Diagnosis: Malignant Melanoma

History: A 76 y/o man presented with spontaneous bleeding from left eye for 3 days. A black mass was present on the surface of the left eye for an unknown duration of time. He had a foreign body sensation but no pain. His right eye was enucleated in 1970 following an automobile accident. His left eye was severely injured in a fight in 1979 leaving him with no perception of light. There was no recent history of ocular or facial trauma.

Findings: CT Scan: - The CT scan revealed an absent right eye. - On the left side there was reasonably normal-sized eye and on the surface of the eye there was an irregular soft tissue prominence. - The globe itself contained calcification (bone) and soft tissue. Histopathology: - There was intraocular & extraocular tumor. - The tumor was composed of small and large, bizarre tumor cells which had epithelioid cell features. - Many of the cells were pigmented and stained for melanin. There were areas containing many balloon cells. - The eviscerated intraocular contents also showed large areas of small and large epithelioid melanoma cells. - Fragments of bone and degenerated uveal tissue were present. Immunopathology: - The following stains were positive: HMB-45, MEL IP and XIAP. - Stains for a variety of cytokeratins and EMA were negative. Final Diagnosis:Melanoma , epithelioid cell type arising in the uveal tract.

Dxhow: histology

Exam: The man was in good health and took no medications. Ocular Examination: - He was status post enucleation, right eye. - The left eye was blind and “phthisical”. - There was a large, black and bloody mass measuring 15x15x5mm extending from the surface of the globe. - He was placed on antibiotics and given a tetanus booster and sent for a CT scan.