Clinical History:
- For the past 3 months, a 53-year-old woman has had decreasing vision in her right eye. Today she has experienced sudden loss of vision on the right, as though a window-shade had been pulled down. Fundoscopic examination reveals a 13 mm choroidal mass on the right. The left eye appears normal.
Gross and Microscopic Pathology:
- The cross section of the enucleated eye reveals a uveal (choroidal) mass that is darkly pigmented. Microscopically, there are polygonal cells with enlarged nuclei, prominent nucleoli, and cytoplasm with brown granules. The Fontana-Masson stain is positive, indicating that the granules are melanin pigment.
Questions:
- What is the diagnosis?
Ocular melonoma.
- What sudden complication did she have?
A retinal detachment occurred. The choroidal mass can lift off the overlying retina.
- What is the significance of the histologic appearance of this lesion?
Spindle cell melanomas have a better prognosis. Epithelioid melanomas such as this one have a poor prognosis. Larger tumor size, higher mitotic rate, and greater nuclear pleomorphism are also worse prognostic factors.
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