Amelanotic Choroidal Melanoma (non-pigmented), 3D-OCTA. A very rare case. 
Complaints of VA loss and dark shadow in the right eye for 2 months.

 

 

Fig 1.  The color fundus revealed a large mass with little pigmentation.
Ultrasound suggested mushroom-like mass at size 10.5*9.6mm, vessel inside.
MRI: T1WI isointense, T2WI slightly hyperintense.
PET-CT: Slightly metabolically active in the choroidal lesion, suspected to be a malignant lesion. 
No abnormal activity indicates malignancy was found in the body.

Fig 2. OCTA of superficial vessel compared with FFA (top), 
and OCTA of deep vessel compared with ICGA (bottom).

 

Fig 3. 3D-OCTA of "Double circulation" pattern. 
Vascularity of the overlying #retina (blue), and internal circulation within the lesion (purple).

 

All OCT&OCTA images were captured and processed by a 400kHz Swept-Source OCT (BMizar from TowardPi Medical).

This patient underwent enucleation surgery and pathology results confirmed the finding (choroidal malignant melanoma). Amelanotic (non-pigmented) is rare in Choroidal Melanoma (only 15%). Unlike pigmented melanoma, the amelanotic lesion is not as hyperintense on T1-weighted MRI images. TowardPi's full-range swept-source OCTA provided visualization of vessel patterns in this tumor case, which helped in diagnosis.

Case and images courtesy: Prof. Jie Hu and Dr. Xintong Jiang (Zhongshan Ophthalmic Center)
Editors: Dr. Jian Zhou (TowardPi) and Dr. Xin Li 李鑫 (TowardPi)