Reyes Arnulfo Garza, Lewis Chad Y, Pham Chau, Boldt H Culver, Lozano Lola P, Syed Nasreen A, Binkley Elaine M
Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
Institute for Vision Research, 451 Newton Road, Iowa City, IA, 52242, USA.
Am J Ophthalmol Case Rep. 2024 Jul 31;36:102137. doi: 10.1016/j.ajoc.2024.102137. eCollection 2024 Dec.
To describe a rare case of clinically pigmented choroidal schwannoma with extraocular extension in an elderly patient.
We report a case of a 79-year-old Black male who presented with a clinically pigmented, juxtapapillary choroidal tumor with concern for extraocular extension on standardized ocular echography. The lesion was concerning for choroidal melanoma with extraocular extension. He had no history of cancer or known genetic disease. After an extensive discussion of management options, he underwent enucleation of the left eye. Histopathology of the tumor showed non-pigmented cells with bland, spindle-shaped nuclei and areas of Antoni A pattern along with immunostaining consistent with choroidal schwannoma with extraocular extension.
Choroidal schwannoma can mimic choroidal melanoma and can have a clinically pigmented appearance particularly in darkly complected individuals. This case highlights the importance of including choroidal schwannoma on the differential diagnosis for choroidal neoplasms, particularly in populations of individuals in whom melanoma is less common. Though more common in younger patients, choroidal schwannoma can present in elderly patients.
描述1例老年患者临床上色素沉着性脉络膜神经鞘瘤伴眼外扩展的罕见病例。
我们报告1例79岁黑人男性患者，其临床表现为色素沉着性、邻近视乳头的脉络膜肿瘤，经标准化眼部超声检查怀疑有眼外扩展。该病变怀疑为脉络膜黑色素瘤伴眼外扩展。他无癌症病史或已知的遗传疾病。在对治疗方案进行广泛讨论后，他接受了左眼眼球摘除术。肿瘤的组织病理学显示为无色素细胞，细胞核温和、呈梭形，有Antoni A型区域，免疫染色结果与脉络膜神经鞘瘤伴眼外扩展一致。
脉络膜神经鞘瘤可模仿脉络膜黑色素瘤，并且临床上可能有色素沉着表现，尤其是在肤色较深的个体中。该病例突出了在脉络膜肿瘤的鉴别诊断中纳入脉络膜神经鞘瘤的重要性，特别是在黑色素瘤不太常见的人群中。虽然脉络膜神经鞘瘤在年轻患者中更常见，但也可出现在老年患者中。
