Korean J Ophthalmol.  2007 Dec;21(4):261-264. 10.3341/kjo.2007.21.4.261.

Cancer-associated Nummular Loss of the Retinal Pigment Epithelium

• Lee JM
• Seong HK
• Nam WH
• Kim HK

• KMID: 754647
• DOI: http://doi.org/10.3341/kjo.2007.21.4.261

Abstract

PURPOSE: To report a case of cancer-associated nummular loss of the retinal pigment epithelium. METHODS: A 47-year-old man with a history of hepatocellular carcinoma presented with three weeks of bilateral visual loss. His best-corrected visual acuity was 20/40 in each eye. He had multiple round confluent grayish-brown patches at the level of retinal pigment epithelium, and no pigmented choroidal lesions. Fluorescein angiography showed circular areas of transmission defect and indocyanine green angiography showed early hyperfluorescence, corresponding with the multiple round confluent patches. CONCLUSIONS: We report a case of visual paraneoplastic syndrome which showed nummular loss of the pigment epithelial cells which distinguishes the clinical component of BDUMP syndrome.

Keyword

Bilateral diffuse uveal melanocytic proliferation; Cancer-associated retinopathy; Paraneoplastic syndrome

MeSH Terms

Carcinoma, Hepatocellular/*pathology
Diagnosis, Differential
Fatal Outcome
Fluorescein Angiography
Fundus Oculi
Humans
Liver Neoplasms/*pathology
Male
Middle Aged
Paraneoplastic Syndromes/*diagnosis
Pigment Epithelium of Eye/*pathology
Retinal Diseases/*diagnosis
Tomography, Optical Coherence

Figure

• 

  Fig. 1 Initial visit. (A) Fundus photograph. Multiple round confluent grayish-brown patches are noted at the level of retinal pigment epithelium. There were no pigmented choroidal lesions. (B) Fluorescein angiography. Hyperfluorescence due to window defects associated with the widespread retinal pigment epithelium damage is seen corresponding to the lesion. No significant leakage. (C) Optical coherence tomography. OCT image showed zones of retinal pigment epithelium loss alternating with areas of thickened retinal pigment epithelium and deposit of debris that correspond with the multiple round confluent patches.

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  Fig. 2 Two months later. (A) Fundus photograph. (B) Fluorescein angiography. (C) Indocyanin green angiography. Both the number and size of multiple round patches increased.

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