Patient Details

Age: 42 years

Sex: Male

Date of initial presentation: 28/11/1974

Clinical Diagnosis

Malignant melanoma of ciliary body

29/11/1974

1/2 eye photographed by surgeon

18/12/1974

Preliminary Report

A large choroidal melanoma is present displacing the ciliary body forward, but not invading the angle of the anterior chamber. The tumour is very necrotic and shows extensive areas of haemorrhage. There is a marked fibre content and many cystic spaces. There is invasion of the sclera up to half depth in one section. The cell morphology is mixed. 

Diagnosis

Malignant melanoma of the choroid, mixed cell type

2/6/1975

The sections show a large nodule of malignant melanoma apparently centred in the anterior choroid extending from the vicinity of the equator to the middle portion of the ciliary body, the latter being reflected axially by the tumour. The neoplasm has a rather low pigment content and is composed of mixed cells, spindle and epithelioid; some balloon cells also seem to be present, but a number of small cavities in the tissue suggest the possibility of artefact. Large haemorrhagic spaces and areas of necrosis are also observed. The overlying sclera bears an inflammatory reaction: an Axenfeld nerve loop is present close to the filtration angle related to the tumour; it shows pigmented cells close to the neoplasm but these cells have the appearance of normal dendritic melanocytes of the uvea: the large cells with prominent nucleoli representing the outer limit of the tumour are found close by but not within the scleral loop. The retina is degenerate over the tumour detached at the periphery but attached posteriorly and on the opposite side. The cornea on the side of the neoplasm shows a peripheral vascular pannus and an inflammatory reaction is present in the ciliary body close to the base of the nerve loop.

Diagnosis

Malignant melanoma of anterior choroid and ciliary body
Axenfeld never loop
Episcleritis and iridocyclitis