97th DOG Annual Meeting 1999



C. W├╝llenweber1, L. Frisch1, M. Bettag2, O. Schwenn1

Case report: A 19-year old male patient was admitted to us with a retrobulbar melanoma which had been confirmed by biopsy. The tumour had been noticed after protrusion and double vision for more than 4 months. Besides frontotemporal headaches there were no general symptoms. The visual acuity and ophthalmoscopy were normal. The MRT showed a tumour which filled the whole orbital apex and expanded through the optic canal towards the suprasellar cistern.

Course: We performed orbital exentereration under preservation of eyelids and conjunctiva. Due to the extension of the tumour the excision of adjacent structures was necessary. Parts of the sphenoid bone had to be resected after coagulation of ophthalmic artery using a subfrontal approach. The complete tumour could be removed. Because of fistulation of cerebrospinal fluid we placed a temporary drainage system. The diagnose of a spindle cell type malignant melanoma was histologically confirmed.

Immunohistochemistry: distinct expression of Vimentin and HMB-45; NSE and synaptophysine focal positive; CD-57 (Leu7) negative; S-100 negative, PAS negative, cytokeratine negative, SM-Actine negative, CD-68 negative. The MiB1 (proliferation rate) was in mean 20% and focal 30%. An extensive examination in other disciplines showed no evidence for another primary tumour. The patient started an interferone therapy for a 2-year term due to the expansive and destructive growth.

Conclusion: The patient's age and the localisation of the tumour are very uncommon for malignant melanoma. Due to histology and the absence of another primary tumour we conclude a primary malignant melanoma of the orbit.

1 University Eye Hospital Mainz, Langenbeckstr. 1, 55131 Mainz
2 Neurosurgery University Hospital Mainz, Langenbeckstr. 1, 55131 Mainz