7. Pseudometastatic lesions of the choroid

A 64-year-old man with a six-month history of visual loss was found to have multiple darkly pigmented lesions scattered throughout the choroid of both eyes. Some lesions, up to several disc diameters in size, were flat, but others were elevated one to two millimeters. The right eye also contained a darkly pigmented ciliary body mass. Impairment of light transmission was striking. Ultrasonography of the elevated lesions demonstrated solid masses with high internal reflectivity. The initial diagnostic differential included the possibility of pigmented metastases from a primary tumor elsewhere, as well as multiple primary nevi. A general medical examination demonstrated arteriosclerotic heart disease, hypertension, diabetes mellitus, areas of patchy pigmentation of the oral mucosa, and a hilar prominence. A mediastinal lymph node biopsy specimen showed a grade 3 undifferentiated carcinoma compatible with a lung primary carcinoma. Enlargement of the choroidal lesions was observed until the patient's death 15 months later. Autopsy showed an undifferentiated carcinoma of the lung with widespread metastases. Each eye showed multiple discrete benign melanocytomas within a diffuse nevus involving the entire uveal tract. The nature of the relationship between multiple uveal melanocytomas and the systemic carcinoma is uncertain, but recognition of multiple uveal melanocytomas warrants a general medical examination to exclude primary malignancy elsewhere.