Massive retinal gliosis

Background Massive retinal gliosis is a rare, extreme form of a reactive glial cell proliferation and can cause difficulties in the differential diagnosis of intraocular tumors. Patient and methods A 33-year-old patient presented with a painful neovascular glaucoma and a solid intraocular mass. The left globe was subsequently enucleated. The fundus could not be visualized due to lens opacities and an incomplete occlusive membrane. The findings of the magnetic resonance imaging were compatible with an intraocular malignant choroidal melanoma. Results Histologically the intraocular tumor proved to be a massive retinal gliosis replacing all retinal layers. Immunohistological reactions were positive for GFAP ("glial fibrillary acidic protein"). There were many dilated vessels within the glial mass. Conclusions Massive proliferations of glial cells represent secondary changes which are usually found in blind eyes with various underlying diseases. They can be confused with other intraocular tumors, particularly if the fundus cannot be visualized. Ultrasound-reflectivity and magnet resonance imaging findings of massive retinal gliosis may resemble a malignant choroidal melanoma.