Metastatic Choroidal Melanoma Presenting as Neovascular Glaucoma

Uveal melanoma is the most common primary intraocular tumor in adults and can have varying presentations, although it is frequently asymptomatic. One rare presentation of uveal melanoma is neovascular glaucoma (NVG). We present a case of a 20-year-old male who presented with 2 weeks of left eye redness and decreased vision who was found to have NVG. He was referred for evaluation of glaucoma. Fundoscopic and ultrasonographic examination revealed a mushroom-shaped choroidal mass with low internal reflectivity consistent with choroidal melanoma. The patient underwent enucleation, and metastatic workup revealed hepatic metastases. The patient died 18 months after initial diagnosis. This case emphasizes the importance of a complete ophthalmic evaluation in cases presenting with NVG of unclear etiology to exclude the presence of a potentially life-threatening intraocular tumor.

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Uveal Melanoma and Secondary Angle-Closure Crisis: A Case Report and Literature Review

Case Reports in Ophthalmology ◽

10.1159/000513133 ◽

2021 ◽

pp. 476-480

Author(s):

Tung Thanh Hoang ◽

Tuan Anh Hoang ◽

Peter McCluskey ◽

John Grigg

Keyword(s):

Retinal Detachment ◽

Uveal Melanoma ◽

Vision Loss ◽

Serous Retinal Detachment ◽

Anterior Segment ◽

Angle Closure ◽

Large Tumor ◽

Tumor Mass ◽

Healthy Female ◽

Life Threatening

A 66-years-old Vietnamese healthy female patient presented with prolonged severe right ocular pain and complete vision loss in that eye. Anterior segment assessment including gonioscopy identified angle-closure configuration. A suspected ciliary body melanoma was seen through the pupil. Posterior segment examination revealed a large tumor mass and 360° retinal detachment (kissing configuration). An ultrasound examination was consistent with a uveal tumor. The painful, blind right eye with a tumor mass was enucleated. Histopathology confirmed a type A uveal spindle cell melanoma associated with total serous retinal detachment without evidence of tumor necrosis, epithelioid cells, scleral, or optic nerve infiltration. There was no evidence of metastasis after 1-year of follow-up. It is critically important to differentiate primary and secondary angle closure, especially in cases with life-threatening ocular malignancy as uveal melanoma.

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Liver transplant in an infant with bilateral cystic neuroblastoma complicated by hepatic metastases and life-threatening consumption coagulopathy

Pediatric Transplantation ◽

10.1111/j.1399-3046.2008.00887.x ◽

2008 ◽

Vol 12 (3) ◽

pp. 358-362 ◽

Cited By ~ 7

Author(s):

Mehmet Haberal ◽

Figen Ozcay ◽

Sinasi Sevmis ◽

Hamdi Karakayali ◽

Gokhan Moray ◽

...

Keyword(s):

Liver Transplant ◽

Hepatic Metastases ◽

Consumption Coagulopathy ◽

Life Threatening

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A life-threatening rare presentation of spontaneous liver tumor rupture with respiratory distress and further lifesaving management with literature review

Visual Journal of Emergency Medicine ◽

10.1016/j.visj.2021.101146 ◽

2021 ◽

Vol 25 ◽

pp. 101146

Author(s):

Saba Nabavi Monfared ◽

Phool Iqbal ◽

Sushil Niraula

Keyword(s):

Literature Review ◽

Respiratory Distress ◽

Liver Tumor ◽

Tumor Rupture ◽

Rare Presentation ◽

Life Threatening

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Treatment of bulky uveal melanoma (UN) hepatic metastases with doxorubicin eluting beads (DEBDOX) followed by 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) TACE: an initial experience

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.12.107 ◽

2014 ◽

Vol 25 (3) ◽

pp. S45

Author(s):

A.L. Tan ◽

D.J. Eschelman ◽

C.F. Gonsalves ◽

A. Frangos ◽

T. Sato

Keyword(s):

Uveal Melanoma ◽

Hepatic Metastases ◽

Initial Experience

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Stridor: a rare presentation of motor neuron disease

BMJ Case Reports ◽

10.1136/bcr-2021-241923 ◽

2021 ◽

Vol 14 (7) ◽

pp. e241923

Author(s):

Brian Gordon ◽

Eimear Joyce ◽

Timothy J Counihan

Keyword(s):

Motor Neuron ◽

Motor Neuron Disease ◽

Vocal Cord ◽

Poor Response ◽

Vocal Cord Palsy ◽

Pharmacological Therapy ◽

Rare Presentation ◽

Emergency Tracheostomy ◽

Life Threatening ◽

History Of

A 74-year-old farmer presented to the emergency department with a subacute history of progressive dyspnoea, wheeze and dysphonia. He was treated for an exacerbation of asthma with poor response to pharmacological therapy. Investigation of dysphonia via laryngoscopy identified a bilateral vocal cord palsy. Subsequently, the patient developed an episode of life-threatening stridor and hypercapnic respiratory failure requiring an emergency tracheostomy. Neurology input identified evidence of widespread muscle fasciculations on clinical examination. MRI of the brain and cervical spine were unremarkable. Electromyogram testing identified changes of acute denervation in several limbs consistent with a diagnosis of motor neuron disease (MND). Bilateral vocal cord palsy has been rarely reported in the literature as the heralding symptom resulting in the diagnosis of MND. In patients with a subacute onset of dysphonia, dyspnoea and stridor, MND should be a differential diagnosis.

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Diagnostic A-Scan of Choroidal Tumors: Comparison of Quantified Parameters

Ocular Oncology and Pathology ◽

10.1159/000495350 ◽

2019 ◽

Vol 5 (5) ◽

pp. 358-368 ◽

Cited By ~ 2

Author(s):

Nakul Singh ◽

Yombe Fonkeu ◽

Brandy H. Lorek ◽

Arun D. Singh

Keyword(s):

Clinical Diagnosis ◽

Choroidal Melanoma ◽

Choroidal Metastasis ◽

Choroidal Hemangioma ◽

Custom Made ◽

Tissue Sensitivity ◽

Choroidal Nevus ◽

The Mean ◽

Standard Techniques ◽

Internal Reflectivity

Aim: To compare quantified ultrasonographic A-scan parameters of common choroidal tumors. Methods: Consecutive patients with a clinical diagnosis of choroidal melanoma (n = 100), choroidal nevus (n = 30), choroidal metastasis (n = 10), and circumscribed choroidal hemangioma (n = 10) were included in this study. Ultrasonographic A-scans (8 MHz, 1,550 m/s, tissue sensitivity = 67 dB) were performed by standard techniques. Using a custom made MATLAB® script, four quantifiable A-scan parameters: tumor height (mm), number of internal reflectivity peaks (numerical value), median internal reflectivity (%), and angle κ (°) were obtained for all (n = 150) tumors. Results: The mean number of internal reflectivity peaks for choroidal nevus, choroidal metastasis, and circumscribed choroidal hemangioma was 3.1, 5.1, and 4.0, respectively. The median internal reflectivity for choroidal melanoma varied from 21.5 to 99.5% (mean = 76.4%). The median internal reflectivity was ≥65% in all choroidal nevus (100%), choroidal metastasis (100%), and circumscribed choroidal hemangioma (100%), and majority of the choroidal melanoma (78%). Conclusions: The quantified A-scan patterns of common choroidal tumors were significantly influenced by the tumor height. Other than median internal reflectivity of < 65%, which seems to distinguish choroidal melanoma from other tumors (choroidal nevus, choroidal metastasis, and circumscribed choroidal hemangioma), there were no specific diagnostic patterns.

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MRI in the detection of hepatic metastases from high-risk uveal melanoma: a prospective study in 188 patients

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2012-302323 ◽

2012 ◽

Vol 97 (2) ◽

pp. 159-163 ◽

Cited By ~ 56

Author(s):

Ernie Marshall ◽

Christopher Romaniuk ◽

Paula Ghaneh ◽

Helen Wong ◽

Marie McKay ◽

...

Keyword(s):

High Risk ◽

Prospective Study ◽

Uveal Melanoma ◽

Hepatic Metastases ◽

A Prospective Study

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OCT changes in peri-tumour normal retina following ruthenium-106 and proton beam radiotherapy for uveal melanoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314802 ◽

2020 ◽

pp. bjophthalmol-2019-314802

Author(s):

Rumana Hussain ◽

Florian Moritz Heussen ◽

Heinrich Heimann

Keyword(s):

Proton Beam ◽

Uveal Melanoma ◽

Choroidal Melanoma ◽

Retinal Layer ◽

Proton Beam Radiotherapy ◽

Retinal Layers ◽

Spectral Domain Oct ◽

Ruthenium 106 Brachytherapy ◽

Safety Margins ◽

Plaque Brachytherapy

IntroductionUveal melanoma is most commonly treated with radiotherapy, destroying the tumour cells with adequate safety margins and limiting collateral damage to surrounding structures to preserve maximal vision. We used optical coherence tomography (OCT) to study the effects of radiotherapy on the retina.MethodsPatients with posteriorly located choroidal melanoma treated with proton beam radiotherapy (PBR) and ruthenium-106 brachytherapy between January 2010 and June 2014 underwent spectral domain OCT.ResultsImages of 32 patients following ruthenium-106 brachytherapy and 44 patients following proton beam teletherapy were analysed. Following plaque brachytherapy, an early marked disruption of the outer retinal layers could be observed in 30 cases (94%) with retinal atrophy evident in 26 cases (81%). In contrast, the images from patients who underwent PBR showed subtle outer retinal layer change with 16 cases (36%) showing some inner-outer segment junction disruption by 6 months and 63% by 24 months with minimal atrophy. In cases with tumours <2 mm from the fovea, the visual loss was significantly less at 6 and 12 months in the proton beam group.ConclusionIn comparison to ruthenium-106 plaque brachytherapy, PBR leads to more subtle and slower changes in the outer retinal layers enabling retention of visual function for longer. The difference in dosing regime and dose distribution across the tumour is likely to be causative for this structural differential.

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A rare presentation of an ectopic kidney with pyelonephritis mimicking appendicitis

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz342 ◽

2019 ◽

Vol 2019 (11) ◽

Cited By ~ 1

Author(s):

Yaying Eileen Xu ◽

Rasika Hendahewa

Keyword(s):

Early Recognition ◽

Correct Diagnosis ◽

Clinical Settings ◽

Ectopic Kidney ◽

Rare Presentation ◽

Lower Quadrant Pain ◽

Lower Quadrant ◽

Right Lower Quadrant Pain ◽

Life Threatening ◽

Rare Diagnosis

Abstract Acute appendicitis is one of the top differential diagnoses of right lower quadrant pain in the emergency department. There are many other conditions that may mimic appendicitis such as diverticulitis, colitis and gynecological conditions. We report a rare diagnosis of a patient who presents with characteristic clinical and laboratory features of appendicitis with severe sepsis, but later showed acute pyelonephritis of a malrotated right ectopic kidney on computer tomography. An ectopic kidney is very rare with an incidence of 1 in 3000. It is usually asymptomatic, although it may also associate with obstruction, infection and urolithiasis. This case report raises the importance of early recognition of the correct diagnosis using imaging in appropriate clinical settings, and prompt antibiotic treatment can avoid unnecessary surgical intervention, preserve renal function and prevent a life-threatening catastrophe.

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