Sentinel Vessel Sign: A Shadow of the Subway Storm Setting into Strike Sight
NJ01-NJ02
Correspondence
Dr. Rakesh Kumar Jha,
Assistant Professor, Department of Ophthalmology, Command Hospital, Cariappa Road, Lucknow Cantonment, Lucknow-226002, Uttar Pradesh, India.
E-mail: rkjhan2@y7mail.com
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 1)a). An undilated examination revealed a normal pupillary area (Table/Fig 1)b, but a dilated examination revealed a retrolental dome-shaped dark-brown mass in the superonasal quadrant protruding into the vitreous cavity (Table/Fig 1)c. Ultrasonography revealed a 9 mm acoustically-solid mass in maximum dimension with medium internal reflectivity (Table/Fig 1)d. A diagnosis of ciliochoroidal melanoma was made. A Computed Tomography (CT) scan of the head excluded extraocular extension (yellow arrow, (Table/Fig 1)e). 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.