case_images: PMC11413469_01
case_images: Clinical findings of cases 1 and 5 masquerading as neovascular complications. Neovascular glaucoma in case 1. (A) Slit lamp photograph shows corneal edema, rubeosis, and hyphema. (B) B-scan with diffuse vitreous opacities with membrane formation without masses. (C) Hematoxylin-eosin staining of the cutaneous shoulder biopsy demonstrates atypical, pigmented cells with prominent nucleoli, corresponding with similar cells on vitreous cytology. Apparent non-clearing vitreous hemorrhage in case 5. (D) Slit lamp photograph at presentation, with pigmentary deposits on the posterior lens surface of the cataract. (E) Wide-field fundus photograph showed hazy media and diffuse pigmentary deposition in the posterior pole. (F) B-scan illustrated numerous vitreous opacities and clumping along the residual vitreous skirt (arrow) in this patient who was previously vitrectomized. OCT 1 month after the first intravitreal melphalan (G) and following two additional monthly injections (H) suggested a reduced metastatic tumor burden in the vitreous and on the retinal surface. A corresponding reduction in the pigmentation on wide-field fundus photographs were seen at these intervals (I, J).
case_images: nihms-1968737-f0001.jpg
case_images: PMC11413469_05_nihms-1968737-f0001.jpg
case_images: F1
case_images: A slit lamp examination showed brown deposits along the corneal endothelium, posterior capsule, and vitreous (Figure 1D). The retina appeared flat with diffuse pigment on limited examination (Figure 1E). High-resolution ultrasonography and B-scan showed opacities along the residual vitreous skirt and cavity (Figure 1F). Brown pigment deposits over the optic nerve and retinal surfaces markedly improved with serial injections (Figure 1G-J).
case_images: PMC11413469_02
case_images: Clinical findings of case 2 masquerading as a posterior pigmented mass. (A) Posterior lenticular opacities. (B) B-scan shows dense vitreous cellularity, posterior vitreous detachment, and a hyperechoic lesion of minimal vascularity with biconvex cross-sectional shape, measuring 7.2 x 7.2 x 1.3 mm. (C) Intraoperative membrane peeling during diagnostic vitrectomy. Vitreous biopsy (D, E) showed atypical, pigmented cells with prominent nucleoli, in a background of erythrocytes. Cutaneous biopsy results from the original cheek lesion (F) are consistent with melanoma. No magnifications are available.
case_images: nihms-1968737-f0002.jpg
case_images: PMC11413469_02_nihms-1968737-f0002.jpg
case_images: F2
case_images: A slit lamp examination of the left eye revealed a nuclear cataract with posterior capsular pigment (Figure 2A). B-scan ultrasonography showed diffuse, mobile subhyaloid opacities with a vascularized lesion at 9:30 that measured 7.5 mm in diameter and 1.3 mm in thickness (Figure 2B). Intraoperatively, an elevated choroidal mass nasal to the optic nerve, an epiretinal membrane layered with brown pigment, and a superior retinal break were found (Figure 2C). Cytology confirmed the diagnosis of VMCM (Figure 2D-E), corresponding to the original histological specimen of the CM lesion (Figure 2F).
case_images: Case 2. Gross enucleation specimen photographs (A-C) and histology slides (D-G). Gross specimens with extensive deposition of pigmented melanoma cells invading the iris, (A) ciliary body and angle (B), and posterior segment (C). The corresponding hematoxylin-eosin stains demonstrate invasion of the sclerotomy suture track (D, original magnification, x200), trabecular meshwork (E, original magnification, x200), iris surfaces (F, original magnification, x100), and posterior lens capsule (G, original magnification, x200). Coronal section of the enucleated globe (F). Disseminated melanoma cells are noted along the nasal retinal mass (a, 1; Melan-A, original magnification, x100), optic nerve (b, 2; HMB-45, original magnification, x40), fovea (c, 3; hematoxylin-eosin, original magnification, x200), and perivascular distribution (d, 4-5; hematoxylin-eosin, original magnification, x400 and x200 respectively).
case_images: nihms-1968737-f0003.jpg
case_images: PMC11413469_02_nihms-1968737-f0003.jpg
case_images: F3
case_images: Histopathology of the enucleated globe revealed melanoma cells invading the trabecular meshwork, angle, and retina, optic nerve, and suture tracks, with perivascular spread (Figure 3).
case_images: PMC11413469_03
case_images: Cases 3 and 4 presented vitreous metastasis of cutaneous melanoma masquerading as intermediate uveitis. (A) B-scan initially showed dense vitreous debris limiting the view to the fundus. (B) Intraoperative image of the diagnostic vitrectomy in case 3 shows a predominance of amelanotic cells. There were clear media and absence of chorioretinal lesions postoperatively following vitrectomy and six intravitreal injections of melphalan. The post-diagnostic vitrectomy findings in case 4 included (C) few vitreous opacities and punched-out chorioretinal scars seen on wide-field fundus photo and (D) OCT demonstrating an irregular retinal surface with few deep vitreous cells.
case_images: nihms-1968737-f0004.jpg
case_images: PMC11413469_04_nihms-1968737-f0004.jpg
case_images: F4
case_images: PPV confirmed VMCM (Figure 5A). Punchedout chorioretinal lesions were visualized, mimicking multifocal chorioretinitis (Figure 4C). OCT at postoperative month 1 showed inactive preretinal cells (Figure 4D).
case_images: Cytology results of diagnostic vitrectomy in cases 3 (A), 4 (B), and 5 (C). From left to right: (A) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), and SOX-10 (x600). (B) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), SOX-10 with red chromogen (original magnification, x600). (C) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), SOX-10 with red chromogen (original magnification, x600).
case_images: nihms-1968737-f0005.jpg
case_images: PMC11413469_05_nihms-1968737-f0005.jpg
case_images: F5
case_images: Cytology was consistent with metastatic melanoma (Figure 5C).
case_images: PMC11413469_04
case_images: Cases 3 and 4 presented vitreous metastasis of cutaneous melanoma masquerading as intermediate uveitis. (A) B-scan initially showed dense vitreous debris limiting the view to the fundus. (B) Intraoperative image of the diagnostic vitrectomy in case 3 shows a predominance of amelanotic cells. There were clear media and absence of chorioretinal lesions postoperatively following vitrectomy and six intravitreal injections of melphalan. The post-diagnostic vitrectomy findings in case 4 included (C) few vitreous opacities and punched-out chorioretinal scars seen on wide-field fundus photo and (D) OCT demonstrating an irregular retinal surface with few deep vitreous cells.
case_images: nihms-1968737-f0004.jpg
case_images: PMC11413469_04_nihms-1968737-f0004.jpg
case_images: F4
case_images: PPV confirmed VMCM (Figure 5A). Punchedout chorioretinal lesions were visualized, mimicking multifocal chorioretinitis (Figure 4C). OCT at postoperative month 1 showed inactive preretinal cells (Figure 4D).
case_images: Cytology results of diagnostic vitrectomy in cases 3 (A), 4 (B), and 5 (C). From left to right: (A) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), and SOX-10 (x600). (B) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), SOX-10 with red chromogen (original magnification, x600). (C) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), SOX-10 with red chromogen (original magnification, x600).
case_images: nihms-1968737-f0005.jpg
case_images: PMC11413469_05_nihms-1968737-f0005.jpg
case_images: F5
case_images: Cytology was consistent with metastatic melanoma (Figure 5C).
case_images: PMC11413469_05
case_images: Clinical findings of cases 1 and 5 masquerading as neovascular complications. Neovascular glaucoma in case 1. (A) Slit lamp photograph shows corneal edema, rubeosis, and hyphema. (B) B-scan with diffuse vitreous opacities with membrane formation without masses. (C) Hematoxylin-eosin staining of the cutaneous shoulder biopsy demonstrates atypical, pigmented cells with prominent nucleoli, corresponding with similar cells on vitreous cytology. Apparent non-clearing vitreous hemorrhage in case 5. (D) Slit lamp photograph at presentation, with pigmentary deposits on the posterior lens surface of the cataract. (E) Wide-field fundus photograph showed hazy media and diffuse pigmentary deposition in the posterior pole. (F) B-scan illustrated numerous vitreous opacities and clumping along the residual vitreous skirt (arrow) in this patient who was previously vitrectomized. OCT 1 month after the first intravitreal melphalan (G) and following two additional monthly injections (H) suggested a reduced metastatic tumor burden in the vitreous and on the retinal surface. A corresponding reduction in the pigmentation on wide-field fundus photographs were seen at these intervals (I, J).
case_images: nihms-1968737-f0001.jpg
case_images: PMC11413469_05_nihms-1968737-f0001.jpg
case_images: F1
case_images: A slit lamp examination showed brown deposits along the corneal endothelium, posterior capsule, and vitreous (Figure 1D). The retina appeared flat with diffuse pigment on limited examination (Figure 1E). High-resolution ultrasonography and B-scan showed opacities along the residual vitreous skirt and cavity (Figure 1F). Brown pigment deposits over the optic nerve and retinal surfaces markedly improved with serial injections (Figure 1G-J).
case_images: Cytology results of diagnostic vitrectomy in cases 3 (A), 4 (B), and 5 (C). From left to right: (A) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), and SOX-10 (x600). (B) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), SOX-10 with red chromogen (original magnification, x600). (C) PAP (original magnification, x600), Melan-A with red chromogen (original magnification, x600), SOX-10 with red chromogen (original magnification, x600).
case_images: nihms-1968737-f0005.jpg
case_images: PMC11413469_05_nihms-1968737-f0005.jpg
case_images: F5
case_images: Cytology was consistent with metastatic melanoma (Figure 5C).