Hammamji Karim, Reich Ehud, Arora Amit, Cohen Victoria M L, Sagoo Mandeep S
aOcular Oncology Service, Moorfields Eye Hospital and St. Bartholomew's Hospital, London, UK.
cUniversity of Montreal Health Center, Montreal, Québec, Canada.
Case Rep Neurol. 2017 Mar 20;9(1):31-35. doi: 10.1159/000462970. eCollection 2017 Jan-Apr.
Melanoma of the eye is rare, but can mimic a range of disorders. This report highlights 2 cases of choroidal melanoma with vision loss mimicking neurological diagnoses. The first patient is a 41-year-old white male with a known history of multiple sclerosis and a previous episode of optic neuritis in the right eye, who presented with a 6-month history of decreased vision in the same eye, and occasional photopsiae. He was treated with 2 courses of oral steroids for presumed recurrent optic neuritis. After a temporary improvement in his symptoms, his vision worsened, following which he had a head MRI, which revealed a solid intraocular mass. He was subsequently diagnosed with a choroidal melanoma for which he was treated successfully with ruthenium-106 plaque brachytherapy. The second patient is a 57-year-old female, who presented with a progressive cerebellar syndrome under investigation by the neurology service, as well as decreased vision in the right eye. Her visual acuity gradually deteriorated and her neurological assessment, which included a PET-CT, revealed uptake in the right eye. The diagnosis of a choroidal melanoma was made, and following conservative treatment with proton beam radiotherapy, she had an enucleation of the eye. Intraocular tumours can masquerade as many different entities. Unexplained unilateral visual loss, especially if it is atypical for a neurological syndrome, should prompt dilated fundoscopy and referral to an ophthalmologist.
眼部黑色素瘤较为罕见，但可模仿一系列病症。本报告重点介绍了2例脉络膜黑色素瘤病例，其视力丧失表现酷似神经系统疾病的诊断。首例患者是一名41岁的白人男性，有已知的多发性硬化病史，右眼曾患视神经炎，此次因右眼视力下降6个月且偶尔出现闪光幻觉前来就诊。他因疑似复发性视神经炎接受了2个疗程的口服类固醇治疗。症状暂时改善后，视力又恶化，随后进行了头部MRI检查，发现眼内有实性肿块。他随后被诊断为脉络膜黑色素瘤，并成功接受了钌 - 106敷贴近距离放疗。第二例患者是一名57岁女性，因出现进行性小脑综合征正在接受神经科检查，同时右眼视力下降。她的视力逐渐恶化，包括PET - CT在内的神经学评估显示右眼有摄取情况。诊断为脉络膜黑色素瘤，在接受质子束放疗保守治疗后，她接受了眼球摘除术。眼内肿瘤可伪装成许多不同的病症。不明原因的单侧视力丧失，尤其是不符合神经系统综合征典型表现时，应及时进行散瞳眼底检查并转诊给眼科医生。
