Abstract Malignant melanomas occasionally are clinically manifested as pigmented growths more or less confined to the substance of the optic nerve head. In most instances such lesions are found, on histologic examination, to be located in part within the choroid adjacent to the nerve-fiber layer as it courses backward to enter the posterior scleral foramen as the optic nerve. The involvement of the papilla in such instances is considered to be an extension of the growth from the choroid and, since the studies of Reese1 in 1933, the cases have been designated "juxtapapillary malignant melanoma of the choroid." The recognition of the pathogenesis of this type of melanoma was of particular importance in making possible its differentiation from a much rarer, relatively benign pigmented tumor situated predominantly in the papilla, histologically not traceable to the choroid, and considered a primary tumor of the optic disc. Several years ago, in discussing References 1. The 10 cases referred to above are those of Murray3 (1911), Vasquez-Barrière4 (1911), Oloff5 (1915), Cosmettatos 6 (1923), Speciale-Cirincione7 (1925), Oguchi8 (1933), Levine9 (1935), Bucalossi10 (1935), Fry and DeLong11 (1942), and Cordes and Hogan12 (1949). 2. Bleaching was accomplished by the potassium permanganate—oxalic acid technique. 3. Pallor of the cytoplasm after bleaching was an impressive feature. The cells in the unbleached state were jet black—an appearance which Zimmerman 13 emphasized by remarking that "every cell of each of these nerve-head tumors appears to contain a maximum amount of pigment." When the pigmentation was discharged by the bleaching process almost no stainable protoplasm remained, a feature suggesting that the cells functioned chiefly as storers of melanin or chromatophores. In contrast, the cells of the usual uveal melanomas show great variation in pigmentation and after bleaching show varying intensity of cytoplasmic staining. 4. This paper has not yet been published in full but a brief summary is available.16 5. Reese, A. B.: Pigmentation of the Optic Nerve , Arch. Ophth. 9:560, 1933.Crossref 6. deVeer, J. A.: Juxtapapillary Malignant Melanoma of the Choroid and So-Called Malignant Melanoma of the Optic Disc , A.M.A. Arch. Ophth. 51:147, 1954.Crossref 7. Murray, G. D.: Sarcoma of the Optic Disk , Ophthalmology 7:11, 1910. 8. Vazquez-Barrière, A.: Bemerkenswerter Fall von Melanosarkom der Papille , Klin. Monatsbl. Augenh. 49:43, 1911. 9. Oloff, R.: Über primäre Tumoren und tumorähnliche Bildungen der Papilla nervi optici , Klin. Monatsbl. Augenh. 55:313, 1915. 10. Cosmettatos, G. F.: Sarcome primitif du nerf optique , Rev. gen. ophth. 37:5, 1923. 11. Speciale-Cirincione: Sul sarcoma del disco ottico , Ann. ottal. 53:849, 1925. 12. Oguchi, T.: Über einen Fall von Melanosarkom der Sehnervenpapille , Arch. f. Ophth. 130: 427, 1933. 13. Levine, J.: Primary Melanosarcoma of the Optic Disk , Arch. Ophth. 14:229, 1935.Crossref 14. Bucalossi, A.: Su di un sarcoma della papilla ottica , Ann. ottal. ocul. 63:676, 1935. 15. Fry, W. E., and DeLong, P.: Tumor Formation at the Disc , Tr. Am. Ophth. Soc. 40:325, 1942. 16. Cordes, F. C., and Hogan, M. J.: Primary Malignant Melanoma of the Optic Disc: Report of Case , Am. J. Ophth. 32:1037, 1949. 17. Zimmerman, L. E.: Personal communication to the author. 18. Friedenwald, J. S., and others: Ophthalmic Pathology , Philadelphia, The W. B. Saunders Company, 1952, p. 403. 19. Reese, A. B.: Tumors of the Eye and Adnexa , Sect. X, Fasc. 38, Atlas of Tumor Pathology, Washington, D.C., Armed Forces Institute of Pathology, 1956, p. 126. 20. Zimmerman, L. E.: Pigmented Tumors of the Optic Nerve Head , Tr. College of Physicians of Philadelphia, Section on Ophthalmology, A.M.A. Arch. Ophth. 64:163, 1960.
Archives of Ophthalmology – American Medical Association
Published: Apr 1, 1961