Orbital cellulitis and massive chemosis as first sign of a cilio-choroidal malignant melanoma without extraocular extension: A case report

IF 0.2 Q4 ONCOLOGY Current problems in cancer. Case reports Pub Date : 2023-09-01 DOI:10.1016/j.cpccr.2023.100253

Matteo Mario Carlà , Carmela Grazia Caputo , Maria Grazia Sammarco , Federico Giannuzzi , Chiara Fantozzi , Gustavo Savino , Maria Antonietta Blasi , Monica Maria Pagliara

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Abstract

Purpose

To describe a case of cilio-choroidal melanoma presenting as aseptic orbital cellulitis with massive conjunctival chemosis.

Methods

Case report.

Results

A 51-year-old man with a left retro-iris pigmented lesion had acute lid edema, conjunctival chemosis, and extensive hyphema. Ultrasound revealed a large, lobulated, wide-base choroidal-starting lesion affecting the ciliary bodies and vitreous chamber. MRI revealed low-intermediate T2-signal and intermediate-high T1-signal, with substantial post-contrastographic enhancement. After one week of systemic corticosteroids, the chemosis reduced significantly, and the patient was referred for enucleation, even without histologic confirmation. Post-surgical histopathology found 90% necrotic tissue, few viable cells, and no scleral or vascular invasion, with genetic analysis showing monosomy of chromosome 3 and 8q gain.

Conclusion

Choroidal melanoma, particularly if necrotic, may occasionally present as aseptic orbital cellulitis, even without extraocular spread.

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眼眶蜂窝织炎和大量化脓是无眼外扩展的纤毛-脉络膜恶性黑色素瘤的第一个征象:1例报告

目的报告一例睫状脉络膜黑色素瘤，表现为无菌性眼眶蜂窝织炎伴大量结膜化脓。MethodsCase报告。结果男性51岁，左侧虹膜后色素性病变，伴有急性眼睑水肿、结膜化脓和广泛的前房积血。超声显示一个大的、分叶状的、宽基的脉络膜起始病变，影响睫状体和玻璃体腔。MRI示中低t2信号和中高t1信号，造影后增强明显。经过一周的全身皮质类固醇治疗后，化疗明显减少，即使没有组织学证实，患者也被转诊为去核手术。术后组织病理学发现90%坏死组织，少量活细胞，无巩膜或血管浸润，遗传分析显示3号染色体单体和8q增加。结论脉络膜黑色素瘤，特别是坏死时，可能偶尔表现为无菌性眼眶蜂窝织炎，甚至没有眼外扩散。

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