Fluid State of Malignant Choroidal Melanoma Growth Presenting as Exudative Retinal Detachment

Abstract

The extension of a malignant choroidal melanoma of an epithelioid cell type all through the subretinal space exhibiting a change of its solid state with its own stroma and blood supply in the choroid into a fluid growth phase resembling a tissue culture in the subretinal space is demonstrated in this case. This fluid state is represented by free-floating malignant melanoma cells living without their own stroma or direct blood supply in subretinal exudate. The transitional interface between the solid and fluid neoplastic states of this choroidal melanoma is demonstrated. The development of the fluid state indicates a potential of choroidal melanomas for isolation and survival of its cells without stroma and is related to the processes of regional seeding and metastatic dispersion.

Subretinal pigment dispersion following transpupillary thermotherapy for choroidal melanoma

“…The fear of extension of neoplastic melanocytes into subretinal space is real. Melanoma cells usually take along their supporting stroma and blood supply, or may induce local neovascularization in order to feed themselves (Wolter 1989). On rare occasions, such cells may survive as isolated clusters through the rich nutritional milieu of the subretinal fluid without any need of a direct blood supply (Wolter 1989).…”

Retinoinvasive malignant melanoma of the uvea

“…Analogous to many diffuse melanomas,11 12 26 28 37 a long delay in diagnosis and, apparently, slow growth are typical 2325 29 The tumour has time to spread locally, to cause secondary glaucoma that facilitates posterior dissemination, and to develop unusual clones of neoplastic cells 813 Two retinoinvasive tumours proved fatal, one from intracranial growth of an orbital recurrence 7 years after enucleation indicating slow growth,23 and the other from metastases 1 year after enucleation 25…”

“…3 5-7 It is most frequent close to the optic disc and ora serrata, where the retina is relatively fixed 13 5 These uveal melanomas may also seed the subretinal space,8 the vitreous,5 9 10 and the surface of the retina 15 8 11-17 The inner retina resists infiltration, however 1…”

“…3 5 These uveal melanomas may also seed the subretinal space,8 the vitreous,5 9 10 and the surface of the retina 15 8 11-17 The inner retina resists infiltration, however 15 Uveal melanomas also show little if any tendency to horizontally invade non-adjacent retina 1…”

“…5 Uveal melanomas also show little if any tendency to horizontally invade non-adjacent retina 15 6 8 12 13 15-17 …”