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Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()

PURPOSE: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension. OBSERVATIONS: A 67-year-old Caucasian female was referred to the Stanford Ocular...

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Autores principales: Yu, Michael D., Chiang, Bryce, Pasricha, Malini Veerappan, Erickson, Benjamin P., Mruthyunjaya, Prithvi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871740/
https://www.ncbi.nlm.nih.gov/pubmed/36703903
http://dx.doi.org/10.1016/j.ajoc.2023.101797
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author Yu, Michael D.
Chiang, Bryce
Pasricha, Malini Veerappan
Erickson, Benjamin P.
Mruthyunjaya, Prithvi
author_facet Yu, Michael D.
Chiang, Bryce
Pasricha, Malini Veerappan
Erickson, Benjamin P.
Mruthyunjaya, Prithvi
author_sort Yu, Michael D.
collection PubMed
description PURPOSE: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension. OBSERVATIONS: A 67-year-old Caucasian female was referred to the Stanford Ocular Oncology Service with concern for malignant transformation of a previously stable choroidal nevus in her left eye. Her funduscopic examination demonstrated a dome-shaped choroidal lesion with overlying associated lipofuscin and subretinal fluid, consistent with a diagnosis of small choroidal melanoma. By B-scan ultrasonography, the lesion measured 8.0 × 6.0 mm in base and 2.1 mm in thickness. B-scan ultrasonography also disclosed an associated retroscleral mass, which appeared contiguous with the intraocular melanoma and was confirmed on subsequent orbital magnetic resonance imaging. A decision was made to proceed with enucleation. Under direct endoscopic visualization, the globe and extrascleral mass were fully isolated, mobilized, and removed in toto. At 24 months post-enucleation, the patient remains disease-free without evidence of systemic metastasis or local recurrence. CONCLUSIONS/IMPORTANCE: This case describes a small choroidal melanoma hiding massive extrascleral extension, underscoring the value of B-scan ultrasonography. This case also describes the unique management of choroidal melanoma with extrascleral extension using endoscopic enucleation. Performing enucleation under direct endoscopic visualization ensures complete resection and prevents inadvertent transection of the extrascleral component.
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spelling pubmed-98717402023-01-25 Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension() Yu, Michael D. Chiang, Bryce Pasricha, Malini Veerappan Erickson, Benjamin P. Mruthyunjaya, Prithvi Am J Ophthalmol Case Rep Case Report PURPOSE: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension. OBSERVATIONS: A 67-year-old Caucasian female was referred to the Stanford Ocular Oncology Service with concern for malignant transformation of a previously stable choroidal nevus in her left eye. Her funduscopic examination demonstrated a dome-shaped choroidal lesion with overlying associated lipofuscin and subretinal fluid, consistent with a diagnosis of small choroidal melanoma. By B-scan ultrasonography, the lesion measured 8.0 × 6.0 mm in base and 2.1 mm in thickness. B-scan ultrasonography also disclosed an associated retroscleral mass, which appeared contiguous with the intraocular melanoma and was confirmed on subsequent orbital magnetic resonance imaging. A decision was made to proceed with enucleation. Under direct endoscopic visualization, the globe and extrascleral mass were fully isolated, mobilized, and removed in toto. At 24 months post-enucleation, the patient remains disease-free without evidence of systemic metastasis or local recurrence. CONCLUSIONS/IMPORTANCE: This case describes a small choroidal melanoma hiding massive extrascleral extension, underscoring the value of B-scan ultrasonography. This case also describes the unique management of choroidal melanoma with extrascleral extension using endoscopic enucleation. Performing enucleation under direct endoscopic visualization ensures complete resection and prevents inadvertent transection of the extrascleral component. Elsevier 2023-01-16 /pmc/articles/PMC9871740/ /pubmed/36703903 http://dx.doi.org/10.1016/j.ajoc.2023.101797 Text en © 2023 Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Yu, Michael D.
Chiang, Bryce
Pasricha, Malini Veerappan
Erickson, Benjamin P.
Mruthyunjaya, Prithvi
Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()
title Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()
title_full Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()
title_fullStr Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()
title_full_unstemmed Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()
title_short Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()
title_sort endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension()
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871740/
https://www.ncbi.nlm.nih.gov/pubmed/36703903
http://dx.doi.org/10.1016/j.ajoc.2023.101797
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