Authors
Stoyukhina A.S.
Krasnov Research Institute of Eye Diseases, Moscow
Abstract
Rationale: The article discusses difficulties in the differential diagnosis of intraocular tumors (IOT), particularly in cases of small choroidal melanoma. Despite a substantial number of publications dedicated to the diagnosis of intraocular tumors, difficulties in interpreting imaging methods, such as optical coherence tomography (OCT), persist.
Objective: to analyze the OCT patterns that have led to diagnostic errors.
Methods: We analyzed the OCT results of 15 patients whose diagnosis of «choroidal hemangioma» was revised to «choroidal melanoma» in 11 cases or «progressive nevus» in 4 cases. The mean age at the time of IOT detection was 50.20±13.08 years (range: 35–79 years); the average tumor prominence was 2.22±0.82 mm (range: 1-3.6 mm), and the average diameter was 8.01±2.72 mm (range: 3.11–11.5 mm). A detailed analysis of the specific OCT patterns that led to diagnostic errors was conducted.
Results and discussion: The characteristics of the identified OCT patterns that frequently caused diagnostic difficulties were thoroughly examined, such as cystic changes and the «subretinal cleft» phenomenon. Cases in which complex OCT patterns overlapped with both melanoma and hemangioma were also analyzed, reinforcing the need for a multimodal approach to the interpretation of imaging data. Conclusion: for accurate diagnosis and to avoid erroneous planning of treatment strategies, OCT should be evaluated within the context of the clinical picture and patient history.
Keywords: choroidal melanoma, choroidal hemangioma, choroidal nevus; differential diagnosis, optical coherence tomography, intraretinal cysts, «subretinal cleft», « Retinal pigment epithelial trough».
References
1. Brovkina A. F. Oftal’moonkologiya. Rukovodstvo dlya vrachei / A. F. Brovkina, pod red. A. F. Brovkina, M.: Meditsina, – 2002. 420 s. (In Russ.)
2. Ziangirova G. G., Likhvantseva V. G. Opukholi sosudistogo trakta glaza / G. G. Ziangirova, V. G. Likhvantseva, M.: «Poslednee slovo», – 2003. (In Russ.)
3. Myakoshina E. B. Kompleksnaya diagnostika nachal’noi melanomy khorioidei. // Rossiiskii elektronnyi zhurnal luchevoi diagnostiki. 2016;6(4):19-28. (In Russ.)
4. Myakoshina E. B., Saakyan S. V. Opticheskaya kogerentnaya tomografiya v diagnostike nachal’noi melanomy khorioidei // Vestnik oftal’mologii. 2020;136(1): 56-64. (In Russ.)
5. Samkovich E. V., Melikhova M. V., Panova I. E. Kompleksnaya instrumental’naya diagnostika «malykh» novoobrazovanii khorioidei // Sovremennye tekhnologii v oftal’mologii. 2019;6: 104-107. (In Russ.)
6. Stoyukhina A. S. Mul’timodal’nyi algoritm differentsial’noi diagnostiki opukholei i opukholepodobnykh zabolevanii glaznogo dna // Vestnik oftal’mologii. 2023;139(3-2): 56-62. (In Russ.)
7. Stoyukhina A. S. OKT-klassifikatsiya nevusov khorioidei // Vestnik oftal’mologii. 2023; 139(3): 49-62. (In Russ.)
8. Shepkalova V. M., Khorasanyan-Tade A. A., Disler O. N. Vnutriglaznye opukholi. Atlas / V. M. Shepkalova, A. A. Khorasanyan-Tade, O. N. Disler, M.: Meditsina, – 1965. 232 s. (In Russ.)
9. Al-Dahmash S. A., Shields C. L., Kaliki S. et al. Enhanced depth imaging optical coherence tomography of choroidal metastasis in 14 eyes // Retina. – 2014. – Vol.34, No.8. – P. 1588–1593.
10. Cennamo G., Romano M. R., Breve M. A. et al. Evaluation of choroidal tumors with optical coherence tomography: Enhanced depth imaging and OCT-angiography features // Eye. – 2017. – Vol.31, No.6. – P. 906–915.
11. Cennamo G. G., Montorio D., Carosielli M. et al. Multimodal Imaging in Choroidal Metastasis // Ophthalmic Research. – 2021. – Vol.64, No.3. – P. 411–416.
12. Demirci H., Cullen A., Sundstrom J. M. Enhanced depth imaging optical coherence tomography of choroidal metastasis // Retina. – 2014. – Vol.34, No.7. – P. 1354–1359.
13. Fung A. T., Pellegrini M., Shields C. L. Congenital hypertrophy of the retinal pigment epithelium: Enhanced-depth imaging optical coherence tomography in 18 cases // Ophthalmology. – 2014. – Vol.121, No.1. – P. 251–256.
14. Heimann H., Jmor F., Damato B. Imaging of retinal and choroidal vascular tumours // Eye. – 2012. – Vol.27, No.2. – P. 208–216.
15. Jonna G., Daniels A. B. Enhanced Depth Imaging OCT of Ultrasonographically Flat Choroidal Nevi Demonstrates 5 Distinct Patterns // Ophthalmology Retina. – 2019. – Vol.3, No.3. – P. 270–277.
16. Mashayekhi A., Siu S., Shields C. L., Shields J. A. Retinal pigment epithelial trough: a sign of chronicity of choroidal nevi. // European Journal of Ophthalmology. – 2012. – Vol.22, No.6. – P. 1019–1025.
17. Rojanaporn D., Kaliki S., Ferenczy S. R., Shields C. L. Enhanced depth imaging optical coherence tomography of circumscribed choroidal hemangioma in 10 consecutive cases // Middle East African Journal of Ophthalmology. – 2015. – Vol.22, No.2. – P. 192–197.
18. Sayanagi K., Pelayes D. E., Kaiser P. K., Singh A. D. 3D spectral domain optical coherence tomography findings in choroidal tumors // European Journal of Ophthalmology. – 2011. – Vol.21, No.3. – P. 271–275.
19. Shields C. L., Furuta M., Mashayekhi A. et al. Clinical Spectrum of Choroidal Nevi Based on Age at Presentation in 3422 Consecutive Eyes // Ophthalmology. – 2008. – Vol.115, No.3. – P. 546-552.e2.
20. Shields C. L., Pellegrini M., Ferenczy S. R., Shields J. A. Enhanced depth imaging optical coherence tomography of intraocular tumors: from placid to seasick to rock and rolling topography--the 2013 Francesco Orzalesi Lecture. // Retina. – 2014. – Vol.34, No.8. – P. 1495–1512.
21. Shields C. L., Manalac J., Das C. et al. Review of spectral domain enhanced depth imaging optical coherence tomography of tumors of the choroid // Indian Journal of Ophthalmology. – 2015. – Vol.63, No.2. – P. 117–121.
22. Torres V. L. L., Brugnoni N., Kaiser P. K., Singh A. D. Optical coherence tomography enhanced depth imaging of choroidal tumors // American Journal of Ophthalmology. – 2011. – Vol.151, No.4. – P. 586-593.e2.
23. Vishnevskia-Dai V., Zur D., Yaacobi S. et al. Optical Coherence Tomography: An Adjunctive Tool for Differentiating between Choroidal Melanoma and Metastasis. // J Ophthalmol. – 2016. – Vol.2016. – P. 9803547.
24. Witkin A. J., Fischer D. H., Shields C. L. et al. Enhanced depth imaging spectral-domain optical coherence tomography of a subtle choroidal metastasis. // Eye (London, England). – 2012. – Vol.26, No.12. – P. 1598–1599.
