Benign tumors of the choroid

Benign tumors of the choroid are rare, they are represented by hemangioma, osteoma and fibrotic histiocytoma.

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Hemangioma of the choroid

Hemangioma of the choroid - a rare congenital tumor, refers to hamartomas. It is detected accidentally or when visual functions are impaired. Reducing vision is one of the earliest symptoms of growing hemangioma in adults, in the childhood, first of all, the strabismus attracts attention. In the choroid, hemangioma almost always looks like an isolated node with sufficiently distinct boundaries, round or oval, with a maximum tumor diameter of 3-15 mm. The tumor's prominence ranges from 1 to 6 mm. Usually the color of the tumor is pale gray or yellowish pink, it can be intense red. Secondary retinal detachment, its folding are observed in practically all patients, with large tumors it becomes vesicular. Caliber of retinal vessels, unlike that of choroidal melanoma, does not change, but small hemorrhages can form on the surface of the tumor. With mildly expressed subretinal exudate, the dystrophy of the retina creates a picture of the "openwork" of the tumor.

Diagnosis of cavernous hemangioma of the choroid is difficult. The discrepancy between the clinical data and the results of histological examination is noted in 18.5% of cases. In recent years, the diagnosis has become more reliable due to the use of fluorescent angiography. Treatment for a long time was considered to be unpromising. Currently, laser coagulation or brachytherapy (contact irradiation with radioactive ophthalmic applicators) is used. Resorption of the subretinal fluid helps to reduce retinal detachment and increase visual acuity. The prognosis for life is favorable, but vision with untreated hemangioma or lack of treatment effect can be lost irretrievably as a result of total retinal detachment. In some cases, the total detachment results in secondary glaucoma.

Pigmentary tumors of the choroid

The source of development of pigmented tumors is melanocytes (cells that produce pigment), which are common in the stroma of the iris and ciliary body, as well as in the choroid. The degree of pigmentation of melanocytes is different. Uveal melanocytes begin to produce a pigment in the late stage of embryonic development.

Nevus Choroid

Nevus choroidi - the most common benign intraocular tumor, in almost 90% of cases is localized in the posterior part of the fundus. With ophthalmoscopy, nevi detect 1-2% of the adult population. There is reason to believe that the frequency of nevi is actually much higher, since some of them do not contain pigment. Most nevi are congenital, but their pigmentation occurs much later, and these tumors are discovered accidentally after 30 years. On the fundus, they have the appearance of flat or slightly piercing foci (up to 1 mm in height) of light gray or gray-green color with pinnate but distinct boundaries, their diameter varies from 1 to 6 mm. Non-pigmented nevi have an oval or round shape, their boundaries are more even, but less distinct due to the lack of pigment. In 80% of patients, single glands of the vitreous plate are found. As the nevus increases, the dystrophic changes in the pigment epithelium increase, which leads to the appearance of a greater number of drushes of the vitreous plate and subretinal exudate, a yellowish halo appears around the nevus. The color of the nevus becomes more intense, the boundaries are less distinct. The described picture indicates the progression of the nevus.

Patients with stationary nevi do not require treatment, but they need a dispensary observation, as during the life of the tumor can grow, passing to the stage of a progressive nevus and even initial melanoma. Progressing nevuses taking into account the potential possibility of their degeneration and transition to melanoma are subject to treatment. The most effective method of destruction of a progressive nevus is laser coagulation. With a stationary nevus, the prognosis for both vision and life is good. Progressive nevus should be considered as a potentially malignant tumor. There is an opinion that 1.6% of nevi are necessarily regenerated in melanoma. As a rule, up to 10% of nevi are malignant, their diameter is more than 6.5 mm and their height is more than 3 mm.

Melanocyte choroida

Choroidal melanocyte is a large-cell nevus with a benign course, it is usually localized on the optic disc, but may also be located in other parts of the choroid. The tumor is asymptomatic, and in 90% of patients it is detected accidentally. With large melanocytes, small visual disturbances and an increase in the blind spot can occur. The tumor is represented by a single node, it is flat or slightly dominant (1-2 mm), the boundaries are sufficiently clear. Dimensions and localization are different, but more often the melanocyte is located near the optic nerve disc, covering one of its quadrants. The color of the tumor in most patients is intensely black, on the surface there may be light foci - druses of the vitreous plate.

Treatment is not required, but patients should be under the systematic supervision of an ophthalmologist. When the tumor is stationary, the prognosis for vision and life is good.