Lenticular meridional astigmatism secondary to iris mesectodermal leiomyoma.

A 61-year-old African American man presented with decreased vision of 2 months duration. Examination revealed a significant lenticular astigmatism and sectoral cataract as a result of an amelanotic iris lesion. Slitlamp optical coherence tomography (OCT) revealed angle crowding. An excisional biopsy was performed along with phacoemulsification in the right eye, with intraocular lens implantation for meridional lenticular astigmatism. Histopathology and histoimmunochemistry confirmed a diagnosis of uveal mesectodermal leiomyoma. Lenticular astigmatism may be a subtle sign of an anterior segment tumor. Anterior segment slitlamp OCT is an effective tool in diagnosing as well as monitoring small interval changes in these types of tumors.

A case of primary peripheral T-cell type non-Hodgkin lymphoma originating in the iris--clinicopathological findings.

BACKGROUND: The ocular adnexal region is the primary localization of extranodal lymphoma in 5% to 15% of all Non-Hodgkin lymphoma. Intraocular lymphoma of T-cell origin is extremely rare and such sites of infiltration have been rarely observed in clinical examination. CASE REPORT: We presented a 56-year-old man with iris infiltration by primary intraocular peripheral T-cell lymphoma. The patient was in clinical stage I BE and the treatment was initiated according to cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone (CHOP) regimen. When the second course of the therapy was scheduled, the patient developed central nervous system lymphoma infiltration. Although De Angelis regimen was used, 3 months after the diagnosis was established, lethal outcome ensued due to disease progression. CONCLUSION: According to our experience we can conclude that further therapeutical approach to patients with primary intraocular T-cell lymphoma requires modification of conventional treatment regimens. The lower median survival in these patients suggests that the disease may be of more aggressive course.

Iris melanoma.

The iris is the least common site of primary uveal melanoma. The prognosis of iris melanoma is better than that of melanoma of the ciliary body and choroid, but the reason for this difference is unclear. One possible explanation is that iris melanoma is smaller than its posterior segment counterparts at the time of diagnosis. Most iris melanomas are spindle cell types, according to a modified Callender classification system. There is evidence that the proliferation of melanocytes of the anterior iris surface (iris plaque) and diffuse stromal invasion may be risk factors for local recurrence and metastasis, respectively.

Brown cornea.

BACKGROUND: A brown cornea is relatively rare. We report a case of progressive brown corneal pigmentation in a patient with a primary acquired melanosis of the conjunctiva. Later the patient developed an iris melanoma. METHODS: Case report with clinico-pathological correlation and discussion of possible mechanisms of particle clearance of the cornea. RESULTS: A 36-year-old female developed a corneal stromal pigmentation adjacent to a pigmented conjunctival lesion of the left eye. The corneal pigmentation had progressed through 8 years. The conjunctival lesion was surgically removed, and proved histopathologically to be a compound nevus with slight atypia and an acquired melanosis. Despite surgery the corneal pigmentation increased, and visual acuity dropped in the diseased eye. A perforating keratoplasty was performed, and two small pigmented iris nodules were now noted. Three years after grafting, growth of the two iris tumours was obvious. In addition, pigmentation of the trabecular meshwork and large, pigmented endothelial precipitates were observed. The corneal pigmentation also increased. The eye was enucleated. Histopathologic evaluation demonstrated a marked accumulation of melanophages on the endothelium of the graft. The host cornea contained pigmented cells in the mid-stroma. The iris contained two melanomas. CONCLUSIONS: The brown pigmentation of the cornea was due to pigment granules from the iris tumours liberated to the anterior chamber. The pigment was transported into the cornea through the endothelium and accumulated in melanophages between corneal lamellas. The pigment subsequently cleared via the corneal limbus in a process resembling clearance of corneal haemochromatosis.

Metastatic esophageal adenocarcinoma presenting in the iris.

PURPOSE: To report a case of metastatic esophageal adenocarcinoma presenting as an acute primary iris tumor of unknown origin. DESIGN: Interventional, clinicopathologic case report. METHODS: A 47-year-old healthy man sought treatment for a three-week history of a progressively enlarging red spot on the left iris. Presentation, local and systemic evaluation, and treatment are described. RESULTS: Iris biopsy revealed the lesion represented metastasis, and a systemic evaluation later revealed the primary source as esophageal adenocarcinoma. The patient began systemic chemotherapy. CONCLUSIONS: Metastatic iris lesions can have atypical presentations. Tissue biopsy, tumor antigens, and a thorough systemic evaluation are crucial in identification of primary tumors in cases of unknown metastatic origin.

Red lesions of the iris, choroid, and skin secondary to metastatic carcinoma of the thyroid: a review.

An 83-year-old man was seen with a history of bilateral progressive loss of vision of 1 month's duration. On examination, there was a reddish, nodular lesion adjacent to the right side of the nose. Slit-lamp examination revealed a reddish iris mass in the left eye. Ophthalmoscopic examination revealed two orange choroidal lesions in the right eye and a large subretinal hemorrhage in the posterior pole with a central reddish vascular lesion in the left eye. An excisional biopsy of the skin lesion was performed. A diagnosis of metastatic follicular thyroid carcinoma was made according to the histopathologic findings and immunohistochemistry. The patient had no known history of thyroid malignancy and a metastatic survey revealed widespread metastasis. The patient had a total thyroidectomy followed by two series of radioactive iodine ablation. The iris lesion completely resolved and the choroidal lesions in the right eye showed partial regression during the follow-up period. Ocular and skin metastasis secondary to thyroid carcinoma is uncommon. In a review of English literature we found reports of 12 clinically well-documented cases of choroidal metastasis and two cases of iris metastasis. Our case and review of the previous cases reveal that reddish/orange color is a commonly observed feature of the uveal metastasis of thyroid carcinoma. Although ocular and skin metastases from thyroid carcinoma are rare, this possibility should be considered in the differential diagnosis of reddish-colored iris and choroidal masses as well as reddish nodular lesions of the scalp, face, and neck.

Cavernous hemangioma of the iris in an infant.

Iris hemangioma is a rare intraocular tumor which can present with spontaneous hyphema. Juvenile xanthogranuloma, malignant melanoma with proliferation of vessels or hemorrhages in the region of cystic degeneration, and inflammatory granulomas are frequently confused with the true hemangiomas. Some authors have even questioned the very existence of iris hemangioma. Clinical case reports of iris hemangiomas with histopathologic evidence and clinical course after surgery are uncommon. We could not find any reports of iris vascular tumors confirmed using immunohistochemical staining with vascular markers. We report a case of a cavernous hemangioma of the iris in a 3-month-old infant treated surgically, and the histopathological findings and immunohistochemical analysis with vascular markers (factor VIII and CD34) are also shown.

Adenoma of the iris and ciliary body. Case report.

A case of rare tumor of the iris and ciliary body in a 24-year old woman is presented, which was diagnosed as adenoma of the nonpigmented ciliary body epithelium. The diagnosis was confirmed immunohistochemically.

Biopsy in indeterminate intraocular tumors.

OBJECTIVE: To describe an intraocular biopsy technique that allows accurate histopathologic diagnosis in cases of clinically unclassifiable uveal tumors. DESIGN: Retrospective noncomparative consecutive interventional case series. PARTICIPANTS/METHODS: Intraocular biopsies were performed by a vitreous cutter either by a two-port clear cornea approach in 11 patients with unclassifiable iris tumors or by a three-port pars plana vitrectomy in 23 patients with unclassifiable choroidal tumors. Specimens were formalin fixed and paraffin processed. Hematoxylin-eosin and periodic acid-Schiff stains were performed in all cases, with additional immunohistochemical stains using the alkaline phosphatase, antialkaline phosphatase method in cases that could not be conventionally classified. MAIN OUTCOME MEASURES: Clinical observation and histopathologic examination of intraocular biopsies. RESULTS: In 97% of cases (n = 33) a definite diagnosis could be established by the biopsy specimen. A melanoma could be diagnosed in 73% of cases (n = 8) of iris tumors and in 57% of cases (n = 13) of posterior intraocular tumors. Other diagnoses included nevus, metastasis, vasoproliferative tumor, hemorrhage, gliosis, and scleritis. Complications were encountered in four cases: a vitreous hemorrhage occurred twice, an inconclusive biopsy result, and an intraocular tumor spread occurred once, respectively. No increased tumor-related mortality was observed after a mean follow-up of 44 months. CONCLUSIONS: Intraocular biopsy by a vitreous cutter allows the histopathologic examination of formalin-fixed paraffin-embedded tumor tissue. This increases the diagnostic accuracy, avoiding the risk of extraocular tumor spread seen with transscleral biopsy techniques.

Tapioca melanomas of the iris: immunohistology and report on two cases.

BACKGROUND: Tapioca-like tumors are rare, and their benign or malignant nature is obscure without histological work-up. We report on the clinical and histological features of different types of tumors in two patients. CASE REPORT: Two patients aged 17 and 45 years presented with brownish iris masses increasing in size. Full-thickness en bloc excision of melanocytic tumors (5.5 mm and 7.0 mm in diameter) was carried out. Histological work-up revealed a nevus cell nevus in the young patient and an epithelioid malignant melanoma in the middle-aged patient evolving from the ciliary body. Staining for HMB-45 was marked in both tumors, for S-100 low in the nevus and marked in the melanoma, and for p53 negative in the nevus and positive in the melanoma. Ki67 stains were negative. CONCLUSION: We propose that excision of anteriorly located pigmented tumors that increase in size is indicated in order to determine whether they are benign or malignant. In these case reports, tapioca-like tumors include a benign and a malignant entity. To our knowledge, a nevus cell nevus presenting as a tapioca-like tumor has not previously been described. Curative surgery and histological and immunohistological evaluation are required to characterize the malignant potential of these tumors and the prognosis.

Iris metastasis from endometrial carcinoma.

PURPOSE: To report a case of metastasis to the iris from endometrial carcinoma. METHOD: Case report. A 67-year-old woman with a history of endometrial carcinoma and local recurrence after surgery presented 11 months later with two yellow-pink nodules on the iris of the right eye. RESULTS: Systemic medical evaluation demonstrated no other metastases. The iris tumors were removed surgically, and histology demonstrated adenocarcinoma consistent with endometrial carcinoma. CONCLUSIONS: Endometrial carcinoma can metastasize to the iris. This possibility should be considered because the frequency of endometrial carcinoma is increasing.

The behavior of two cell lines obtained from murine (B16-F10) and human (G-361) melanomas implanted into the eyes of New Zealand white rabbits, and their microscopic, immunohistochemical and ultrastructural appearances.

A transcleral inoculation of 15x10(6) melanocytes of the B16-F10 and G-361 cell lines was carried out in the anterior chamber of one eye in New Zealand white rabbits. Tumor growth occurred in 24 eyes (77%) of the B16-F10 group and in 22 (73%) of the G-361 group. The tumors of the latter group were mostly amelanic and showed local aggression with ocular perforation and extrascleral growth one month post-implant, while the tumors of the B16-F10 group were intensely pigmented and grew over the iris although they did not perforate the eyeball. Microscopically, the tumors of both groups were of the mixed type, made up of epithelioid and fusiform melanocytes. S-100 protein and Nki C3 monoclonal immunohistochemical techniques showed a positive immunoreaction in all cases of tumor growth. Ultrastructurally, the G-361 melanocytes showed a few melanosomes corresponding to maturity state II and, occasionally, state III, while totally melanized state IV cells predominated in the B16-F10 group. Aberrant melanosomes were common in both groups. The inoculation of 15x10(6) melanocytes of either cell line was useful to produce ocular melanomas.

Histopathology, morphometry, and nuclear DNA content of iris melanocytic lesions.

PURPOSE: To compare the histologic, morphometric and nuclear DNA content of a group of benign and malignant melanocytic lesions of the iris. METHODS: Forty-four surgically excised melanocytic lesions of the iris were histologically classified as nevus or melanoma. Morphometric analysis using a digital filar micrometer (LaSICO 1602N-10 and 5-4A) measured the mean size of the 10 largest nucleoli, and Feulgen staining and image cytometry (CAS 200 Cell Analysis Systems) analyzed the nuclear DNA ploidy in the lesions. Patient follow-up information was obtained whenever possible. RESULTS: Sixteen cases were histologically classified as nevi and twenty-eight cases as melanoma. The mean of the 10 largest nucleoli of the nevi was smaller than the mean among the melanomas (1.772 microns [SD = 0.366] and 2.773 microns [SD = 0.565], respectively). Feulgen staining revealed that all lesions were diploid, with the exception of two hyperdiploid and two hypodiploid melanomas. Of the patients with follow-up information available, none with nevi developed a metastasis and two with melanoma died of metastatic disease. CONCLUSIONS: The histologic classification of iris melanocytic lesions (i.e., nevus versus melanoma) correlates to nucleolar size (P < 0.001) but not to nuclear DNA ploidy.