At the SI “The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine,” a rare variant of latent intraocular melanoma was identified during a histomorphological examination. Its clinical manifestations may have been masked for a prolonged period by symptoms of severe neovascular glaucoma.

The study was conducted by specialists of the Pathological Anatomy Group of the Institute’s Laboratory Research Center under the supervision of its head, Candidate of Medical Sciences Oleksandr Valentynovych Artiomov.

Clinical Features of the Case

A 50-year-old patient was hospitalised with advanced neovascular glaucoma that had developed as a consequence of thrombosis of the central retinal vein of the right eye. Despite the treatment provided, the pathological process progressed and resulted in loss of vision in the setting of established vitreous hemorrhage (hemophthalmos).

During the histomorphological examination, the most pronounced pathological changes were found inside the eyeball. A massive hemorrhage into the vitreous body was established, along with total retinal detachment, degenerative changes in nerve cells, and significant gliosis. At the same time, inflammatory changes predominated in the anterior segment of the eye and the iridocorneal zone. This significantly complicated the identification of the underlying cause of the prolonged and progressive pathological process. 

Histomorphological Features

During a detailed investigation, pigment formations with histomorphological signs of a neoplastic process were identified. However, their malignant nature was not obvious in all areas. 

Considering the clinical course of the disease, the prolonged ineffectiveness of therapeutic measures, and the nature of the identified changes, the neoplastic process in the iridociliary zone  was interpreted as a particular variant of melanoma.

A distinctive feature of this case was the predominant localisation of neoplastic proliferations in the iridocorneal angle and deep within the root of the iris.

Such a location of the tumor process is extremely rare and practically precludes its timely detection by means of standard clinical examination. In this case, histomorphological examination made it possible to establish the true nature of the pathological changes.

Diagnostic Significance of the Case

The distinctive feature of the latent variant of intraocular melanoma is that even a small volume of neoplastic proliferation may produce severe clinical manifestations.

In such patients, neovascular glaucoma may become the predominant clinical manifestation, while simultaneously masking the underlying neoplastic process and significantly complicating its diagnosis.

This clinical and morphological case demonstrates the importance of a comprehensive approach to the diagnosis of complex pathological processes of the organ of vision and highlights the particular role of histomorphological examination in detecting latent neoplastic changes.

The study provides another example of the high diagnostic value of the morphological service of the SI “The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine,” which provides in-depth research of complex and rare ophthalmopathological cases.

The experience of specialists at the Filatov Institute in diagnosing complex pathology of the organ of vision contributes to a deeper understanding of rare forms of ophthalmic diseases and to the improvement of approaches to their diagnosis.