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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 14  |  Issue : 2  |  Page : 106-108

Choroidal melanoma in a young patient ultrasonography and magnetic resonance imaging


Department of Radiodiagnosis, Jawarharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission21-Jun-2018
Date of Decision09-Dec-2018
Date of Acceptance14-Aug-2019
Date of Web Publication25-Nov-2019

Correspondence Address:
Dr. Konika S Chaudhary
Department of Radiodiagnosis, Jawarharlal Nehru Medical College, Sawangi, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_48_18

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  Abstract 


Most common primary intraocular malignant tumor of an adult is choroidal melanoma. It is found rarely in general population. It is usually found in the sixth decade of population. Diagnosis of choroidal melanoma is made by fundoscopy, ultrasonography, and magnetic resonance imaging. Here, we report a case on choroidal melanoma and its imaging features are also discussed.

Keywords: Choroidal melanoma, intraocular tumor, magnetic resonance imaging, ultrasonography


How to cite this article:
Chaudhary KS, Phatak SV. Choroidal melanoma in a young patient ultrasonography and magnetic resonance imaging. J Datta Meghe Inst Med Sci Univ 2019;14:106-8

How to cite this URL:
Chaudhary KS, Phatak SV. Choroidal melanoma in a young patient ultrasonography and magnetic resonance imaging. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2019 Dec 11];14:106-8. Available from: http://www.journaldmims.com/text.asp?2019/14/2/106/271552




  Introduction Top


Choroidal melanoma is the most common primary intraocular malignant tumor of an adult; the metastasis rate is <1% during initial diagnosis. Liver is the most common site for metastasis; therefore, liver imaging is essential.[1] The diagnosis of the tumor is not possible by direct view due to opaque vitreous humor.[2] Ultrasonography high frequency is the best imaging to see intraocular tumors.[3] Magnetic resonance imaging (MRI) brain with orbit is done to distinguish between the various choroidal tumors.[4]


  Case Report Top


A 25-year-old male patient presented to our institution with chief complaints of diminished vision from 8 days with pain in the right eye and severe headache for the past 8 days along with watering and photophobia. It was sudden painless diminution of vision which was rapidly progressive. On examination of the right eye, there was loss of vision, mild lid edema, conjunctival congestion, corneal edema, and shallow anterior chamber, and on fundal examination, there was no glow. However, left eye examination was normal. Due to the opaque vitreous humor in the right eye and as on fundal examination of the right eye nothing was appreciable, the patient was referred to the radiology department for ultrasonography. On ultrasonography, there is examination of (e/o) V-shaped membrane attached to fovea suggestive of (s/o) retinal detachment and a large hyperchoic lobulated lesion of size 15 mm × 10 mm seen behind detached retina on the temporal side. [Figure 1] After diagnosis of intraocular tumor, the patient was referred for MRI. On MRI, there is e/o well-defined lesion of altered signal intensity noted in the superior temporal quadrant of right eye appearing hyperintense of T1 [Figure 2], hypointense on T2/FLAIR [Figure 3] and [Figure 4], and intense enhancement on gadolinium-enhanced contrast MRI. The lesion measures approximately 13.2 mm × 13 mm × 10 mm. There is no e/o of any extraocular extension. On ultrasonography of the abdomen, no liver metastasis was noted.
Figure 1: B-mode ultrasonography depicting V-shaped membrane attach to fovea s/o retinal detachment and a large hyperechoic lobulated lesion on the temporal side measuring 15 mm × 10 mm seen behind detached retina

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Figure 2: T1-weighted image depicting hyperintense well-defined mass in the superior temporal quadrant of globe

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Figure 3: Magnetic resonance imaging brain with orbit –T2-weighted image depicting well-defined mass which is hypointense noted in the superior temporal quadrant

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Figure 4: Axial T1 fast spin echo + contrast depicting moderate tumor enhancement

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  Discussion Top


It is the most common tumor in the sixth decade. Males are commonly affected. It is found common in Whites more than in African Americans. Patients of choroidal melanoma may or may not present with visual problem. It is an incidental finding on routine eye examination. The most common symptoms are visual field defect, visual loss, and photopsia. On B-mode ultrasonography, choroidal melanoma appears as a mushroom-shaped, lobulated mass arising from the choroid and with broad base, and it extends into the vitreous and accompanying with retinal detachment, posterior scleral bowing, choroidal excavation, and vitreous and subretinal seeding. Ultrasonography is reported as 95% accurate for diagnosis. On A-mode ultrasonography, tumor appears as low-to-medium internal reflectivity spikes on the tumor surface and vascular oscillations. On computed tomographic imaging, it appears as nonspecific soft tissue mass, and after intravenous contrast, it shows diffuse moderate enhancement.[4] At MRI, on T1-weighted images - it is hyperintense; it appears on T2-weighted images as hypointense; after administration of gadolinium contrast, it shows tumor enhancement and fat suppression useful in detecting extraocular extension.[2],[4] The differential diagnosis of choroidal melanoma is choroidal nevus, choroidal metastasis, disciform degeneration, congenital hypertrophy of retinal pigment epithelium, and choroidal hemangioma.[5],[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Balasubramanya R, Selvarajan SK, Cox M, Joshi G, Deshmukh S, Mitchell DG, et al. Imaging of ocular melanoma metastasis. Br J Radiol 2016;89:20160092.  Back to cited text no. 1
    
2.
Stroszczynski C, Hosten N, Bornfeld N, Wiegel T, Schueler A, Foerster P, et al. Choroidal hemangioma: MR findings and differentiation from uveal melanoma. AJNR Am J Neuroradiol 1998;19:1441-7.  Back to cited text no. 2
    
3.
Wang TJ, Yang CH, Liao SL, Ho TC, Huang JS, Lin CP, et al. Characteristic ultrasonographic findings of choroidal tumors. J Med Ultrasound 2003;11:55-9.  Back to cited text no. 3
    
4.
Tartaglione T, Pagliara MM, Sciandra M, Caputo CG, Calandrelli R, Fabrizi G, et al. Uveal melanoma: Evaluation of extrascleral extension using thin-section MR of the eye with surface coils. Radiol Med 2014;119:775-83.  Back to cited text no. 4
    
5.
Shields JA, Augsburger JJ, Brown GC, Stephens RF. The differential diagnosis of posterior uveal melanoma. Ophthalmology 1980;87:518-22.  Back to cited text no. 5
    
6.
Shukla S, Acharya S, Dulani M. Choroid melanoma – A rare case report. J Clin Diagn Res 2015;9:ED09-10.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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