Clinical Advances in Hematology & Oncology Volume 3, Issue 5 May 2005 425 H&0 CLINICAL CASE STUDIES Ocular Melanoma Versus Ocular Metastasis: A Diagnostic Dilemma Case Report A 54-year-old white male presented with blurred vision in the left eye, diplopia, and pain. External and anterior seg- ment examinations were normal. Ophthalmic examination showed a choroidal tumor in the macular area of the left eye with overlying serous retinal detachment (Figure 1A). B-scan ultrasonography showed a tumor in the posterior pole with subretinal fluid collection (Figure 2A). A-scan ultrasonography demonstrated low to medium internal reflectivity of the tumor, strongly suggestive of melanoma (Figure 2B). Based on the ultrasound and retinal findings (Figures 1 and 2), a diagnosis of intraocular melanoma was entertained. A magnetic resonance imaging (MRI) scan of the orbit and brain also showed a mass in the posterior pole of the left globe without involvement of the optic nerve or extraocular muscles. Systemic staging workup initiated prior to definitive local therapy for the mela- noma showed numerous low attenuation lesions in the liver consistent with hepatic metastasis (Figure 3A) and fractures of multiple transverse processes of the lumbar vertebrae suggestive of bony metastases. Bone imaging with a technetium scan also detected a left acetabular lesion. While multiple bone metastases are not uncom- mon with choroidal melanoma, they do not usually occur at presentation. herefore, a diagnostic biopsy of a liver lesion was performed. Small, round malignant cells with uniform nuclei (Figures 4A and 4B) negative for mela- noma-specific antigen (HMB-45), MART-1, and S-100 protein on immunohistochemistry were observed. Tumor cells were weakly positive for chromogranin and negative Madhu Midathada, MD Ammar Safar, MD Robert Schaefer, MD Sanjaya Viswamitra, MD Manish Kohli, MD University of Arkansas for Medical Sciences Central Arkansas Veterans Healthcare System Little Rock, Ark. Address correspondence to: Madhu Midathada, MD, Attn: Slot 508, University of Arkansas for Medi- cal Sciences, 4301 West Markham Street, Little Rock, AR 72205-7199; E-mail: midathadamadhuv@uams.edu. Figure 1. (A) Retinal examination showing macular elevation (arrows) caused by the choroidal tumor with overlying serous retinal detachment. (B) Posttreatment resolution of the tumor with areas of loss of retinal pigmentation.