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CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 67-68

An Incidental Finding of Optic Disc Melanocytoma in a Primigravida Female


1 Regional Hospital, Kullu, India
2 Department of Ophthalmology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India

Date of Web Publication26-Feb-2018

Correspondence Address:
Neha Chauhan
C/O Sh. Shashi Kant Sood, Village Dehan, Post Office Maranda, Tehsil Palampur, Kangra - 176 102, Himachal Pradesh
India
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DOI: 10.4103/sjopthal.sjopthal_20_17

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  Abstract 


Melanocytoma is a benign heavily pigmented tumour developing from melanocytes. Here we report a case of optic disc melanocytoma in a primigravida female who was referred to our department for fundus evaluation for PIH.

Keywords: Magnocellular nevus, malignant transformation, melanocytoma, melanoma, optic disc


How to cite this article:
Chauhan N, Sharma G. An Incidental Finding of Optic Disc Melanocytoma in a Primigravida Female. Sudanese J Ophthalmol 2017;9:67-8

How to cite this URL:
Chauhan N, Sharma G. An Incidental Finding of Optic Disc Melanocytoma in a Primigravida Female. Sudanese J Ophthalmol [serial online] 2017 [cited 2022 Jan 25];9:67-8. Available from: https://www.sjopthal.net/text.asp?2017/9/2/67/226144




  Introduction Top


Melanocytoma, also known as magnocellular nevus, is a benign, stationary heavily pigmented tumor that may develop wherever uveal melanocytes are present and while some melanocytomas occur on the disc, most involve the adjacent retina or choroid.[1] It may be confined to the optic disc, or it may have contiguous involvement of the choroid or sensory retina. It is important to differentiate this benign lesion from a malignant melanoma. Although melanocytoma is typically relatively stationary, it can cause visual loss due to a variety of mechanisms. More importantly, it can undergo malignant transformation into melanoma in 1%–2% of cases.


  Case Report Top


A 24-year-old primigravida female with period of gestation of 25 weeks presented to our department as a referred case from the obstetrics department for routine fundus evaluation for pregnancy-induced hypertension. She had no ocular complaint. Her visual acuity was 6/6 in both the eyes. Pupils were reacting normally to light, and the extraocular movements were unrestricted and full. Slit lamp examination was normal.

On fundus examination, the left eye showed an elevated dark brown to black lesion occupying the inferior part of the disc with surrounding subretinal fluid and macular folds. The surface of the lesion was smooth, and the course of blood vessels over it was undisturbed [Figure 1]. No abnormality was detected in the right eye. B-scan of the left eye showed an elevated lesion over the optic nerve head that gave high reflectivity on A-scan [Figure 2]. Visual fields of the left eye done with Humphrey's automated perimeter showed enlargement of the blind spot [Figure 3].
Figure 1: Optic disc melanocytoma: fundus image as seen ophthalmoscopically

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Figure 2: B-scan of the left eye showing an elevated lesion on the optic disc having high reflectivity

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Figure 3: Visual fields 30-2 of the left eye showing enlargement of the blind spot

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  Discussion Top


Melanocytoma of the optic disc is rarer than melanocytoma of the uvea. Opthalmoscopically, it appears uniformly black with fibrillate margins due to infiltration into the adjacent retina. Some patients have afferent pupillary defects and nerve fiber bundle defects possibly due to nerve fiber layer compression. Histopathologically, the tumor cells are round or slightly polyhedral with distinct borders and small, round, and normochromic nuclei. Melanocytoma commonly involves the inferotemporal aspect of the optic disc.[2]

Since melanocytoma of the optic disc can sometimes evolve into malignant melanoma, examination and fundus photography should be done annually. Small degrees of growth may not signify malignant change. However, more progressive growth and visual loss should suggest malignant transformation, and enucleation should be considered. Shields et al. recently documented that the rate of malignant transformation is approximately 1%–2%.[3]

Zimmerman and Garron in their study have reported the occurrence of a sudden fall in vision with papillitis and retinal hemorrhages due to ischemic necrosis in a case of melanocytoma. Malignant melanoma was suspected, and the eye was enucleated.[1] Similar such incidences have happened in the past. Reidy et al. have observed one patient, in whom a melanocytoma of the optic disc which had been followed for 17 years suddenly transformed into a malignant melanoma.[4] Thus, it can be concluded that melanocytoma may be asymptomatic and picked up incidentally as in our case; however, the patient should be counseled and kept under follow-up as malignant transformation may occur.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zimmerman LE, Garron LK. Melanocytoma of the optic disc. Int Ophthalmol Clin 1962;2:431-40.  Back to cited text no. 1
    
2.
Gahankari MD, Jehangir R, Bhatti SS. Melanocytoma of the optic disc. J Postgrad Med 1992;38:135-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Shields JA, Demirci H, Mashayekhi A, Shields CL. Melanocytoma of optic disc in 115 cases: The 2004 Samuel Johnson memorial lecture, part 1. Ophthalmol 2004;111:1739-46.  Back to cited text no. 3
    
4.
Reidy JJ, Apple DJ, Steinmetz RL, Craythorn JM, Loftfield K, Gieser SC, et al. Melanocytoma: Nomenclature, pathogenesis, natural history and treatment. Surv Ophthalmol 1985;29:319-27.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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