History of present illness
A 21-year-old male patient with an unremarkable medical history was referred for a macular finding on routine examination.
Ocular examination findings
Visual acuity was 20/20 in each eye. Intraocular pressures were normal. Dilated fundus examination showed a small pigmented parafoveal lesion in the left eye.
Imaging
Optical coherence tomography (OCT) showed a hyperreflective protuberance from the inner retina with dense posterior shadowing.
Questions to ask
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Does the patient have a history of malignancy?
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No
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Has this finding been noted previously?
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No
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Assessment
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This is a case of a 21-year-old male patient with no pertinent medical history with a very well-delineated, pigmented parafoveal macular lesion.
Differential diagnosis
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Choroidal nevus
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Choroidal melanoma
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Combined hamartoma of the retina and retinal pigment epithelium (RPE)
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Congenital hypertrophy of the RPE
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Congenital simple hamartoma of the RPE
Working diagnosis
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Congenital simple hamartoma of the RPE
Multimodal testing and results
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Fundus photographs
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On fundus examination, a heavily pigmented, well-circumscribed parafoveal mass is typically seen ( Fig. 72.1 ). ,
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