Choroidal nevus and chrpe

nevus and chrpe

1. Choroidal nevus and CHRPE

2. Nevus COMS def. - <= 5mm basal diameter <= 1 mm height Freckle - visible, normal choroidal vessels passing undisturbed through

3. Pathology Plumper melanocytes Involves entire thickness of choroid with sparing of choriocapillaries Pigmentation vary polyhedral, fusiform, dendritic , spindle, balloon Calender’s classification - composed entirely of spindle A cells Spindle B cells

4. Clinical features Asymptomatic RPE atrophy

5. chronic foveal edema, and persistent subretinal fluid - photoreceptor atrophy metamorphopsia or photopsia

6. PED

7. Drusen – sign of chronicity

8. Choroidal neovascularization - sign of chronicity

9. Clinical Variants Halo Nevus

10. Choroidal Melanocytosis

11. Amelanotic Nevus ? choroidal metastases, ? Choroidal hemangioma or ? inflammatory granuloma

12. Risk Factors for Malignant Transformation freckles - not known to undergo malignant transformation CNV – not indicative of malignancy Thickness > 2 mm Orange pigment Margin touching disc Visual symptoms Sub retinal fluid Orange pigment

13. Diagnostic Evaluation Fundus photography, oct fluorescein angiography, autofluorescence imaging, Ultrasonography fine-needle aspiration biopsy

14. EDI - OCT Amelanotic nevi - homogenous with a medium reflective band and visible choroidal vessels Melanocytic nevi - highly reflective band within the choriocapillaris layer with posterior shadowing

15. ICG Might be malignant

16. Differential Diagnosis Reactive retinal pigment epithelial hyperplasia Congenital hypertrophy of the retinal pigment epithelium

17. CHRPE divided into solitary and multifocal variants, - also known as congenital grouped pigmentation or “ bear tracks .” unlike choroidal nevus and melanoma, no predilection for race . not associated with an increased incidence of FAP or gastrointestinal malignancy

18. Solitary CHRPE Pigmented (88%) / depigmented Only 2% are macular or peripapillary Lacunae - depigmented foci depigmented ring or “halo ”

19. FFA – blocked fluorescence AF – hypoautofluorescence USG – nondiagnostic – 0.5 to 1 mm thickness Oct - retinal thinning, loss of photoreceptors, and moderate shadowing of the underlying choroid

20. Management periodic observation nodular growth - exudation or subretinal fluid - photocoagulation or cryotherapy Macular lesion - surface wrinkling retinopathy

21. Mlultifocal CHRPE groups of well-delineated, flat, slate gray lesions - usually sectoral distribution Each individual lesion is similar to unifocal CHRPE, but is usually smaller and does not show the lacunae or haloes of depigmentation

22. Nonpigmented - “ polar bear tracks,”

23. a close relationship has been recognized with FAP and Gardner syndrome familial colonic cancer fundus lesions have been called CHRPE, but they are actually different from they are bilateral , more haphazard distribution, more irregular borders