We report the case of a 58-year-old man who came to the emergency department with severe eye pain accompanied by progressive visual loss in his left eye.
The exploration revealed an iridocorneal angle pigmented mass protruding to the anterior chamber affecting the iris.
The patient's clinical picture was compatible with acute glaucoma secondary to the anterior chamber mass.
The ophthalmoscopy showed a pigmented mass of large size and irregular appearance, with more elevated areas.
The ocular echography findings were compatible with a large and diffuse extension ocular melanoma.
Nuclear Magnetic Resonance (NMR) showed a 17 mm-based mass slightly hyperintense on T1 and hypointense on T2, compatible with the diagnosis of choroidal melanoma (1).
The Metastatic Service implemented an extension study that ruled out metastatic dissemination.
Given the tumor extension, the patient's symptoms and the absence of possibility of visual recovery, treatment was proposed by enucleation (1.3).
1.
Macroscopic visual examination of the eyeball, after extraction, showed the presence of scleral invasion.
The patient achieved favorable posture while maintaining ocular motility and a satisfactory appearance with external ocular prosthesis.
Macroscopic examination of serial sections of the eyeball showed a circumferential mass of endophytic growth covering almost all the choroid extending to the ciliary body and iris, corresponding histologically to a prominent epithelioid proliferation of spindle cells.
The number of mitoses was high, with hemorrhagic and necrotic foci.
These pathological data confirmed the diagnosis of diffuse uveal melanoma with perforation of the scleral wall reaching its external surface.
