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• W2023014609 abstract "Editor, A 28-year-old white male patient was referred with peripheral visual field defect and decreased visual acuity of the right eye. There was no information about systemic disease or metabolic problems in his medical history. In the right eye, we noted thick episcleral sentinel vessels nasally; the anterior segment was quiet and otherwise intact. With funduscopy we observed a highly elevated pigmented mass based nasally at the periphery of the fundus, accompanied by a flat retinal detachment. The clinical diagnosis was choroidal malignant melanoma. The left eye was healthy. Ultrasound examination showed a smooth, highly reflective surface, medium-to-low homogeneous internal reflectivity with attenuation and numerous fluctuations, and choroidal excavation. There was a circumscribed, highly reflective area with marked acoustic shadowing close to the ‘neck’ of the mushroom-shaped tumour (Fig. 1A). (A) Ultrasound B-scan shows the calcification at the ‘neck’ of the tumour. (B) Calcification [C] related to Bruch’s membrane [B] is clearly visible (H&E). (C) The presence of osteoblasts can be excluded at higher magnification. A metastatic work-up proved negative. In view of the large size of the tumour (9.4 × 9.3 × 9.2 mm), enucleation was performed. Histopathological examination confirmed the diagnosis of malignant melanoma, as well as the calcification of the highly reflective part (Fig. 1B). The calcified area was located at the Bruch’s membrane and was at the limit between a spindle cell and an epitheloid clone of tumour cells (Fig. 1C). There was no histological evidence of circulation problems (e.g. tumour necrosis) related to the calcified area. Ultrasound examination is one of the most informative imaging methods for the diagnosis of intraocular melanomas. Echographic signs of calcification are very typical, but intraocular tumours with calcification are mostly retinoblastomas and choroidal osteomas. This is reflected by the fact that in the literature we found only six cases of calcification in intraocular melanomas. Kellner et al. (1993) reported three cases (from 1300 treated cases) of small choroidal melanomas with calcification-like echographic patterns after brachytherapy. Kiratli & Bilgic (2001) described ultrasonic sign of intratumoural calcification in a juxtapapillary melanoma after fractional transpupillary thermotherapy. These two reports suggest that calcification of intraocular melanomas is mostly related to destructive therapeutic interventions. Additionally, calcification in a choroidal melanoma was reported by Jensen & Andersen (1974). They described spontaneous regression of a choroidal melanoma with dot-like multiple calcifications close to the surface of the tumour. Our case is somewhat similar to that reported by Chan et al. (1995), who described a choroidal melanoma case with Bruch’s membrane-related calcification. In contrast to that report, however, we did not find osteocytes related to the calcium deposit; in our case it was a pure calcification, not bone formation. Our case shows that intratumoural calcification can occur spontaneously, without influence from previous therapeutic interventions. Furthermore, by histopathological examination the tumour showed neither signs of regression nor evidence of necrosis. The cause of calcium deposition is unknown. Histopathology did not reveal ischaemic changes or necrosis in or around the area of calcification. Although secondary drusen of the overlying pigment epithelium can show calcification (Yanoff & Fine 1982), this explanation seems improbable because of the intratumoural localization of the calcium deposit. A pre-existing calcification (e.g. idiopathic sclerochoroidal calcification) at the level of the Bruch’s membrane is also a possibility. It is worth noting also that this feature occurred in the tumour of an unusually young patient. We conclude that although it is true that intratumoural calcification is rare in choroidal malignant melanoma, ultrasonic signs of a calcified area within a tumour do not contradict or exclude a diagnosis of malignant melanoma. Because echography is the most informative imaging method for blind eyes with opaque media, this finding may be of value in avoiding diagnostic errors." @default.
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• W2023014609 date "2009-07-21" @default.
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• W2023014609 title "Spontaneous calcification of a choroidal melanoma" @default.
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• W2023014609 doi "https://doi.org/10.1111/j.1755-3768.2008.01231.x" @default.
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