title: Choroidal paraganglioma with metastases to the fellow eye.
abstract: OBJECTIVE
  To report a case of a paraganglioma in the right eye with metastatic disease in the fellow eye 3 years later.
  
  
  METHODS
  A 70-year-old man presented with a painful amblyopic right eye; rubeosis iridis and a large choroidal tumor were found. The tumor was treated by enucleation. Pathology diagnosed the tumor as a paraganglioma. Screening for other tumors or metastatic disease was negative at that moment. After 3 years, a paraganglioma skin metastasis was detected, and screening revealed metastatic disease in the liver. Another 6 months later he was referred for tumors in the left eye, which were treated by radiotherapy. He succumbed 6 months later.
  
  
  RESULTS
  Histopathology of the right eye revealed the typical image of a paraganglioma, with expression of synaptophysin, neuron-specific enolase and chromogranin. S-100 staining was positive in the sustentacular cells; staining for HMB-45, SME, EMA and pan-keratin was negative. Microscopy of the tumors in the skin and liver 3 years later showed a dedifferentiated tumor with the same immunological characteristics, but with higher Ki67 expression and more mitoses.
  
  
  CONCLUSIONS
  This report documents a very rare choroidal paraganglioma which presented clinically as a melanoma. The patient succumbed 4 years later to generalized metastatic disease. No other primary paraganglioma was found; however, paraganglion cells in the eye have never been described.
authors.affiliation: Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium ; Department of Pathology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Rita Van
authors.initials: RV
authors.lastname: Ginderdeuren
authors.forename: Guy S
authors.initials: GS
authors.lastname: Missotten
authors.forename: Joost
authors.initials: J
authors.lastname: van den Oord
keywords: Choroidal tumor; Metastatic disease; Paraganglioma