Orbital melanoma with calcification: A diagnostic dilemma.

Primary orbital melanoma is rare and has varied initial presentation. A 28-year-old female presented with proptosis and decreased vision in the left eye. Computed tomography scan showed an orbital mass with contrast enhancement and calcification around the optic nerve leading to a diagnosis of meningioma. The patient chose to be on observation. Loss of vision with an increase in proptosis was seen at 6 months follow-up. On surgical exploration, a well-defined pigmented mass was seen encasing the optic nerve. Histopathological analysis revealed a malignant melanoma. Metastatic workup was negative. Left eye lid sparing exenteration was done. A high index of suspicion is necessary in a rapidly growing suspected optic nerve sheath meningioma and a differential diagnosis including orbital melanoma be considered.

Subcutaneous Dissemination from an Orbital Diffuse Large B Cell Lymphoma.

Secondary cutaneous dissemination from an orbital diffuse large B cell lymphoma has not been described before. The authors report an unusual case of anaplastic variant of diffuse large B cell lymphoma which primarily presented in the orbit and during the course of disease had subcutaneous dissemination.

Bilateral acute ptosis leading to the diagnosis of a presumed metastatic gastric adenocarcinoma.

We report the case of a 57 year old diabetic Indian male with no history of malignancy, who presented with severe bilateral upper lid acute aponeurotic ptosis, following intravitreal bevacizumab for diabetic retinopathy. Brain MRI revealed lesions in the vault of the skull, both superior recti and an intraorbital lesion on the lateral aspect of the right optic nerve. PET-CT revealed multiple metabolically active lesions in both the lobes of the liver, cervical vertebrae and in the lesser curvature of the stomach. A biopsy taken from the lesion in the lesser curvature of the stomach showed poorly differentiated adenocarcinoma. The patient was treated with palliative chemotherapy (Epirubicin, Oxaliplatin and Capecitabine), but had progressive disease after two cycles and died 8 weeks after diagnosis. Gastric carcinoma is a quiescent carcinoma wherein metastatic manifestations often lead to the diagnosis of the primary tumor.

Choroidal metastasis as the presenting feature in a case of testicular choriocarcinoma.

A twenty-six year old male with decreased vision in right eye was diagnosed with non-rhegmatogenous retinal detachment. Further evaluation revealed a yet undiagnosed left testicular mass found to be choriocarcinoma on histopathology. Chemotherapy resulted in complete remission; however, there was no improvement in vision. There is a substantial risk of visual loss in the presence of ocular metastatic lesions. Early detection and treatment is highly effective in terms of tumor control and a more favorable survival and visual outcome. The onus of the ocular diagnosis lies on the ophthalmologist. The presence of a testicular origin tumor must be considered in a young male with intraocular metastasis.

Metastasis to optic nerve presenting as ill-fitting prosthesis.

We report a rare case of metastatic adenocarcinoma of lung in anophthalmic socket, which presented as painful and difficult prosthetic wear long after an uneventful enucleation. Bulge in the socket indicated amputation neuroma, a rarity in itself; but further evaluation concealed a yet silent pulmonary mass. No case report so far describes metastatic mass in an anophthalmic socket and we describe first case of unknown lung malignancy presenting as ill-fitting prosthesis.

Tuberculous orbital abscess associated with thyroid tuberculosis.

PURPOSE: To report an unusual presentation of tuberculosis. CASE REPORT: A six-year old boy presented with left upper lid swelling of 15 days' duration and an asymptomatic midline neck mass from 2 months ago. Imaging studies, and microbiologic tests which demonstrated acid-fast bacilli in the fine needle aspirate of the thyroid mass, both confirmed a diagnosis of cold tuberculous thyroid abscess with presumed hematogenous spread to the orbit. The patient demonstrated marked improvement of both lesions with antitubercular drugs. CONCLUSION: This case illustrates a very rare association of orbital and thyroid tuberculosis.