Hodgkin's lymphoma

A 76-year-old man with compressive optic neuropathy secondary to a retrobulbar mass was managed by orbitotomy and removal ofthe mass. The lesion proved histopathologically to be an unusual orbital melanoma with massive central necrosis. There was no histopathological evidence of congenital melanocytosis. Dermatological and systemic evaluation before and after orbital surgery revealed no evidence ofprimary melanoma elsewhere. The patient developed hepatic metastasis 2 years after excision of the orbital tumour. It appears that the melanoma was a primary orbital tumour and not a metastatic melanoma from an occult primary lesion. (BrJ7 Ophthalmol 1993; 77: 187-189) Wills Eye Hospital, Thomas Jefferson University, Philadelphia Ocular Oncology Service J Shields C Shields P De Potter Department of Pathology R C Eagle Lehigh Valley Hospital, Allentown, PA, USA G L Oliver Correspondence to: Jerry A Shields, MD, Director, Ocular Oncology Service, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107, USA. Accepted for publication 8 December 1992 Orbital malignant melanoma most often occurs from direct orbital extension of uveal, conjunctival, or eyelid melanoma.'4 Less often, orbital melanoma can occur as a metastasis from a previously diagnosed non-ocular melanoma. Primary orbital melanoma tends to occur in patients with predisposing melanocytic lesions such as congenital orbital melanocytosis or cellular blue naevus. 1-18 Primary orbital melanoma arising de novo without such preexisting conditions is exceedingly rare. We report an unusual case of orbital melanoma that apparently developed as a primary orbital lesion in a patient who had no clinical or histopathological evidence of congenital orbital melanocytosis or cellular blue naevus. The lesion presented as a circumscribed orbital mass with extensive central necrosis. Case report A 76-year-old white male, who had no previous ocular problems except for mild amblyopia of the left eye, developed blurred vision in the right eye associated with epibulbar redness. An orbital -computed tomography (CT) detected a retrobulbar mass. The initial clinical diagnosis was orbital inflammatory pseudotumour. After a 14 day course of oral corticosteroids failed to relieve his symptoms, the patient was referred to the ocular oncology service on 10 December 1990 for further evaluation and management. The patient had a history of medically controlled hypertension, three previous myocardial infarctions, a prostatectomy for benign prostatic hypertrophy, and an inguinal herniorrhaphy. Two histopathologically confirmed seborrhoeic keratoses had been recently excised from his right scapular area. There was no history of ocular or cutaneous melanoma. Our evaluation revealed best corrected visual acuities of 6/12 in the right eye and 6/21 in the amblyopic left eye. Intraocular pressures were normal. There was mild oedema of the right upper and lower eyelids and no proptosis. Ocular motility and colour plates were normal. Fundus examination of the right eye showed an elevated, hyperaemic optic disc and several juxtapapillary flame shaped haemorrhages. The left eye was normal except for decreased visual acuity due to amblyopia. B-scan ultrasonography showed a rounded retrobulbar mass with acoustic hollowness and good sound transmission. CT revealed a 1 -5 cm round, well circumscribed, intraconal mass abutting the globe and the optic nerve superotemporally (Fig 1). 187 group.bmj.com on October 15, 2017 Published by http://bjo.bmj.com/ Downloaded from