Congenital simple hamartoma of the retinal pigment epithelium: optical coherence tomography and angiography features

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM

PURPOSE

To describe the optical coherence tomography angiography features of congenital simple hamartoma of the retinal pigment epithelium.

METHODS

Case report.

RESULTS

A 14-year-old boy was referred for an asymptomatic fundus tumor in the left eye. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. The right fundus was normal. The left fundus disclosed a gray-white nodular retinal mass of 2-mm diameter in the juxtafoveal region, protruding into the vitreous cavity and causing radial retinal folds. The mass demonstrated echodensity without calcification on ultrasonography, hypoautofluorescence on short-wavelength autofluorescence, and mixed hyporeflective and hyperreflective areas on near-infrared reflectance imaging. By fluorescein angiography, the mass showed absolute hypofluorescence through the arteriovenous phase and diffuse late hyperfluorescence and staining. Optical coherence tomography revealed an optically dense lesion with abrupt posterior shadowing, whereas optical coherence tomography angiography showed an extensive haphazard intratumoral vascular network with fairly large-caliber (100-200 microns) vessels occupying full-thickness tumor, demonstrating more vascular details than visualized on fluorescein angiography. Serial segmental evaluation of the optical coherence tomography angiography en face images confirmed an intratumoral vascular network for full tumor depth down to retinal pigment epithelium, not related to projection artifact. Final diagnosis was congenital simple hamartoma of the retinal pigment epithelium. Considering the benign tumor, observation was recommended.

CONCLUSION

Optical coherence tomography angiography of congenital simple hamartoma of the retinal pigment epithelium revealed an extensive intratumoral, haphazard, large-caliber vascular network, more evident than seen on fluorescein angiography. Optical coherence tomography angiography has added new insight into this rare tumor.

Congenital simple hamartoma of the retinal pigment epithelium with depigmentation at the margin in an Indian female

Objective: To report a case of congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) with depigmentation at the margin. Method: Case report. Result: A 40-year-old Indian female was noted to have a small pigmented lesion with a depigmented margin toward the fovea in the right eye. The best-corrected vision was 6/6 in either eye. The optical coherence tomography revealed a highly reflective lesion at the retinal surface causing a shadow effect, suggestive of CSHRPE. Conclusion: Imaging features of a patient with CSHRPE with a crescent-like depigmented area at the margin are presented.

Congenital simple hamartoma of the retinal pigment epithelium: What is the probable cause?

Congenital simple hamartoma of the retinal pigment epithelium is localized to the retinal tissue only with variable amount of surface extension. With consistent morphological and OCT features of the lesion around fovea, it appears that some of the embryologically undifferentiated ectopic progenitor cells destined for RPE within the retinal tissue may not undergo any further differentiation due to lack of necessary homeostatic factors leading to only hyperplasia and accumulation of the cells within the retina leading to simple hamartoma.

Long-Term Follow-Up of Congenital Simple Hamartoma of the Retinal Pigment Epithelium: A Case Report

Background

Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare benign tumor of the retinal pigment epithelium characterized by a focal, darkly pigmented nodule in the macular lesion in healthy persons. We report a case of CSHRPE with long-term follow-up.

Case

A 41-year-old Japanese woman was incidentally discovered to have a dark lesion on the fundus of the left eye. We evaluated the patient by measuring her best-corrected visual acuity (BCVA) and by slit-lamp biomicroscopy, fundus color photography, and optical coherence tomography (OCT) over a 10-year period. The BCVA gradually declined during the early follow-up period, having decreased from 1.2 to 0.8 in the left eye 3 years after the initial examination, and then has been maintained for the following 7 years. The lesion did not show a change in OCT 10 years after the first examination.

Conclusion

It is important to follow a CSHRPE carefully over the long term because visual acuity might decrease.

Full-thickness macular hole associated with congenital simple hamartoma of retinal pigment epithelium (CSHRPE)

PURPOSE

To report a unique case of congenital simple hamartoma of retinal pigment epithelium (CSHRPE) associated with full-thickness macular hole (FTMH).

METHODS

A 14-year-old female with a previous diagnosis of simple hamartoma of retinal pigment epithelium in the left eye presented with a 3-week onset of reduced visual acuity in the same eye. Complete ophthalmological examination with spectral domain ocular coherence tomography (SD-OCT) and autofluorescence imaging was carried out. Results were compared with the last 4-year follow-up data.

RESULTS

On examination, visual acuity in the left eye was counting fingers compared to 20/100 documented in the last follow-up. Fundoscopy revealed a nodular, heavily pigmented, circumscribed foveal mass, with 0.5 mm basal diameter and 1.1 mm thickness corresponding to the simple RPE hamartoma. Although the latter remained unchanged throughout the follow-up period, a new lesion at the inferior edge of the hamartoma was noted. SD-OCT confirmed the presence of a FTMH with no evidence of associated epiretinal membrane, vitreomacular traction or posterior vitreous detachment. After explaining the risks and benefits of vitrectomy for FTMH, the patient declined surgery.

CONCLUSIONS

CSHRPE may have associated features such as feeding vessels, retinal surface wrinkling, pigmented vitreous cells, retinal exudation and vitreoretinal adhesion. The case presented herein broadens the clinical spectrum of CSHRPE and emphasizes that despite the benign nature of the lesion, which remains stable without growth, visual loss may occur, attributable to foveal traction and development of FTMH. We postulate that protrusion of the tumor into the vitreous cavity results in tissue stretching and development of anteroposterior and tangential forces which may lead to development of macular hole.

Simple hamartoma of the retinal pigment epithelium with macular edema

PURPOSE

Presumed congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare intraocular finding that is described as a focal, nodular, jet black lesion. These lesions frequently occur at or near the macula and have no known association with changes in the surrounding neurosensory retina, retinal pigment epithelium, or choroid, nor have they been related with exudation or hemorrhage. Until now, there have been no cases reported of CSHRPE with associated vascular activity.

CASE REPORT

A 14-year-old Hispanic adolescent girl with a presumed CSHRPE presented with adjacent macular edema. The patient was treated with an off-label intravitreal bevacizumab injection to decrease the edema. Two months later, the patient presented with improved visual acuity and decreased macular edema.

CONCLUSIONS

This is the first documented case of macular edema secondary to vascular activity being associated with these rare lesions. When CSHRPE is found to have secondary vascular activity and associated macula edema, treatment of intravitreal bevacizumab may lead to improved visual and anatomical outcomes.

High-penetration optical coherence tomography and enhanced depth imaging in presumed retinal pigment epithelial hamartoma

PURPOSE

To report on high-penetrating swept source optical coherence tomography (SS-OCT) imaging and enhanced depth imaging in an eye with presumed retinal pigment epithelial hamartoma .

METHODS AND PATIENTS

A 60-year-old man with presumed retinal pigment epithelial hamartoma underwent complete ophthalmologic examination, including fluorescein angiography, indocyanine green angiography, enhanced depth imaging OCT, and SS-OCT.

RESULTS

In the left eye, there were six darkly pigmented, nodular, circumscribed lesions in the macular area. The margins were well defined and were not associated with changes such as edema, exudation, or hemorrhage. Fluorescein angiography revealed a minimally dilated feeding artery and draining vein in each lesion. Spectral domain OCT demonstrated an elevation of the retina at the site of the lesions with greatly enhanced optical reflectivity of the inner surface and complete shadowing of optical transmission with crisp vertical margins. However, enhanced depth imaging OCT and SS-OCT revealed deeper retinal layer structures in the pigmented lesions. Intraretinal lesions showed superficial involvement and preretinal extension with or without superficial hyporeflective regions.

CONCLUSION

Enhanced depth imaging OCT and SS-OCT revealed deeper retinal layer structures in the pigmented lesions in a case with presumed retinal pigment epithelial hamartoma. Enhanced depth imaging OCT and SS-OCT are useful for visualization of intraretinal structures in these lesions, leading to further investigation of the origin and development of retinal pigment epithelial hamartoma.

Congenital simple hamartoma of the retinal pigment epithelium with a full-thickness macular hole

BACKGROUND

Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare tumor that, to our knowledge, has not been previously reported as being associated with a full-thickness macular hole.

METHODS

We report a case of a CSHRPE associated with a full-thickness macular hole. Findings of funduscopy and optical coherence tomography are described.

RESULTS

A 10-year-old boy presented with visual acuity of 20/80 in the right eye. Funduscopy revealed a juxtafoveal pedunculated, well-circumscribed, darkly pigmented lesion measuring one third of a disk diameter. There was an associated full-thickness macular hole that separated the main dark mass nasally from a linear pigmented lesion. Optical coherence tomography showed a mass with optical shadowing and confirmed the presence of a full-thickness macular hole surrounded by intraretinal cystic edema. No evidence of a posterior vitreous detachment or significant epiretinal membrane was seen.

CONCLUSION

We observed a full-thickness macular hole with a CSHRPE in a 10-year-old boy. The CSHRPE may have induced tangential traction along the posterior hyaloid or abnormal anteroposterior traction with foveal dehiscence. It is possible that exudation from the lesion into the vitreous cavity may result in vitreous changes with premature liquefaction and degenerative alterations that may induce abnormal vitreous adhesion and traction. Optical coherence tomography did not show evidence of such changes.

Congenital simple hamartoma of retinal pigment epithelium: clinical and imaging findings

Congenital simple hamartoma of retinal pigment epithelium (CSHRPE) is a rare, asymptomatic, and incidentally detected benign lesion. However, it is very important to do the differential diagnosis from other pigmented retinal lesions. Its clinical presentation and imaging findings are very helpful in doing this differentiation. This paper presents clinical and imaging findings of a 56-year-old woman with incidentally detected CSHRPE. The lesion was small, heavily pigmented, well circumscribed, and slightly elevated. Optical coherence tomography (OCT) scanning was diagnostic and showed an elevated retina at the site of the lesion, increased optical reflectivity on its inner surface, optical shadowing of deeper structures, and clearly cut tumor margins. Ocular ultrasonography, fluorescein angiography, and fundus autofluorescence imaging which is firstly described in this report did not show any characteristic finding.