Sentinel Vessel Sign: A Shadow of the Subway Storm Setting into Strike Sight

Abstract

A 56-year-old woman presented with a complaint of painless diminished vision in the right eye for nine months. Best-corrected visual acuity was 20/400 Oclulus Dexter (OD) and 20/20 Oculus Sinister (OS). Ophthalmological examination revealed a prominent solitary, tortuous, dilated episcleral sentinel vessel in the superonasal aspect of the right eye (white arrow, [Table/Fig-1a]). An undilated examination revealed a normal pupillary area [Table/Fig-1b], but a dilated examination revealed a retrolental dome-shaped dark-brown mass in the superonasal quadrant protruding into the vitreous cavity [Table/Fig-1c]. Ultrasonography revealed a 9 mm acoustically-solid mass in maximum dimension with medium internal reflectivity [Table/Fig-1d]. A diagnosis of ciliochoroidal melanoma was made. A Computed Tomography (CT) scan of the head excluded extraocular extension (yellow arrow, [Table/Fig-1e]). Metastatic work-up, along with radiological imaging, excluded distant metastasis. Given the involvement of the ciliary body (which carries a worse prognosis), the involved eye was enucleated after due counseling with the patient. Subsequent histopathological examination, along with immunohistochemistry analysis of the lesion, revealed it to be a grade III-pT1-stage malignant melanoma with no local invasion. After enucleation, subsequent follow-up examinations for one year excluded any recurrence.

Keywords

• ciliary body melanoma
• melanoma
• ocular tumour