Circumscribed choroidal hemangioma: An overview of clinical manifestation, diagnosis and management

Mrittika Sen, Santosh G HonavarIndian Journal of Ophthalmology 2019 67(12):1965-1973 Circumscribed choroidal hemangioma is a benign vascular tumor which presents in middle-aged adults with progressive diminution of vision, metamorphopsia, floaters, and visual field defects. Diagnosis is based on the characteristic clinical features. It is an orange-red, usually solitary, tumor situated in the posterior pole. The visual symptoms are because of the associated subretinal fluid, cystoid macular edema, and, in long-standing cases, retinal pigment epithelium changes, subretinal fibrosis and retinoschisis. It must be distinguished from the more ominous amelanotic melanoma and choroidal metastasis. Diagnostic tools such as ultrasound, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography are helpful in cases with diagnostic dilemma. Treatment is indicated in symptomatic cases. The management of choroidal hemangioma has evolved over the years beginning with laser photocoagulation to transpupillary thermotherapy, photodynamic therapy, plaque brachytherapy and external beam radiotherapy. No one therapeutic option holds superiority over the other. In this article, we review the epidemiology, clinical manifestations and treatment of the circumscribed variant of choroidal hemangioma.
Source: Indian Journal of Ophthalmology - Category: Opthalmology Authors: Source Type: research

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igk Lohmann Several tumors, including uveal melanoma, show somatic mutations of GNAQ/GNA11. Circumscribed choroidal hemangioma is a benign tumor that becomes symptomatic in adulthood. In some patients, morphologic examination of biopsies is required for differential diagnosis between amelanotic choroidal melanoma and circumscribed choroidal hemangioma. Here, we report the results of GNAQ/GNA11 mutation analysis in samples from circumscribed choroidal hemangioma. Deep amplicon sequencing (Illumina MiSeq, San Diego, CA, USA) of positions R183 and Q209 of GNAQ and GNA11 in tissue samples from 33 patients with histologi...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
Abstract PURPOSE: To investigate demographics and clinical features of patients with amelanotic choroidal tumours. DESIGN: Retrospective analysis. METHODS: Comparison of demographic and clinical features of various amelanotic choroidal tumours based on stratification by patient age, sex and tumour diameter. Included were all patients with amelanotic choroidal tumours evaluated on the Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA, over a 45-year time period. RESULTS: A total of 5586 amelanotic choroidal tumours in 4638 eyes of 4441 patients were included with a mean age...
Source: The British Journal of Ophthalmology - Category: Opthalmology Authors: Tags: Br J Ophthalmol Source Type: research
We report a case of circumscribed choroidal hemangioma which was successfully treated with CyberKnife therapy. The literature search reveals cases of uveal melanoma, intraocular, and periocular lymphoma successfully treated with CyberKnife therapy. To the best of our knowledge, this is the first report on such treatment for choroidal hemangioma.
Source: Indian Journal of Ophthalmology - Category: Opthalmology Authors: Source Type: research
Authors: Posch H, Erb-Eigner K Abstract Today, magnetic resonance imaging (MRI) is considered the diagnostic tool of choice for eye and orbital pathologies. In this article, the MR image characteristics of relevant pathologies are illustrated with case-based examples in the context of clinical findings. Vascular pathologies (such as capillary and cavernous hemangioma), inflammatory diseases (such as endocrine orbitopathy), and neoplasms (such as lymphoma, uveal melanoma, retinoblastoma, and ocular/orbital metastasis) are described. Additionally, the role of MRI in the acute clinical setting and in trauma are discus...
Source: Klinische Monatsblatter fur Augenheilkunde - Category: Opthalmology Tags: Klin Monbl Augenheilkd Source Type: research
Conclusions: The quantified A-scan patterns of common choroidal tumors were significantly influenced by the tumor height. Other than median internal reflectivity of #x3c; 65%, which seems to distinguish choroidal melanoma from other tumors (choroidal nevus, choroidal metastasis, and circumscribed choroidal hemangioma), there were no specific diagnostic patterns.Ocul Oncol Pathol
Source: Ocular Oncology and Pathology - Category: Opthalmology Source Type: research
Conclusion: CCH displays typical findings on SD-OCT. ODR is a new important tool in the differential diagnosis of choroidal tumors and should be considered for enhancing the accuracy of diagnosing CCH. This benefit is especially relevant for cases in which the presentation of CCH is atypical.Ophthalmologica
Source: Ophthalmologica - Category: Opthalmology Source Type: research
Diagnosis of circumscribed choroidal hemangioma could be challenging in some patients. The classical features of orange colored mass on fundus examination, acoustic solidity and high internal reflectivity on B- and A-scan ultrasonography, and late “wash-out” hypofluorescence on the late phase of indocyanine green angiography might not be enough for diagnosis. In a review of 200 circumscribed choroidal hemangiomas, Shields et al. reported that 38% of cases were initially diagnosed as choroidal melanoma or metastasis before referral to the ocular oncology center.1With axial resolution up to 5
Source: Ophthalmic Surgery, Lasers and Imaging : the Official Journal of the International Society for Imaging in the Eye - Category: Opthalmology Authors: Source Type: research
Conclusions: New multiple enhancing solid liver lesions should raise suspicion of uveal melanoma liver metastases. Discussion of challenging cases with the radiologist may be beneficial, as pertinent information such as size, location, and molecular prognostication status of the primary tumor can guide radiological interpretation of hepatic lesions.Ocul Oncol Pathol 2018;4:254-260
Source: Ocular Oncology and Pathology - Category: Opthalmology Source Type: research
SummaryAchromic choroidal lesions can be an achromic melanoma, a choroidal hemangioma or a metastasis. It is rarer to have scleritis ar the origin of an achromic chorodal mass but this can be seen in sarcoidosis rarelyAchromic choroidal melanomas are not rare. They are often mushroom shape and have a typical ultrasonographic aspect. In the presence of an achromic melanoma, it is always important to rule out the possibility of a metastasis by doing a chest and abdominal CT.Metastasis are easy to diagnose when they occur in a patient with known metastatic disease, when they are multiple or bilateral. They are trickier when t...
Source: Acta Ophthalmologica - Category: Opthalmology Authors: Tags: Abstracts from the 2016 European Association for Vision and Eye Research Conference Source Type: research
Conclusion: Differentiating between amelanotic melanoma and choroidal hemangioma can be challenging. Relying solely on ophthalmoscopic features can be misleading. Ancillary studies such as indocyanine green and standardized A-scan ultrasonography bring clarity in differentiating circumscribed choroidal hemangioma from choroidal melanoma. Although cytology or histopathology is the only definitive method of establishing the diagnosis, careful emphasis on key diagnostic features can obviate the need for diagnostic fine-needle aspiration biopsy in most cases.
Source: Retinal Cases and Brief Reports - Category: Opthalmology Tags: Case Report Source Type: research
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