Área Técnica: Oncologia
OPTICAL NERVE INVASION OF UVEAL MELANOMA
Describe a clinical case of a patient with choroidal melanoma and invasion to the optic nerve.
Female patient, 69, referred to the Ocular Oncology department of the Federal University of São Paulo in April 2015 with severe complaints of pain, hyperemia and edema in the right eye (OD). She reported sudden loss of vision and pain in the eye since July 2014, being treated for neovascular glaucoma since. She also had a personal history of hypertension, diabetes and smoking. On examination: visual acuity of light perception OD and 20/20 in the left eye (OS). The anterior segment presented conjunctival hyperemia 3 + / 4 +, anterior chamber formed, hypopyon, rubeosis iridis, uveal ectropion and hemorrhage in anterior vitreous in OD, OS was normal. Intraocular pressure of 38 mmHg to 12 mmHg OD and in OS. fundus revealed dense vitreous hemorrhage (VH) in OD, preventing posterior segment display, and the OS showed myopic fundus and diabetic retinopathy. Ocular ultrasound showed a solid lesion of medium / low internal reflectivity to 16.6 mm in height (occupied 2/3 of the eyeball), VH and detachment perilesional retina. The treatment plan was performing enucleation in OD. Anatomic pathology (enucleation OD) revealed epithelioid melanoma widely necrotic, measuring 19x19mm, infiltration of the largest sclera 2/3 of its thickness and optic nerve infiltration with absence of vascular invasion (pathological staging - pT4).
Most melanomas of the choroid to invade the optic nerve are justapapilares and large tumors that invade the nerve by proximity to this. The optic nerve invasion is found in only 5% of all eyes enucleated for uveal melanoma and is associated with poor prognosis and high frequency orbital recurrence. Predictive factors in the literature, besides the juxtapapillary location are low visual acuity and increased intraocular pressure, these factors are present in this case.