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Kim BZ, Lim JZ, McGhee CNJ. Cysts and tumours of the iris: Diagnostic tools and key management considerations-A review. Clin Exp Ophthalmol 2024; 52:665-683. [PMID: 38577954 DOI: 10.1111/ceo.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
The iris is a unique structure, with exquisite variations in colour and form. Pathological changes, specifically including iris cysts and tumours are relatively uncommon, difficult to diagnose, and yet potentially blinding or life-threatening. Based on a comprehensive literature review, with highly illustrated key case examples, this report aims to guide the clinician in filtering the differential diagnoses of iris cysts and tumours. Evaluation is in the context of key diagnostic clinical tools and management considerations. Diagnostic imaging techniques include serial anterior segment photography, ultrasound, anterior segment optical coherence tomography, and iris fluorescein angiography, however, the roles of computerised topography and magnetic resonance imaging are also considered in this review. Management includes categorisation in terms of solid iris tumours (melanocytic vs. non-melanocytic), or iris cysts (primary vs. secondary) that may be usefully differentiated by clinical assessment, avoiding more invasive interventions. Cystic lesions are generally benign, although implantation cysts in particular cause significant complications and surgical challenges. Most solid tumours are melanocytic and also typically benign. However, in larger lesions, rapid growth, symptoms and complications more likely indicate malignancy, requiring further investigation.
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Affiliation(s)
- Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Joevy Z Lim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
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2
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Lee T, Semenova E, Proia AD, Materin MA. A CASE OF HIGH-RISK CILIARY BODY MELANOMA ARISING IN AN EYE AFTER RESECTION OF AN IRIDOCILIARY MELANOCYTOMA. Retin Cases Brief Rep 2023; 17:126-129. [PMID: 34183612 DOI: 10.1097/icb.0000000000001178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of a benign iridociliary melanocytoma recurring as malignant melanoma after excision. METHODS Observational case report with clinical data, slit-lamp examination findings, ultrasound biomicroscopy results, and histopathological and genetic analyses. RESULTS A 40-year-old African American woman initially presented with a superonasal iridociliary mass with a maximal thickness of 2.5 mm. Visual acuity of the involved eye was 20/25, intraocular pressure was 52 mmHg on maximal pressure-lowering medications, and Humphrey visual field testing revealed an inferior altitudinal defect. Fine-needle aspiration biopsy and incisional biopsy followed by tumor excision confirmed a benign melanocytoma. After 5 years of stability, possible recurrence was detected on ultrasound biomicroscopy as an increase in ciliary body thickness. The new lesion grew to a thickness of 5.1 mm over the next 18 months of observation. Fine-needle aspiration biopsy and gene expression profile of the recurrent lesion diagnosed a malignant melanoma with high metastatic potential (Class 2). The patient underwent plaque brachytherapy and has ongoing regression of the tumor. CONCLUSION Transformation of benign iridociliary melanocytoma to melanoma is rare. To the best of the authors' knowledge, this is the first documented case of a melanoma arising in an eye after initial excision of a melanocytoma. Close monitoring of these patients is warranted even years after the initial excision.
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Affiliation(s)
| | | | - Alan D Proia
- Ophthalmology, and
- Pathology, Duke University School of Medicine, Durham, North Carolina; and
- Department of Pathology, Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, North Carolina
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3
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Valenzuela DA, Biscotti CV, Daniels AB. A Pigmented Iris Lesion. JAMA Ophthalmol 2022; 140:1239-1240. [PMID: 36301517 DOI: 10.1001/jamaophthalmol.2022.4484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A patient in their mid-60s presented with a left iris pigmented lesion that had been present for decades and remained stable in size. What would you do next?
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Affiliation(s)
- Daniel A Valenzuela
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
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4
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Solomon DA, Ramani B, Eiger-Moscovich M, Milman T, Uludag G, Crawford JB, Phan I, Char DH, Shields CL, Eagle RC, Bastian BC, Bloomer MM, Pekmezci M. Iris and Ciliary Body Melanocytomas Are Defined by Solitary GNAQ Mutation Without Additional Oncogenic Alterations. Ophthalmology 2022; 129:1429-1439. [PMID: 35835335 DOI: 10.1016/j.ophtha.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/20/2022] [Accepted: 07/05/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To analyze the genetic features of melanocytomas and melanomas of the anterior uvea and assess the value of molecular testing for diagnosis and prognostication. DESIGN Retrospective case-control study. SUBJECTS Patients with melanocytoma (n = 16) and melanoma (n = 19) of the anterior uvea. METHODS Targeted next-generation sequencing was performed on formalin-fixed, paraffin-embedded tumor tissue from anterior uveal melanocytic tumors and correlated with clinicopathologic features. MAIN OUTCOME MEASURES Presence or absence of accompanying oncogenic alterations beyond GNAQ/GNA11 and their association with histologic features and local recurrence. RESULTS Hotspot missense mutations in GNAQ/GNA11 were identified in 91% (32/35) of all cases. None of the melanocytomas with or without atypia demonstrated chromosomal imbalances or additional oncogenic variants beyond GNAQ mutation, and none recurred over a median follow-up of 36 months. Additional alterations identified in a subset of melanomas include mutations in BAP1 (n = 3), EIF1AX (n = 4), SRSF2 (n = 1), PTEN (n = 1), and EP300 (n = 1); monosomy 3p (n = 6); trisomy 6p (n = 3); trisomy 8q (n = 2); and an ultraviolet mutational signature (n = 5). Local recurrences were limited to melanomas, all of which demonstrated oncogenic alterations in addition to GNAQ/GNA11 (n = 5). A single melanoma harboring GNAQ and BAP1 mutations and monosomy 3 was the only tumor that metastasized. CONCLUSIONS In this study, anterior segment uveal melanocytomas did not display oncogenic alterations beyond GNAQ/GNA11. Therefore, they are genetically similar to uveal nevi rather than uveal melanoma based on their molecular features known from the literature. Molecular testing can be performed on borderline cases to aid risk stratification and clinical management decisions.
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Affiliation(s)
- David A Solomon
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Biswarathan Ramani
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Maya Eiger-Moscovich
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gunay Uludag
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - J Brooks Crawford
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Isabella Phan
- Department of Ophthalmology, Kaiser Permanente San Francisco, San Francisco, California
| | - Devron H Char
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Boris C Bastian
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Michele M Bloomer
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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5
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Meng L, Zhang R, Fa L, Zhang L, Wang L, Shao G. ATRX status in patients with gliomas: Radiomics analysis. Medicine (Baltimore) 2022; 101:e30189. [PMID: 36123880 PMCID: PMC9478307 DOI: 10.1097/md.0000000000030189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
MATERIAL AND METHODS A cohort of 123 patients diagnosed with gliomas (World Health Organization grades II-IV) who underwent surgery and was treated at our center between January 2016 and July 2020, was enrolled in this retrospective study. Radiomics features were extracted from MR T1WI, T2WI, T2FLAIR, CE-T1WI, and ADC images. Patients were randomly split into training and validation sets at a ratio of 4:1. A radiomics signature was constructed using the least absolute shrinkage and selection operator (LASSO) to train the SVM model using the training set. The prediction accuracy and area under curve and other evaluation indexes were used to explore the performance of the model established in this study for predicting the ATRX mutation state. RESULTS Fifteen radiomic features were selected to generate an ATRX-associated radiomic signature using the LASSO logistic regression model. The area under curve for ATRX mutation (ATRX(-)) on training set was 0.93 (95% confidence interval [CI]: 0.87-1.0), with the sensitivity, specificity and accuracy being 0.91, 0.82 and 0.88, while on the validation set were 0.84 (95% CI: 0.63-0.91), with the sensitivity, specificity and accuracy of 0.73, 0.86, and 0.79, respectively. CONCLUSIONS These results indicate that radiomic features derived from preoperative MRI facilitat efficient prediction of ATRX status in gliomas, thus providing a novel evaluation method for noninvasive imaging biomarkers.
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Affiliation(s)
- Linlin Meng
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ran Zhang
- Huiying Medical Technology Co. Ltd, Beijing, China
| | - Liangguo Fa
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lulu Zhang
- Department of Pathology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Linlin Wang
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Guangrui Shao
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- * Correspondence: Guangrui Shao, Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Road, Jinan, Shandong (e-mail: )
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6
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A case of melanocytomalytic glaucoma. J Fr Ophtalmol 2022; 45:e252-e253. [DOI: 10.1016/j.jfo.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
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7
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Al-Kharashi A, Alsakran WA, Alshamrani AA, AlZaid A, Maktabi AMY, Alzahrani YA. Iris Melanocytoma in a Child: Clinical and Histopathological Findings. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931385. [PMID: 34153023 PMCID: PMC8235677 DOI: 10.12659/ajcr.931385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient: Male, 3-year-old Final Diagnosis: Iris melanocytoma Symptoms: Eye pain and redness • photophobia Medication: — Clinical Procedure: — Specialty: Ophthalmology
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Affiliation(s)
- Abdulkarim Al-Kharashi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,King Saud Medical City, Riyadh, Saudi Arabia
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8
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Biopsy of a diffuse anterior chamber angle melanocytoma using a Kahook Dual Blade. Can J Ophthalmol 2021; 56:e121-e122. [PMID: 33667427 DOI: 10.1016/j.jcjo.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/21/2022]
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Xavier C, Hipolito-Fernandes D, Cardigos J, Magriço A. Iris melanocytoma and secondary glaucoma. BMJ Case Rep 2020; 13:13/12/e237269. [PMID: 33318246 PMCID: PMC7737020 DOI: 10.1136/bcr-2020-237269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Iris melanocytoma (IM) is a rare variant of iris nevus with distinctive clinical and histopathological features. A 66-year-old woman, with a history of right eye pigmented iris nevus, presented to us with a recent onset of visual acuity decrease in that eye. She had a melanocytic iris lesion with iridocorneal angle invasion, peripheral corneal adhesion, pupil corectopia, sectorial cataract and high intraocular pressure. Ultrasound biomicroscopy did not exclude malignant transformation, so excisional biopsy was performed revealing the presence of IM without signs of atypia. Subsequently, the patient underwent cataract surgery combined with iridoplasty and later an ab externo trabeculectomy. Most cases of IM remain stable and require no intervention, but in cases of unusual clinical course, with rapid growth or secondary glaucoma, surgical treatment is indicated as a diagnostic and therapeutic measure. This case report highlights the importance of a timely and multidisciplinary ophthalmological approach for a better visual outcome.
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Affiliation(s)
- Catarina Xavier
- Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | | | - Joana Cardigos
- Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Magriço
- Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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10
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Su Y, Xu X, Zuo P, Xia Y, Qu X, Chen Q, Guo J, Wei W, Xian J. Value of MR-based radiomics in differentiating uveal melanoma from other intraocular masses in adults. Eur J Radiol 2020; 131:109268. [DOI: 10.1016/j.ejrad.2020.109268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022]
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11
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Sia DIT, Agi J, Grewal P, Russell L, Weis E. Two Cases of Giant Melanocytoma (Hyperpigmented Magnocellular Nevus). Ocul Oncol Pathol 2020; 6:344-352. [PMID: 33123528 DOI: 10.1159/000507399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022] Open
Abstract
Melanocytoma or hyperpigmented magnocellular nevus is a variant of melanocytic nevus that is most commonly seen in the optic nerve, but has also been reported to occur in the iris, ciliary body, choroid, sclera, and conjunctiva. We present two cases of giant uveal melanocytoma with histopathology. The first case occurred in a 10-year-old girl who presented with decreased vision in the right eye and a mushroom-shaped pigmented choroidal lesion measuring 15.5 mm in apical height. The lesion was abutting the lens but not causing a cataract. This was diagnosed as a choroidal melanocytoma on open scleral window biopsy. The second case was in a 68-year-old lady, referred for a left nasal pigmented choroidal lesion measuring 8 mm in apical height and having a mushroom configuration. The lesion grew to 8.6 mm in height and was complicated by a vitreous hemorrhage and rhegmatogenous retinal detachment and was treated with iodine-125 plaque brachytherapy. Subsequently, the treated eye became a painful phthisical eye and was enucleated. Histopathology confirmed melanocytoma with extrascleral extension but without malignant transformation. Features of melanocytoma and other very large cases reported in the literature are discussed.
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Affiliation(s)
- David I T Sia
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jorge Agi
- Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Alberta, Canada
| | - Parampal Grewal
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Laurie Russell
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ezekiel Weis
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Alberta, Canada
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12
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Shanmugam PM, Sofi IA, Sagar P, Konana VK, Ramanjulu R. Vitrectomy as a treatment modality in vitreous seeding secondary to ciliary body melanocytoma. Indian J Ophthalmol 2019; 67:2083-2085. [PMID: 31755468 PMCID: PMC6896563 DOI: 10.4103/ijo.ijo_439_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Melanocytoma is a locally invasive intraocular tumor usually located in the optic nerve head, iris, ciliary body and choroid. Melanocytoma can undergo necrosis and lead to pigment dispersion. We report a case of melanocytoma of the ciliary body with vitreous seeds filling the vitreous cavity. A sub conjunctival pigmented lesion was seen due to extra scleral extension of the tumor. The diagnosis of melanocytoma was confirmed by biopsy of the sub conjunctival lesion. Pars plana vitrectomy was performed to clear the vitreous cavity with good visual recovery.
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Affiliation(s)
- P Mahesh Shanmugam
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Ishfaq A Sofi
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Pradeep Sagar
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Vinaya K Konana
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Rajesh Ramanjulu
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
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13
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Intraocular Biopsy and ImmunoMolecular Pathology for "Unmasking" Intraocular Inflammatory Diseases. J Clin Med 2019; 8:jcm8101733. [PMID: 31635036 PMCID: PMC6832563 DOI: 10.3390/jcm8101733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/05/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022] Open
Abstract
Intraocular inflammation can hide a variety of eye pathologies. In 33% of cases, to obtain a correct diagnosis, investigation of the intraocular sample is necessary. The combined analyses of the intraocular biopsy, using immuno-pathology and molecular biology, point to resolve the diagnostic dilemmas in those cases where history, clinical tests, and ophthalmic and systemic examinations are inconclusive. In such situations, the teamwork between the ophthalmologist and the molecular pathologist is critically important to discriminate between autoimmune diseases, infections, and intraocular tumors, including lymphoma and metastases, especially in those clinical settings known as masquerade syndromes. This comprehensive review focuses on the diagnostic use of intraocular biopsy and highlights its potential to enhance research in the field. It describes the different surgical techniques of obtaining the biopsy, risks, and complication rates. The review is organized according to the anatomical site of the sample: I. anterior chamber containing aqueous humor, II. iris and ciliary body, III. vitreous, and IV. choroid and retina. We have excluded the literature concerning biopsy for choroidal melanoma and retinoblastoma, as this is a specialized area more relevant to ocular oncology.
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15
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Abstract
PURPOSE OF REVIEW Glaucoma secondary to intraocular tumors is important to consider in eyes with a known tumor and those with unilateral or refractory glaucoma. The purpose of this review is to discuss the mechanisms and management of intraocular tumors with related secondary glaucoma. RECENT FINDINGS Several intraocular tumors can lead to glaucoma, including iris melanoma, iris metastasis, iris lymphoma, trabecular meshwork melanoma, choroidal melanoma, choroidal metastasis, retinoblastoma, and medulloepithelioma. The mechanisms for glaucoma include solid tumor invasion into the angle, tumor seeding into the angle, angle closure, and iris neovascularization. Management of the tumor can lead to resolution of glaucoma. Management of the secondary glaucoma may involve medical therapy, transscleral cyclophotocoagulation, laser trabeculoplasty, and potentially antivascular endothelial growth factor therapy. Minimally invasive glaucoma surgery (MIGS) can be considered for eyes with treated, regressed posterior segment malignancies if there is no iris or ciliary body involvement. Importantly, avoidance of MIGS, filtering, or shunting surgery in eyes with active malignancies is emphasized. SUMMARY Intraocular tumors can produce secondary glaucoma. Treatment of the primary tumor can sometimes resolve the glaucoma. Topical, oral, or laser therapies can be considered. Avoidance of MIGS, filtering, or shunting surgery is advised until the malignancy is completely regressed.
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16
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Pasricha ND, Seider MI. Hyphema from Iris Melanocytoma. Ocul Oncol Pathol 2018; 5:273-275. [PMID: 31367590 DOI: 10.1159/000489997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/08/2018] [Indexed: 11/19/2022] Open
Abstract
Using multimodal imaging, we demonstrate a classic iris melanocytoma presenting with recurrent, spontaneous hyphema in a young female patient. The patient has been observed without tumor growth. Hyphema has not been previously reported to occur with iris melanocytoma.
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Affiliation(s)
- Neel D Pasricha
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Michael I Seider
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Department of Ophthalmology, The Permanente Medical Group, San Francisco, California, USA.,Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
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17
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Woicke J, Haile S, Mysore J, Peden WM, Lejeune T, Sanderson T, Brodie T. Spontaneous Findings in the Eyes of Cynomolgus Monkeys (Macaca fascicularis) of Mauritian Origin. Toxicol Pathol 2018; 46:273-282. [DOI: 10.1177/0192623318758619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Spontaneous findings noted in the eyes of Mauritian cynomolgus monkeys are described and descriptions are supplemented with illustrations. Findings observed after extensive histopathologic examinations (20 to 44 sections per eye) from 20 control, 17 treatment-naive stock monkeys, and 2 findings noted in drug-treated monkeys that were considered to be spontaneous are included. Also included are findings from 361 control monkeys of routine toxicity studies performed at our laboratories, for most of which a standard histopathological examination of 1 section per eye was conducted. Common observations in monkeys examined extensively and in historical controls were limited to lymphocytic or mononuclear cell infiltrations of the uvea and/or conjunctiva/sclera and, less commonly observed, melanocytoma of the ciliary body or iris. Findings noted only in monkeys examined extensively consisted of inflammation of the conjunctiva, ora serrata cysts, glial nodules, focal degeneration of the retina, cystoid degeneration of the central retina, ballooning degeneration of the ciliary epithelium, cyst of the ciliary body, and decreased pigmentation of the retinal pigment epithelium. Changes recorded only in historical controls included retinal atrophy and nuclear displacement in the retina. Lesions are discussed and compared with pertinent literature.
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Affiliation(s)
- Jochen Woicke
- Pathology, Research and Development, Bristol-Myers Squibb, Mount Vernon, Indiana, USA
| | - Solomon Haile
- Charles River Laboratories Montreal ULC, Senneville, Quebec, Canada
| | - Jagannatha Mysore
- Pathology, Research and Development, Bristol-Myers Squibb, New Brunswick, New Jersey, USA
| | - W. Michael Peden
- Pathology, Research and Development, Bristol-Myers Squibb, Mount Vernon, Indiana, USA
| | - Typhaine Lejeune
- Charles River Laboratories Montreal ULC, Senneville, Quebec, Canada
| | - Thomas Sanderson
- Pathology, Research and Development, Bristol-Myers Squibb, Mount Vernon, Indiana, USA
| | - Thomas Brodie
- Pathology, Research and Development, Bristol-Myers Squibb, New Brunswick, New Jersey, USA
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18
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Gutiérrez-Ortiz C, Pareja J, Bolívar G, Cedazo MT, Busteros JI, Teus MA. Iris Melanocytoma Mimicking the Cogan-Reese Syndrome with Monocular Pigment Dissemination. Eur J Ophthalmol 2018; 16:873-5. [PMID: 17191198 DOI: 10.1177/112067210601600617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of iris melanocytoma mimicking the Cogan-Reese syndrome. METHODS A 37-year-old woman presented with pigmentary glaucoma in her left eye. There was diffuse pigmentary dispersion in the anterior segment, pedunculated pigmented nodules on the anterior iris surface, mild iris atrophy, and ectropion iridis. Neither intrinsic vasculature nor a sector cataract was found. The angle was open with marked trabecular pigmentation and no anterior synechiae. The intraocular pressure was 30 mmHg with maximum medical treatment and there was glaucomatous optic atrophy. The differential diagnosis included iris pigmented tumor and iridocorneal endothelial syndrome (Cogan-Reese syndrome). An iris biopsy was performed for diagnostic purposes. RESULTS Histologic diagnosis after evaluation of the specimen was iris melanocytoma. CONCLUSIONS This case presents signs considered quasi-pathognomonic of iridocorneal endothelial syndrome (Cogan-Reese syndrome): glaucoma, mild iris atrophy associated with pedunculated iris nodules, and ectropion iridis. Therefore, iris melanocytoma can present with features that mimic the Cogan-Reese syndrome.
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Affiliation(s)
- C Gutiérrez-Ortiz
- Department of Ophthalmology, Hospital Universitario Príncipe de Astúrias, Madrid, Spain.
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Lisker-Cervantes A, Ancona-Lezama DA, Arroyo-Garza LJ, Martinez JD, Barreiro RGD, Valdepeña-López-Velarde VD, Morales-Canton V, Moragrega-Adame E. Ocular ultrasound findings in optic disk melanocytoma. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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20
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Mustafa OM, Daoud YJ. Melanosis oculi. Am J Ophthalmol Case Rep 2017; 7:38-39. [PMID: 29260076 PMCID: PMC5722173 DOI: 10.1016/j.ajoc.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/21/2017] [Accepted: 05/16/2017] [Indexed: 12/03/2022] Open
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Kusunose M, Sakino Y, Noda Y, Daa T, Kubota T. A Case of Iris Melanocytoma Demonstrating Diffuse Melanocytic Proliferation with Uncontrolled Intraocular Pressure. Case Rep Ophthalmol 2017; 8:190-194. [PMID: 28512420 PMCID: PMC5422834 DOI: 10.1159/000464349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/16/2017] [Indexed: 11/29/2022] Open
Abstract
We report a rare case with histologically proven melanocytoma of the iris that demonstrated diffuse melanocytic proliferation with uncontrolled secondary glaucoma and investigate the etiology of the intraocular pressure elevation. The patient was a 78-year-old man with a history of darkened iris of his left eye. The intraocular pressure was 39 mm Hg. A slit-lamp examination showed a diffuse darkened iris, and a gonioscopic examination revealed open angle with circumferential heavy pigmentation. There was no pigment dispersion of the anterior chamber and no pigment deposition of the cornea. We suspected malignant ring melanoma in the left eye and enucleated it. The globe was examined with light and electron microscopy. Light microscopy revealed the presence of heavily pigmented tumor cells in the iris, ciliary body, trabecular meshwork, and Schlemm's canal. A bleached preparation showed large tumor cells with central and paracentral nuclei without mitosis. Electron microscopy of the trabecular meshwork revealed melanin-bearing tumor cells invading the intertrabecular spaces, and the melanin granules were not phagocytosed in the trabecular cells. The mechanical obstruction of the aqueous flow by the tumor cells may be a major cause of secondary glaucoma in eyes with iris melanocytoma presenting diffuse proliferation.
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Affiliation(s)
- Mami Kusunose
- aDepartment of Ophthalmology, Oita University Faculty of Medicine, Yufu, Japan
| | - Yuji Sakino
- aDepartment of Ophthalmology, Oita University Faculty of Medicine, Yufu, Japan
| | - Yoshihiro Noda
- aDepartment of Ophthalmology, Oita University Faculty of Medicine, Yufu, Japan
| | - Tsutomu Daa
- bDepartment of Pathology, Oita University Faculty of Medicine, Yufu, Japan
| | - Toshiaki Kubota
- aDepartment of Ophthalmology, Oita University Faculty of Medicine, Yufu, Japan
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Shields CL, Shields PW, Manalac J, Jumroendararasame C, Shields JA. Review of cystic and solid tumors of the iris. Oman J Ophthalmol 2014; 6:159-64. [PMID: 24379549 PMCID: PMC3872564 DOI: 10.4103/0974-620x.122269] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iris tumors are broadly classified into cystic or solid lesions. The cystic lesions arise from iris pigment epithelium (IPE) or iris stroma. IPE cysts classically remain stable without need for intervention. Iris stromal cyst, especially those in newborns, usually requires therapy of aspiration, possibly with alcohol-induced sclerosis, or surgical resection. The solid tumors included melanocytic and nonmelanocytic lesions. The melanocytic iris tumors include freckle, nevus (including melanocytoma), Lisch nodule, and melanoma. Information from a tertiary referral center revealed that transformation of suspicious iris nevus to melanoma occurred in 4% by 10 years and 11% by 20 years. Risk factors for transformation of iris nevus to melanoma can be remembered using the ABCDEF guide as follows: A=age young (<40 years), B=blood (hyphema) in anterior chamber, C=clock hour of mass inferiorly, D=diffuse configuration, E=ectropion, F=feathery margins. The most powerful factors are diffuse growth pattern and hyphema. Tumor seeding into the anterior chamber angle and onto the iris stroma are also important. The nonmelanocytic iris tumors are relatively uncommon and included categories of choristomatous, vascular, fibrous, neural, myogenic, epithelial, xanthomatous, metastatic, lymphoid, leukemic, secondary, and non-neoplastic simulators. Overall, the most common diagnoses in a clinical series include nevus, IPE cyst, and melanoma. In summary, iris tumors comprise a wide spectrum including mostly iris nevus, IPE cyst, and iris melanoma. Risk factors estimating transformation of iris nevus to melanoma can be remembered by the ABCDEF guide.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | - Patrick W Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | - Janet Manalac
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | | | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
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Abstract
A 62-year-old female presented to our institution with dimness of vision in her right eye. On examination, her best corrected visual acuity was 20/100 in the right eye. The intraocular pressures were 14 mmHg in both eyes. Slit-lamp examination revealed nuclear sclerotic cataracts bilaterally and iridodialysis in her right eye. Seven days after the first visit, cataract surgery was performed without any complications. One year later, she presented to our institution with acute visual loss and ocular pain in the right eye. Best corrected visual acuity of the right eye was light perception and the intraocular pressure was 44 mmHg. Slit-lamp examination revealed a ciliary body mass with widespread pigment dispersion in the anterior segment. Due to no useful vision and uncontrolled pain, enucleation of the right eye was performed. Histopathologic examination revealed a melanocytoma of the ciliary body.
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Affiliation(s)
- Moosang Kim
- Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Seung-Jun Lee
- Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
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Lee JA, Ahn YS, Cho YK. A Case of Melanocytoma Originating from the Iris. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.5.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin Ah Lee
- Department of Ophthalmology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yong Sun Ahn
- Department of Ophthalmology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Yang Kyung Cho
- Department of Ophthalmology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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Awaji S, Alkatan H, Al-Kharashi S, Al-Rajhi A. Iris melanocytoma in child diagnosed by fine needle aspiration biopsy. Saudi J Ophthalmol 2013; 27:277-80. [PMID: 24371424 DOI: 10.1016/j.sjopt.2013.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/19/2013] [Accepted: 07/29/2013] [Indexed: 02/01/2023] Open
Abstract
We report a case of large iris melanocytoma in a child diagnosed by fine needle aspiration biopsy. In this interventional case report, cytologic features typical of melanocytoma were obtained by fine needle aspiration biopsy (FNAB). FNAB can be used in difficult diagnostic cases if a good sample is obtained, this technique has an accuracy of more than 99% in tumors larger than 3 mm; however, false-negative and false-positive results may be obtained. Its risk of local spread is very small, an advantage over incisional biopsy. The most common complication is intralesional hemorrhage and hyphema.
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Affiliation(s)
- Samira Awaji
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind Alkatan
- Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Soliman Al-Kharashi
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ali Al-Rajhi
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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26
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Reichstein DA, Shields JA, Tran U, Shields CL. Unusual multifocal pigmented lesions of the uvea in a patient with ocular melanocytosis. Retin Cases Brief Rep 2013; 7:399-401. [PMID: 25383808 DOI: 10.1097/icb.0b013e318297f6b0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report findings of unusual multifocal pigmented lesions in a single patient with sector uveal melanocytosis. METHODS Retrospective case report of an otherwise healthy 64-year-old man with unusual uveal pigmentation. Complete ocular examination, including slit-lamp biomicroscopy, ophthalmoscopy, optical coherence tomography, and ultrasound biomicroscopy, was performed. RESULTS Slit-lamp examination disclosed inferior sector pigmentation of the iris. Ophthalmoscopy showed multiple discrete, deeply pigmented, inferior choroidal lesions, and ultrasound biomicroscopy confirmed a small inferior ciliary body mass. The findings were consistent with sector uveal melanocytosis, believed to be the same as a diffuse melanocytoma. CONCLUSION Melanocytoma is typically a unilateral, unifocal lesion that occurs on the optic disc but can be located anywhere in the uveal tract. This is a case of unusual pigmented uveal lesions, likely representing a variant of sector uveal melanocytosis or multiple diffuse uveal melanocytomas.
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Affiliation(s)
- David A Reichstein
- *Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and †Cornea and External Disease Service, Vanderbilt Eye Institute, Vanderbilt University of Medicine, Nashville, Tennessee
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Rennie IG. Don't it make my blue eyes brown: heterochromia and other abnormalities of the iris. Eye (Lond) 2012; 26:29-50. [PMID: 21979861 PMCID: PMC3259577 DOI: 10.1038/eye.2011.228] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 12/26/2022] Open
Abstract
Eye colour is one of the most important characteristics in determining facial appearance. In this paper I shall discuss the anatomy and genetics of normal eye colour, together with a wide and diverse range of conditions that may produce an alteration in normal iris pigmentation or form.
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Affiliation(s)
- I G Rennie
- Academic Unit of Ophthalmology & Orthoptics, University of Sheffield, Sheffield, UK.
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28
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Shields CL, Kancherla S, Patel J, Vijayvargiya P, Suriano MM, Kolbus E, Badami A, Sharma P, Jacobs E, Voluck M, Zhang Z, Kansal R, Shields PW, Bianciotto CG, Shields JA. Clinical survey of 3680 iris tumors based on patient age at presentation. Ophthalmology 2011; 119:407-14. [PMID: 22035581 DOI: 10.1016/j.ophtha.2011.07.059] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To report the spectrum of iris lesions based on patient age at presentation. DESIGN Retrospective, nonrandomized, single-center case series. PARTICIPANTS We included 3680 iris tumors in 3451 patients. METHODS Chart review. MAIN OUTCOME MEASURES Diagnostic category based on age. RESULTS The mean age at presentation was 48 years and there were 449 (12%) tumors in children (≤20 years), 788 (21%) in young adults (21-40 years), 1308 (36%) in mid adults (41-60 years), and 1135 (31%) in senior adults (>60 years). Of 3680 tumors, the diagnostic category was cystic (n = 768; 21%) or solid (n = 2912; 79%). The cystic tumors originated from iris pigment epithelium (IPE; n = 672; 18%) or iris stroma (n = 96; 3%). The solid tumors included melanocytic (n = 2510; 68%) and nonmelanocytic (n = 402; 11%). The melanocytic tumors comprised nevus (n = 1503; 60%), melanocytoma (n = 68; 3%), melanoma (n = 645; 26%), and melanocytosis (n = 64; 3%). Of 2510 melanocytic tumors, the first and second most common diagnoses by age (children, young adult, mid adult, senior adult) were nevus (53%, 57%, 63%, and 63%, respectively) and melanoma (17%, 27%, 26%, and 27%, respectively). The nonmelanocytic tumors included categories of choristomatous (n = 4; <1%), vascular (n = 57; 2%), fibrous (n = 2; <1%), neural (n = 3; <1%), myogenic (n = 2;, <1%), epithelial (n = 35; 1%), xanthomatous (n = 8; <1%), metastasis (n = 67; 2%), lymphoid (n = 12; <1%), leukemic (n = 2; <1%), secondary (n = 12; <1%), and nonneoplastic simulators (n = 198; 5%). The median age (in years) at diagnosis included cystic (39), melanocytic (52), choristomatous (0.7), vascular (56), fibrous (53), neural (8), myogenic (42), epithelial (63), xanthomatous (1.9), metastasis (60), lymphoid (57), leukemic (25.5), secondary (59), and nonneoplastic simulators (49). Overall, the 3 most common specific diagnoses (children, young adult, mid adult, senior adult) were nevus (25%, 36%, 47%, and 47%, respectively), IPE cyst (28%, 30%, 15%, and 14%, respectively), and melanoma (8%, 16%, 20%, and 19%, respectively). CONCLUSIONS In an ocular oncology practice, the spectrum of iris tumors includes cystic (21%) and solid (79%) tumors. The solid tumors were melanocytic (68%) or nonmelanocytic (11%). At all ages, the most common specific diagnoses were nevus (42%), IPE cyst (19%), and melanoma (17%).
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Suite 1440, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA.
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29
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Kathil P, Milman T, Finger PT. Characteristics of Anterior Uveal Melanocytomas in 17 Cases. Ophthalmology 2011; 118:1874-80. [DOI: 10.1016/j.ophtha.2011.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022] Open
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31
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Lee CS, Kim DK, Lee SC. A case of ciliary body melanocytoma presenting as a painful iris mass. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:44-6. [PMID: 20157414 PMCID: PMC2817824 DOI: 10.3341/kjo.2010.24.1.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 01/06/2010] [Indexed: 11/23/2022] Open
Abstract
We report a case of ciliary body melanocytoma in a Korean patient, which presented as an intermittently painful pigmented iris mass and was successfully managed by iridocyclectomy. A 52-year-old healthy man presented with an irregularly-shaped and heavily-pigmented mass at the iris root of his right eye. Visual acuity of the right eye was 20/20 with normal intraocular pressure. Ultrasound biomicroscopy showed a 1.5x1.3-mm ciliary-body mass with extension into the iris root. Iridocyclectomy with scleral resection under a lamellar scleral flap was performed, and the histopathologic features of the resected tissue were consistent with melanocytoma of the ciliary body. The patient's visual acuity remained 20/20 with good postoperative cosmesis. During one year of follow-up, no signs of tumor recurrence were seen, and the patient reported resolution of the intermittent ocular pain in the involved eye.
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Affiliation(s)
- Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
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32
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Jain V, Dabir S, Shome D, Dadu T, Natarajan S. Aspergillus iris granuloma: a case report with review of literature. Surv Ophthalmol 2009; 54:286-91. [PMID: 19298905 DOI: 10.1016/j.survophthal.2008.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the case of a 25-year-old male patient who presented with complaints of redness, photophobia, and decreased vision in the right eye of a week's duration. Slit-lamp biomicroscopic examination revealed a cream-colored, irregular elevated inferior iris mass, extending on to the anterior lens surface. Differential diagnoses of a fungal granuloma, a medulloepithelioma, and an amelanotic melanoma were considered. An excisional biopsy of the mass was performed through a superior clear corneal incision. Polymerase chain reaction analysis of the aqueous humor showed a positive pan fungal genome. Histopathology of the biopsied mass showed a giant cell granuloma with surrounding numerous branching, septate hyphae. Culture growth revealed Aspergillus fumigatus We report this case because of the rarity of Aspergillus iris granuloma as a primary presentation of endogenous Aspergillosis and review the relevant literature. Absence of a significant systemic history compounded the diagnostic dilemma in our patient. Definitive differentiation of this rare entity from a foreign body, amelanotic melanoma, and other inflammatory conditions such as sarcoidosis and tuberculosis, may be possible only on microbiological and histo-pathological evaluation.
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Affiliation(s)
- Vandana Jain
- Department of Cornea and Anterior Segment, Aditya Jyot Eye Hospital Pvt Ltd, Mumbai, India
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33
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Inoue R, Saishin Y, Shima C, Yoshikawa H, Ohguro N, Tano Y. A case of iris melanocytoma transformed to malignant melanoma. Jpn J Ophthalmol 2009; 53:271-3. [PMID: 19484449 DOI: 10.1007/s10384-008-0649-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 12/01/2008] [Indexed: 10/20/2022]
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Odashiro M, Odashiro A, Leite L, Melo M, Odashiro P, Miiji L, Odashiro D, Fernandes P, Burnier M. Melanocytoma of ciliary body and choroids simulating melanoma. Pathol Res Pract 2009; 206:130-3. [PMID: 19410384 DOI: 10.1016/j.prp.2009.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 03/04/2009] [Accepted: 03/30/2009] [Indexed: 11/17/2022]
Abstract
Melanocytoma is a rare intraocular tumor. There are some reports in the literature dealing with primary melanocytomas of the choroid and ciliary body. It is believed that most of these tumors are clinically diagnosed as nevi or melanoma, and are followed up or treated without surgical resection, respectively. Some clinical features can give a clue as to the correct diagnosis. We report on a 47-year-old white female with progressive visual loss of 2 months and right painful eye. Her visual acuity of finger counting was confined to 3.0m OD and 20/20 OS. Biomicroscopy OD showed a 360 degrees posterior synechia, and fundoscopy was not conclusive due to vitreous opacity. No alterations were seen on OS. Intraocular pressure was normal, and the pupillary reflex was present in both eyes. An ultrasound of the OD showed an elevated tumor on topography of the ciliary body and anterior choroid at the ora serrata level. Melanoma was the main diagnosis considered, and enucleation was indicated due to poor prognosis for visual acuity. Gross and histopathologic examinations of the OD showed a heavily pigmented tumor. The brownish pigment obscured the morphology of the tumor cells that could not be visualized by conventional H&E stain. Bleached slides showed that tumor was composed of melanocytoma cells type I.
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Affiliation(s)
- Maçanori Odashiro
- Department of Pathology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
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35
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Tsugu H, Nabeshima K, Matsumoto S, Omura T, Yahiro T, Oshiro S, Komatsu F, Abe H, Fukushima T, Inoue T, Takano K. A case of a heavily pigmented orbital melanocytoma. Brain Tumor Pathol 2009; 26:25-9. [DOI: 10.1007/s10014-008-0242-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 10/16/2008] [Indexed: 12/20/2022]
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36
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Malandrini A, Mittica V, Tosi GM, Paradiso A, Balestrazzi A. Clinical and ultrasound biomicroscopic features in iris melanocytoma. Ophthalmic Surg Lasers Imaging Retina 2009; 40:46-9. [PMID: 19205496 DOI: 10.3928/15428877-20090101-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The clinical and ultrasound biomicroscopic features of two cases of iris melanocytoma are evaluated. On ultrasound biomicroscopy examination, iris melanocytoma appears as a highly reflective nodular mass with a smooth or irregular surface and sharp and well-defined edges. Ultrasound biomicroscopy also allows clear visualization and measurement of the tumors. These findings were compared with clinical and histopathologic findings.
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Affiliation(s)
- Alex Malandrini
- Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy
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Chen MJ, Liu JL, Li WY, Lee FL, Chou CK, Hsu WM. Diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma with iris melanocytoma. J Chin Med Assoc 2008; 71:546-8. [PMID: 18955192 DOI: 10.1016/s1726-4901(08)70166-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Iris melanocytoma is a rare melanocytic nevus with distinctive clinical and pathologic features. Secondary glaucoma may develop rapidly and respond poorly to glaucoma medication in some cases. However, few data are available in the literature with respect to the appropriate treatment for refractory glaucoma associated with iris melanocytoma. Herein, we present a 28-year-old man with blurred vision and an elevated intraocular pressure (IOP) of 40 mmHg in his right eye while on multiple glaucoma medications. A dark brown lobulated iris mass with surrounding small pigmented lesions was noted between the 4 and 5:30 o'clock positions. Sector iridectomy was performed and pathologic examination revealed an iris melanocytoma. After surgery, antiglaucomatous medications still failed to control IOP. The patient then underwent diode laser transscleral cyclophotocoagulation (TSCP). At the last follow-up of 15 months, IOP had returned to normal without the need for medication.
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Affiliation(s)
- Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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42
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Sagoo MS, Mruthyunjaya P, Cree I, Luthert PJ, Hungerford JL. Malignant transformation of iris melanocytoma to iris ring melanoma. Br J Ophthalmol 2007; 91:1571-2. [PMID: 17947283 DOI: 10.1136/bjo.2006.105858] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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43
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Shields JA, Shields CL, Eagle RC. Melanocytoma (hyperpigmented magnocellular nevus) of the uveal tract: the 34th G. Victor Simpson lecture. Retina 2007; 27:730-9. [PMID: 17621182 DOI: 10.1097/iae.0b013e318030e81e] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Optic nerve melanocytoma is a variant of melanocytic nevus that has typical clinical and histopathologic features. In addition to occurring in the optic nerve, melanocytoma can also be found in the uveal tract, including the iris, ciliary body, and choroid. Most ophthalmologists are not familiar with these extrapapilary melanocytomas. This review covers the history, terminology, demographics, clinical futures, clinical course, histopathology, differential diagnosis, diagnostic techniques, management, and prognosis for melanocytomas that develop in the uveal tract, separate from the optic nerve. Like standard uveal nevi, melanocytoma can rarely spawn a malignant melanoma.
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Affiliation(s)
- Jerry A Shields
- Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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44
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Sagoo MS, Shields CL, Eagle RC, Materin MA, Ehya H, McQueen B, Shields JA. Brown trabeculectomy bleb from necrotic iris melanocytoma. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1755-3768.2006.00833.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Sagoo MS, Shields CL, Eagle RC, Materin MA, Ehya H, McQueen B, Shields JA. Brown trabeculectomy bleb from necrotic iris melanocytoma. ACTA ACUST UNITED AC 2007; 85:571-2. [PMID: 17655614 DOI: 10.1111/j.1600-0420.2006.00833.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mandeep S Sagoo
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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