title: BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION: A CASE REPORT.
abstract: OBJECTIVE
  To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) in the setting of metastatic ovarian cancer.
  
  
  METHODS
  In this observational case report, a 59-year-old woman presented with bilateral worsening vision and photophobia. She had been diagnosed with metastatic ovarian cancer 5 years prior for which she received Tamoxifen. Ophthalmic examination was completed followed by fluorescein angiography and optical coherence tomography (Spectralis OCT; Heidelberg Engineering).
  
  
  RESULTS
  The visual acuity was 20/150 in both eyes. Exam demonstrated an iris pigmented lesion in the right eye, bilateral nuclear sclerotic cataracts, multiple orange lesions in the fundus, elevated pigmented uveal melanocytic tumors with diffuse choroidal thickening and multifocal early hyperfluorescence of these lesions (giraffe-like pattern) on fluorescein angiography, and exudative retinal detachment on OCT. The patient was diagnosed with BDUMP in the setting of metastatic ovarian carcinoma. Further metastatic workup demonstrated enlarged lymphadenopathy in the right axilla and inguinal regions. The patient declined chemotherapy and was initiated on plasmapheresis.
  
  
  CONCLUSIONS
  BDUMP is a peculiar paraneoplastic syndrome in the setting of metastatic ovarian cancer, where antigens from the retinal pigment epithelium, iris and choroidal melanocytes cross-react with ovarian tumor cell antibodies that are circulating in the serum. Plasmapheresis can decrease the concentrations of the antibodies, maintain reasonable functional vision and improve the quality of life.
authors.affiliation: *Department of Ophthalmology, Ophthalmic Oncology Program, Smilow Cancer Hospital at Yale New Haven, Yale University School of Medicine, New Haven, Connecticut; and †Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alasil
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coady
authors.forename: Sirine
authors.initials: S
authors.lastname: Koudsi
authors.forename: Mahan
authors.initials: M
authors.lastname: Mathur
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Materin
mesh_terms: D002277:Carcinoma / Q000556:secondary*; D049109:Cell Proliferation; D005260:Female; D006801:Humans; D008544:Melanocytes / Q000473:pathology*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000556:secondary*; D059545:Paraneoplastic Syndromes, Ocular / Q000473:pathology*; D014603:Uveal Diseases / Q000209:etiology*