition to starting oral steroids for addressing the patient’s acute symptoms, a metastatic workup was ordered due to the lesion’s appearance. Diagnosis: Computed tomography (CT) of the chest showed nodular lesions and subsequent lung biopsy was S-100 and CD1a positive, diagnostic of Langerhan’s cell histiocytosis (LCH). Treatment and outcome The patient was treated with six cycles of vinblastine and prednisolone therapy followed with a subsequent taper of steroids. Complete resolution of signs and symptoms was noted. Discussion A review of all reported cases of ophthalmic LCH with or without choroidal involvement was conducted. Diagnostic and therapeutic approaches described in these reportshave been summarized in the current manuscript. This case highlights the importance of pursuing a systemic workup in patients with uveal mass lesions. LCH should be considered in the differential of every choroidal mass.

Posterior scleritis following COVID-19 vaccination in an elderly patient

We report a case of posterior scleritis masquerading as choroidal melanoma following COVID-19 vaccination. An 86-year-old Caucasian male presented to a retina specialist with a 2-month history of blurred vision and pain right eye (OD). He received his fourth dose of the Pfizer-BioNTech COVID-19 vaccine before developing ocular symptoms. An intraocular mass was found OD and he was referred to our Ocular Oncology Service for potential choroidal melanoma with exudative retinal detachment. On examination, there was a 360-degree episcleral injection and no evidence of choroidal mass OD. Multimodal imaging confirmed no abnormality. Previous ultrasonography demonstrated an echolucent choroidal mass, likely representing choroidal effusion and minimal episcleral Tenon’s edema, suggesting posterior scleritis with spontaneous resolution over 1 week. Posterior scleritis following COVID-19 vaccination can masquerade as choroidal melanoma. In our case, the scleritis resolved spontaneously with no treatment and minimal consequences.

Choroidal Melanoma in an Asymptomatic Patient

Introduction Choroidal melanoma is considered the most common intraocular malignancy found in adults and typically presents without symptoms in the early stages. They are frequently first seen on routine dilated fundoscopic exams and appear as a pigmented or nonpigmented choroidal lesion. Case Presentation A 58-year-old Caucasian female presented for a comprehensive eye exam with a chief complaint of gradual distance blur in both eyes. On funduscopic examination of the right eye, a suspicious faint, variably pigmented large choroidal lesion was noted adjacent to the optic nerve. The patient was referred to a retinal oncologist for further workup and management. Management and Outcome The retinal oncologist performed multiple imaging tests including B-scan ultrasound, OCT, and Fundus Autofluorescence which revealed a choroidal mass with subretinal fluid, and presence of lipofuscin confirming a diagnosis of a small choroidal melanoma. Systemic workup did not reveal any metastasis of the choroidal lesion. The patient was initially treated surgically with plaque radiotherapy; however, the patient developed ocular complications ultimately leading to enucleation of the right eye. Consequently, the patient was fitted with an ocular prosthesis. Discussion Choroidal melanomas are the most common intraocular malignancy found in adults and encompass 80% of all uveal melanomas. Patients with choroidal melanoma are typically asymptomatic and are commonly first seen on routine dilated fundoscopic exams. Metastasis of choroidal melanomas are rare but can occur in 1-2% of all cases mainly to the liver, bone, and lung. A 50% mortality rate in a 10-year span has been noted for metastasized choroidal melanomas. Ancillary imaging modalities such as Optical coherence tomography, Fundus Autofluorescence, and B-scan ultrasound are useful in aiding in the diagnosis. Treatment and management are modified based on the characteristics of the tumor and patient, which can include brachytherapy, external beam radiotherapy, stereotactic radiotherapy, transpupillary thermotherapy, and enucleation. Timely detection and treatment are key in managing this sight and life-threatening illness CE Notification This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/choroidal-melanoma-in-an-asymptomatic-patient) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Immunoglobulin G4-related ophthalmic disease presenting as a steroid-resistant choroidal mass: a case report

Immunoglobulin G4-related ophthalmic disease presenting as a steroid-resistant choroidal mass: a case report

Choroidal haemangioma and its multimodal diagnosis: A case report

AbstractPurpose: To describe the clinical manifestations and diagnosis of choroidal haemangioma with the aid of different multimodal images, as well as its usefulness for making a differential diagnosis.Methods: A case of a patient who comes due to blurred vision is described, who underwent different complementary tests of multimodal images: optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), autofluorescence (AF), ultrasound eye exam and retinography to achieve the accurate diagnosis.Results: We present the case of a 50‐year‐old patient who debuted with recently‐onset blurred vision in the left eye (LE). In the eye fundus of LE, a yellow‐orange temporal‐inferior lesion of 3 disc diameter (DD) with neurosensory detachment of 4 DD that affects the fovea is observed. An OCT is performed that shows a choroidal mass associated with subretinal and intraretinal fluid with hyperrefringent points, the B‐scan ultrasound shows a hyperechoic lesion in the posterior pole, and both ICGA and FA reveal a hyperfluorescent pattern in all its phases, being the choroidal vessels of better visualization in the latter phase (without double vascularization pattern). AF shows hyperautofluorescence. After the definitive diagnosis of choroidal haemangioma, he was referred for treatment with Argon laser with favourable results.Conclusions: Choroidal haemangioma is a rare benign vascular tumour that occurs in middle‐aged adults and can be circumscribed (CCH) or diffuse depending on its extension. For the diagnosis of intraocular tumours it is very important to make a good differential diagnosis with the help of multimodal images: OCT, FA, ICGA, AF, Ultrasound and retinography; in order to differentiate it from similar posterior pole lesions with worse prognosis. CCH itself is benign and asymptomatic, and its treatment consists of observation; but it can present inflammatory signs with subretinal fluid and affect the macular area and therefore a more invasive treatment is indicated.References.1. Singh AD, Kaiser PK, Sears JE. Choroidal hemangioma. Ophthalmol Clin North Am. 2005;18(1):151–61, ix.2. Berry M, Lucas LJH. Circumscribed choroidal hemangioma: A case report and literature review. J Optom. 2017;10(2):79–83.

Sudden Vision Loss Secondary to Optic Nerve Infiltration as a Presenting Symptom of Metastatic Lung Adenocarcinoma

To report a rare case of left-sided metastatic optic nerve infiltration and right-sided choroidal mass with exudative retinal detachment caused by EGFR exon 19 deletion positive non-small-cell lung adenocarcinoma that responded to targeted therapy with osimertinib (EGFR-TKI). Our patient demonstrated an excellent response with reduced size of the metastatic choroidal mass of the right orbit and improved visual acuity, in addition to systemic disease control. A 66-year-old male patient with a history of diabetes mellitus, hypertension, and tobacco use presented with sudden vision loss in the left eye secondary to optic nerve infiltration and subacute vision loss in the right eye secondary to exudative retinal detachment from a choroidal metastasis. He was found to have a right lung mass, multiple metastatic pulmonary nodules, and liver and bone metastases. Biopsy from a mediastinal lymph node confirmed the diagnosis of metastatic lung adenocarcinoma. He was found to have exon 19 deletion on next-generation sequencing. We treated him with local radiation therapy to the left eye and systemic osimertinib (EGFR-TKI). To our knowledge, our case is the first report of a patient who initially presented with acute vision loss and was found to have metastatic retrobulbar optic nerve infiltration in one eye and metastatic choroidal lesion with exudative retinal detachment in the fellow eye secondary to lung adenocarcinoma. Due to the rarity of this condition, literature regarding effective treatment is scarce. Our patient demonstrated significant improvement in visual acuity and resolution of exudative retinal detachment in the right eye following osimertinib treatment and radiation therapy to the left eye. Further investigation into the role of tyrosine kinase inhibitors and radiation therapy in treating intraocular metastasis involving the optic nerve is needed.

Ocular schwannoma masquerading as amelanotic choroidal melanoma

A 29-year-old male was incidentally diagnosed with amelanotic choroidal melanoma in the nasal quadrant of the right eye following an ocular examination due to accidental entry of an insect in the eye. The patient underwent right eye stereotactic Gamma Knife radiosurgery. The tumor mass showed regression six months after therapy. After 12 months, the patient presented again with diminution of vision with recurrence of choroidal mass and total retinal detachment. He underwent a right eye enucleation. Histopathological examination revealed spindle-shaped cells arranged in fascicles and immune stain positivity for S-100 and negative for HMB-45 and Melan-A—suggestive of schwannoma.

Nodular Posterior Scleritis Masquerading as Amelanotic Choroidal Melanoma

We report a patient of choroidal mass, masquerading as amelanotic choroidal melanoma. A 48 years old male presented in outpatient department (OPD) with painless decrease in vision of left eye. Fundus examination revealed a two disc diameter, non-pigmented, sub-retinal lesion with approximately 3mm basal diameter, superior to the disc with no choroidal folds, retinal detachment or pigmentation over the lesion. B scan revealed a small nodular thickening superior to the optic nerve head with moderate to low internal reflectively and no choroidal excavation. Swept-Source optical coherence tomography (SS OCT) showed massive elevation of retina due to underlying scleral thickening. He was diagnosed as nodular posterior scleritis (NPS). The lesion regressed completely after treatment with topical and systemic Non-steroidal anti-inflammatory drugs (NSAIDs). Despite its low prevalence, NPS should be kept in differential diagnosis of an amelanotic choroidal mass.

Spontaneous and Indentation Subretinal Hemorrhage from Choroidal Melanoma

Choroidal melanoma is the most common primary intraocular malignancy in adults. Herein, the authors report two cases of subretinal hemorrhage associated with it. The first case presented with a large choroidal mass associated with subretinal hemorrhage, no history of trauma and choroidal melanoma diagnosis on ultrasound. The second case was initially diagnosed with retinal detachment but during the surgery a pigmented subretinal mass was observed, starting to bleed after scleral depression. Subretinal hemorrhage can occur due to ruptures in Bruch's membrane spontaneously or precipitated by inadvertent trauma. Despite an unusual manifestation, it should always be considered avoiding misdiagnosis.