Purpose: We report the case of a patient with choroidal malignant melanoma presenting with extensive intraocular necrosis and panophthalmitis-like findings.
Case: The patient was a 44-year-old woman who became aware of decreased visual acuity in her left eye since a year ago and was scheduled to undergo surgery for vitreous hemorrhage at another institution; however, the patient decided to stop going to their outpatient visits. Afterward, the patient visited an ophthalmologist different from the one who made the initial diagnosis because the patient experienced further worsening of visual acuity. A choroidal tumor was suspected based on the results of various examinations; however, aggressive treatment was not offered. Nonetheless, 1 month later, the patient experienced pain in her left eye and was referred to our institution for examination. At her first visit to our in stitution, the patient's left eye presented with pano phthalmitis-like findings and she had no light sensa tion and was experiencing severe eye pain. Choroi dal malignant melanoma was suspected based on magnetic resonance imaging and other findings, and enucleation was performed. Histopathological examinations revealed almost no normal tissue structure in the eye; most of the tissue was necrotic, and infiltration of inflammatory cells, including neutrophils, was noted. Meanwhile, residual fusiform and epithelioid-type heteromorphic cells were identified in the necrotic tissue. Based on the above results combined with the findings of immunohistochemical staining at the same site, the patient was diagnosed with malignant melanoma.
Conclusions: In rare cases of choroidal malignant melanoma, tumor tissue may become necrotic in the eye and inflammatory findings may become the main symptom. Therefore, it is a necessity to consider choroidal malignant melanoma as a differential diagnosis of pathological conditions presenting with panophthalmitis-like symptoms.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 124: 77-82, 2020.