Open AccessChoroidal Melanoma Simulating Adenoma of the Retinal Pigment Epithelium Arising at the Site of Congenital Hypertrophy of the Retinal Pigment Epithelium
Author(s) -
Basil K. Williams,
Maura Di Nicola,
J. Antonio Lucio-Alvarez,
David R. Lally,
Carol L. Shields
Publication year - 2019
Publication title -
ocular oncology and pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.444
H-Index - 10
eISSN - 2296-4681
pISSN - 2296-4657
DOI - 10.1159/000501084
Subject(s) - retinal pigment epithelium , medicine , pathology , retinal , melanoma , fluorescein angiography , retinal detachment , choroid , adenoma , retina , ophthalmology , biology , cancer research , neuroscience
Neoplasms of the retinal pigment epithelium (RPE) are rare tumors that can simulate choroidal melanoma, but clinical and imaging characteristics often differentiate these lesions. We report a 70-year-old male with an abruptly elevated pigmented lesion that arose at the site of congenital hypertrophy of the RPE and demonstrated associated exudation, as well as feeding and draining vessels, suggestive of RPE adenoma. Optical coherence tomography showed retinal elevation with serous retinal detachment adjacent to the mass, and ultrasonography revealed an abruptly elevated, moderately echodense mass of 6.4-mm thickness. Fluorescein angiography showed early tumor hypofluorescence, late tumor hyperfluorescence with staining and leakage, and retinal vessels buried under the mass, suggestive of a retinal tumor. The patient was monitored with the presumed diagnosis of RPE adenoma, but 3 months later, the growth was documented and fine-needle aspiration biopsy revealed choroidal melanoma. Management with I-125 plaque radiotherapy was performed leading to tumor regression and a thickness of 4.6 mm.