Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Morphological assessment of the stylohyoid complex variations with cone beam computed tomography in a Turkish population.

BACKGROUND: The aim of this investigation was to evaluate the length, thickness, sagittal and transverse angulations and the morphological variations of the stylohyoid complex (SHC), to assess their probable associations with age and gender, and to investigate the prevalence of it in a wide range of a Turkish sub-population by using cone beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT images of the 1000 patients were evaluated retrospectively. The length, thickness, sagittal and transverse angulations, morphological variations and ossification degrees of SHC were evaluated on multiplanar reconstructions (MPR) adnd three-dimensional (3D) volume rendering (3DVR) images. The data were analysed statistically by using nonparametric tests, Pearson's correlation coefficient, Student's t test, c2 test and one-way ANOVA. Statistical significance was considered at p < 0.05. RESULTS: It was determined that 684 (34.2%) of all 2000 SHCs were elongated (> 35 mm). The mean sagittal angle value was measured to be 72.24° and the mean transverse angle value was 70.81°. Scalariform shape, elongated type and nodular calcification pattern have the highest mean age values between the morphological groups, respectively. Calcified outline was the most prevalent calcification pattern in males. There was no correlation between length and the calcification pattern groups while scalariform shape and pseudoarticular type were the longest variations. CONCLUSIONS: We observed that as the anterior sagittal angle gets wider, SHC tends to get longer. The most observed morphological variations were linear shape, elongated type and calcified outline pattern. Detailed studies on the classification will contribute to the literature. (Folia Morphol 2018; 77, 1: 79-89).

Influence of oval and circular post placement using different resin cements on push-out bond strength and void volume analysed by micro-CT.

AIM: To evaluate the percentage volume of voids within cement layers, to determine the push-out bond strength of circular and oval fibre posts luted with different commercial resin cements in oval cross-sectional root canals, and to correlate push-out bond strength values and volume of voids of circular and oval fibre posts. METHODOLOGY: Seventy-two mandibular premolars with oval-shaped root canals were selected. The specimens were divided into two main groups according to the post type (oval and circular). Groups were further divided into three subgroups (n = 24) according to resin cement type: Maxcem Elite, Rely-X Unicem and Duo-Link. The volumes of voids within the cements were analysed by micro-computed tomography (micro-CT). The bond strength was then measured using a push-out test with an Instron universal testing machine. The failure modes were evaluated. Statistical analyses were performed using a three-way anova, Tukey's post hoc, Pearson's correlation and chi-square test (P = 0.05). RESULTS: The push-out bond strength values were significantly affected by root canal region, post type and cement type (P < 0.001). Root canal region, post type and cement type also significantly affected void volume (P < 0.001). There was a significant interaction between post type and cement type (P < 0.001). The most frequent failure type was adhesive failure in all the groups. There was no significant correlation between the push-out bond strength and void volume (P > 0.05). CONCLUSIONS: Void volume did not affect push-out bond strength of oval and circular posts luted in oval canals.

A retrospective analysis of prevalence and characteristics of pre-eruptive intracoronal resorption in unerupted teeth of the permanent dentition: a multicentre study.

AIM: This multicentred study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) in unerupted teeth of the permanent dentition using a large sample of panoramic radiographs of a Turkish population. METHODOLOGY: Records of 28 612 patients from three cities in the different regions of Turkey were screened retrospectively in this multicentred study. Patient records and panoramic radiographs were evaluated by three oral and maxillofacial radiologists in the sites. The following data were recorded: age, gender, number of unerupted teeth, number of teeth showing intracoronal resorption, affected tooth type and number of intracoronal resorptions in each case. RESULTS: Overall, 5554 patients had at least one unerupted tooth in 28 612 patients, with a prevalence of 19.4%. Of the 5554 patients screened, 2267 were female and 3287 were male. Intracoronal resorption was observed in 40 of 5554 subjects, with a frequency of 0.7%. The mean age of the patients was 35.9 years. CONCLUSION: Pre-eruptive intracoronal resorption defects occurred in 40 subjects. Increased awareness and careful radiographic examination of unerupted teeth may improve early detection and treatment of PIR defects.

Primary double teeth and their effect on permanent successors.

AIM: Understanding the effects of primary double tooth (PDT) on permanent successors is important to ensure healthy permanent occlusion and aesthetics. The aim of this study is to determine the prevalence and type of PDT, their effect on permanent successors, and the accompanying dental anomalies/pathologies in a Turkish population. MATERIALS AND METHODS: Study design: The records of 63 PDTs in 54 healthy Caucasian children among 10,000 patients were investigated. PDTs were classified according to Aguilo's classification. RESULTS: The prevalence of PDT was 0.6%. Of the 63 PDTs, 14.3% were type I, 11.1% were type II, 31.7% were type III, and 41.3% were type IV; one (1.6%) was a triple tooth. Aplasia of the permanent lateral incisor was observed most frequently in association with type I (56%) PDT. All PDTs associated with a supernumerary permanent tooth were type IV. Dental anomalies/pathologies such as odontoma, talon cusp were observed. Caries involvement was observed most frequently in type IV (58.3%) PDT. STATISTICS: The chi-squared test was used to determine whether successor aplasia depended on PDT type, and contingency coefficients (%) were calculated to determine the degree of association between aplasia and PDT type. CONCLUSION: Clinicians should assess PDT clinically and radiographically to determine whether they are associated with aplasia of permanent lateral incisors (type I) or supernumerary permanent teeth (type IV). Type IV of PDT should be sealed with sealant or resin.

Toll-like receptors and skin.

Toll-like receptors are important pattern recognition receptors which have key roles in both innate and adaptive immune responses. They are strongly associated with the pathogenesis of inflammatory and autoimmune diseases. Furthermore, Toll-like receptors have also been implicated in the pathogenesis of several skin diseases such as skin infections, psoriasis, acne vulgaris, lichen planus, Behçet's disease, leprosy, syphilis, Lyme disease, atopic dermatitis and allergic contact dermatitis, mycosis fungoides, non-melanoma skin cancers and melanoma. In this manuscript, the structure and functions of Toll-like receptors in immune responses, their impact on skin diseases and recent advances on therapeutic usage have been reviewed.

Investigation the anterior mandibular lingual concavity by using cone-beam computed tomography.

BACKGROUND: In the presence of lingual concavity in the mandible, the cortical perforation and consequently the life-threatening intraoral haemorrhages obstructing the upper respiratory tract may be seen during the surgical intervention. The present study was aimed to determine the prevalence of lingual concavity in the interforaminal region and its relationship with gender and dentate status. MATERIALS AND METHODS: The images of 106 patients who underwent cone-beam computed tomography (CBCT) between 2016 and 2017 in Department of Dental and Maxillofacial Radiology Department of Faculty of Dentistry of Ondokuz Mayis University were retrospectively examined. The images were obtained using a Galileos device (98 kVp, 15-30 mA). The bone height and width in interforaminal region and the frequency of lingual concavity were analysed. RESULTS: Of patients involved in the present study, 42.5% were male and 57.5% were female After the examinations performed, the bone was morphologically classified into four classes as type I lingual concavity, type II inclined to lingual, type III enlarging towards labiolingual and type IV buccal concavity. Type III (77.9%) was the most common type in the anterior region, followed by type II (16.5%), type I (4.7%) and type IV (0.9%). The lingual concavity angle was 76.5 ± 3.69º and the concavity depth was 2.09 ± 0.34 mm. CONCLUSIONS: The lingual concavity can be detected by using the cross-sectional CBCT images and the complications related with lingual cortical perforation can be prevented.

Karyological features of wild and cultivated forms of myrtle (Myrtus communis, Myrtaceae).

Myrtle is an evergreen shrub or small tree widespread throughout the Mediterranean region. In Turkey, both cultivated and wild forms, differing in plant and fruit size and fruit composition, can be found. These differences may have resulted from the domestication of the cultivated form over a long period of time. We investigated whether wild and cultivated forms of myrtle differ in karyological features (i.e., number of somatic chromosomes and relative genome size). We sampled two wild forms and six cultivated types of myrtle. All the samples had the same chromosome number (2n = 2x = 22). The results were confirmed by 4',6-diamidino-2-phenylindole (DAPI) flow cytometry. Only negligible variation (approximately 3%) in relative fluorescence intensity was observed among the different myrtle accessions, with wild genotypes having the smallest values. We concluded that despite considerable morphological differentiation, cultivated and wild myrtle genotypes in Turkey have similar karyological features.

Concrescence of a mandibular third molar and a supernumerary fourth molar: report of a rare case.

Concrescence represents a rare developmental anomaly in which two fully formed teeth are joined along the root surfaces by cementum. Maxillary molars are the teeth most frequently involved, especially a third molar and a supernumerary tooth. Very few cases have been reported about the concrescence of a third molar and a supernumerary tooth. According to our current knowledge, this case report is the first in the literature in which concrescence is observed between a third molar and a supernumerary fourth molar in the mandible.

Field evaluation of a PCR for the diagnosis of chlamydial abortion in sheep.

A total of 94 vaginal swab samples and 195 serum samples collected from aborted ewes in 15 flocks were examined by pcr and a complement fixation test, respectively. In addition, 172 samples of stomach contents from fetuses from different flocks submitted for the diagnosis of abortion during the four lambing periods between 2000 and 2004 were tested by pcr. Chlamydial dna was detected in seven vaginal swabs obtained from five of the 15 flocks and in six samples of fetal stomach contents. The results of pcr and flock serology for Chlamydia were positive in five of the 15 flocks and negative in eight.

Antimicrobial susceptibility and coagulase gene typing of Staphylococcus aureus isolated from bovine clinical mastitis cases in Turkey.

The objectives of this study were to determine antimicrobial resistance patterns of Staphylococcus aureus strains isolated from bovine clinical mastitis cases and to subtype the strains by polymerase chain reaction (PCR) technique based on coagulase gene polymorphism. Two hundred sixty-five S. aureus isolates collected from individual animals in different herds (n = 235) from 1995 to 2004 were tested for susceptibility to penicillin, ampicillin, amoxicillin-clavulanate, oxacillin, oxytetracycline, enrofloxacin, kanamycin-cephalexin, and trimethoprim-sulfamethoxazole using the agar disc diffusion test. Strains were also tested for beta-lactamase production. A total of 29.8% of the strains were susceptible to all antimicrobial agents tested. The highest resistance was observed in 63.3% of the strains against beta-lactam antibiotics, penicillin and ampicillin. Oxytetracycline resistance was observed in 27.9% of the strains, either alone or in combination with beta-lactams. No resistance was detected for amoxicillin-clavulanate, oxacillin, enrofloxacin and kanamycin-cephalexin. beta-Lactamase production and resistance to beta-lactam antibiotics were usually correlated. Resistance against beta-lactams increased from 43.5% in 1995 to 58 to 77% from 1999 to 2004. One hundred twenty-five strains were examined for coagulase gene polymorphism. The isolates were subtyped into 4 types by coagulase gene-based PCR. A predominant 1000-bp PCR product was observed in 60.8% of the isolates typed. The results indicate that a few coagulase gene types of S. aureus are responsible for the majority of bovine clinical mastitis cases in one province of Central Anatolia region, Turkey.

The effects of α-lipoic acid on immature rats with traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality during childhood. TBI enhances formation of reactive oxygen species that cause neuron damage and apoptosis. α-Lipoic acid (LA) is a free radical scavenger and biological antioxidant. We investigated the effects of LA treatment on the parietal and prefrontal cortex, and on the hippocampal regions of the brain in 7-day-old rat pups that had been subjected to contusion injury. Forty-two male rats were divided randomly into a control group, a TBI group and a TBI + LA treated group. LA was administered 30 min after TBI through an intragastric tube once daily for 2 days. Forty-eight hours after TBI, the animals were sacrificed and tissues were examined for apoptosis and density of neurons. Terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) and active caspase-3 immunostaining were used to detect apoptosis. Glutathione peroxidase (GPx), superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels also were measured. Histological evaluation showed that LA treatment significantly reduced TBI-induced neuronal death in the hippocampus, prefrontal and parietal cortex; TUNEL- and caspase-3-positive cells also were decreased in the same regions. In addition, LA administration increased GPx and SOD activity in the prefrontal cortex. It appears that LA may be beneficial for TBI in rats.

Choroidal melanoma in a 14-year-old patient with ocular melanocytosis.

A 14-year-old male adolescent with ocular melanocytosis and secondary glaucoma in the left eye had a 2-year history of a progressively enlarging fundus lesion. Ocular examination revealed diffuse hyperpigmentation of the episclera and a smooth velvety thickening and hyperpigmentation of the left iris. Ophthalmoscopy disclosed diffuse choroidal pigmentation and a pigmented mass that occupied the macular area and surrounded the optic nerve. Ultrasonography showed an acoustically hollow lesion with scleral bowing and choroidal excavation. Based on clinical and ultrasonographic findings, the diagnosis was choroidal melanoma in a young patient with ocular melanocytosis. The eye was enucleated. Histopathologic examination revealed ocular melanocytosis with diffuse uveal melanocytosis and amelanotic malignant melanoma of the choroid. The choroidal melanoma apparently arose from a preexisting choroidal nevus. Even young patients with ocular melanocytosis should have regular follow-up examinations for early detection of uveal melanoma.

Adenoma of the ciliary body pigment epithelium: the 1998 Albert Ruedemann, Sr, memorial lecture, Part 1.

BACKGROUND: Adenoma of the pigment epithelium of the ciliary body (CPE) is a rare neoplasm. Most reported cases have been misdiagnosed as ciliary body melanoma. OBJECTIVES: To evaluate clinical features, management, pathological features, and prognosis of adenoma of the CPE and to determine clinical features that may differentiate it from ciliary body melanoma. PATIENTS AND METHODS: A retrospective review was performed of medical charts, photographs, and pathological features of patients with adenoma of the CPE who were treated by the authors. RESULTS: Of the 8 patients with adenoma of the CPE, 3 were male and 5 were female. Seven were white, and 1 was Asian. The mean age at diagnosis was 51 years (range, 8-73 years). The referring diagnosis was ciliary body melanoma in 7 patients and cyst in 1 patient. The lesions were all solitary and unilateral and ranged from 3 x 3 x 3 to 13 x 13 x 8 mm. Clinically, all tumors were gray to black, had abruptly elevated margins, and were dome shaped. Associated findings included secondary cataract (6 patients) and vitreous hemorrhage (1 patient). Results of ancillary studies such as transillumination, fluorescein angiography, and ultrasonography showed patterns that were helpful in differentiation from ciliary body melanoma. Fine needle aspiration biopsy, performed in 3 patients, was an accurate diagnostic adjunct. Microscopic diagnosis was adenoma of the CPE in 7 cases in which tissue was available. A consistent histopathologic feature was the presence of typical clear vacuoles within the tumor. One tumor invaded the sensory retina. Results of immunohistochemical studies were consistent with a tumor of neuroectodermal origin. CONCLUSIONS: Adenoma of the CPE has characteristic features that may help differentiate it from ciliary body melanoma. In contrast to melanoma, it is generally darker and its margins are more abruptly elevated. Although it is benign cytologically, it can exhibit growth. If the diagnosis is suspected, removal of the tumor by local resection is advisable.

Neoplasms of the retinal pigment epithelium: the 1998 Albert Ruedemann, Sr, memorial lecture, Part 2.

BACKGROUND: Neoplasms of the retinal pigment epithelium (RPE) are rare, and little is known about their clinical variations, clinical course, and prognosis. Although most are benign, they can simulate choroidal melanoma. OBJECTIVES: To evaluate the clinical characteristics, management, pathological features, and prognosis of acquired neoplasms of the RPE (adenoma and adenocarcinoma) and to define clinical features that help differentiate them from uveal melanoma. PATIENTS AND METHODS: The medical records of patients with acquired tumor of the RPE were reviewed retrospectively, and the clinical features, management, and histopathologic findings were studied. RESULTS: Of 13 affected patients, 10 were women and 3 were men. Ten were white and 3 were African American. The mean age at diagnosis was 53 years (range, 28-79 years). All patients were referred with the diagnosis of suspected choroidal melanoma. All tumors were solitary, unilateral, and ranged from a small, asymptomatic lesion measuring 2 x 2 x 1 mm to a massive neoplasm that measured 17 x 17 x 17 mm. There was no predilection for retinal location or laterality. The tumors were dark brown to black in 11 patients and only minimally pigmented in 2. Prominent retinal feeder vessels were visualized in 8 patients, 5 of whom had an exudative retinal detachment. Two patients had recurrent vitreous hemorrhage. Transillumination generally revealed blockage of light by the tumor. Fluorescein angiography showed early hypofluorescence and late minimal hyperfluorescence of the tumor, without visibility of choroidal vessels. Ultrasonography typically demonstrated the tumor to be abruptly elevated and to have medium to high internal reflectivity and acoustic solidity. Results of diagnostic fine needle aspiration biopsy, performed on 4 patients, disclosed cells compatible with a pigment epithelial origin. Treatment ultimately included observation in 4 patients, enucleation in 3, local tumor resection in 3, irradiation in 2, and laser therapy in 1. Microscopic verification of the diagnosis was available in 3 eyes after fine needle aspiration biopsy, 3 eyes after local resection, 3 eyes after enucleation, and 1 eye post mortem. The microscopic diagnosis was adenoma in 8 patients and adenocarcinoma in 2. Microscopically, the lesions were composed of a neoplastic proliferation of RPE cells. Tumors arising from the anterior portion of the RPE had a vacuolated pattern, and those in the posterior portion of the RPE had a glandular or tubular configuration. CONCLUSIONS: Neoplasms of the RPE show considerable clinical variation. In contrast to melanoma, they generally are darker, more abruptly elevated, and more likely to have retinal feeder vessels and exudative retinal detachment; show early hypofluorescence and mild late hyperfluorescence on angiographic findings; and have high internal reflectivity on ultrasonographic findings. Although most acquired tumors of the RPE are benign cytologically, they can exhibit aggressive clinical behavior.

Color vision defects in ocular hypertension and glaucoma. Quantification with a computer-driven color television system.

In order to detect early defects of color vision caused by increased intraocular pressure, a computer graphics device and color monitor system were used to measure color contrast sensitivity. The system determines the threshold chrominance of a colored grating in which there is no change in luminance. The study included 13 control subjects aged 10 to 57 years and 19 patients with ocular hypertension or glaucoma aged 20 to 58 years. In the 13 eyes with visual field loss, color contrast sensitivity was profoundly reduced when the grating colors fell on a tritan color confusion line. In the eyes without visual field loss, tritan color contrast sensitivity was reduced to an average level considerably below the extreme limits of the control group. These results were compared with those of other color vision tests and diagnostic criteria for glaucoma. The findings suggest that among the tests used, color contrast sensitivity testing was able to discriminate most effectively between patients who had retinal damage and the normal population.

Intraocular neoplastic cyst from mucoepidermoid carcinoma of the conjunctiva.

An 89-year-old woman with recurrent conjunctival mucoepidermoid carcinoma developed intraocular inflammation and an elevated fundus lesion that simulated choroidal detachment in her affected right eye. Intraocular invasion of squamous cell carcinoma was suspected and the eye was enucleated. Pathologic examination of the enucleated eye showed intraocular invasion by conjunctival mucoepidermoid carcinoma that formed a suprauveal cyst lined with malignant epithelial cells. The patient developed an orbital recurrence 1 year later and underwent orbital exenteration. She died 2 years later from an unrelated cause. Conjunctival mucoepidermoid carcinoma can exhibit intraocular invasion and produce an intraocular neoplastic cyst.

Plaque radiotherapy of uveal melanoma with predominant ciliary body involvement.

BACKGROUND: There are several options for management of ciliary body melanoma, including plaque radiotherapy, charged particle irradiation, local resection, and enucleation. The choice of therapy depends on many factors, and plaque radiotherapy is often used. OBJECTIVES: To determine the outcome of plaque radiotherapy in the management of ciliary body melanoma and to identify the risk factors associated with the development of radiation complications, tumor recurrence, metastasis, and melanoma-related death after plaque radiotherapy of ciliary body melanoma. METHODS: We analyzed the clinical records of 136 patients with ciliary body melanoma who were treated with plaque radiotherapy between July 1976 and June 1992. RESULTS: The median follow-up period was 70 months. Using Kaplan-Meier survival estimates, the most frequent radiation complication at 5 years' follow-up was cataract, developing in 48% of the patients, followed by neovascular glaucoma (21%), retinopathy (20%), scleral necrosis (12%), and vitreous hemorrhage (11%). Visual acuity decrease (by > or =3 Snellen lines) was noted in 40% of the patients at 5 years. Kaplan-Meier estimates showed that 8% of the patients developed recurrence, 28% had metastasis, and 22% died of melanoma-related causes by 5 years. Univariate analysis demonstrated that the factors predictive of radiation cataract were superonasal (P = .003) and inferior tumor meridian (P = .02) compared with inferonasal meridian and apex dose rate greater than 57 cGy/h (P = .05). The development of neovascular glaucoma was significantly related to iris involvement with the ciliary body tumor (P<.001). The factors predictive of development of radiation retinopathy were base dose rate greater than 230 cGy/h (P = .03) and the presence of diabetes mellitus (P = .05). The only predictor of metastasis was tumor thickness greater than 7 mm (P = .02). The risk factors for melanoma-related death were the presence of metastasis (P<.001), tumor thickness greater than 7 mm (P = .02), and recurrence (P = .02). Multivariate analyses showed that the most significant variables predictive of the development of scleral necrosis were intraocular pressure greater than 15 mm Hg (P<.001) and tumor thickness greater than 7 mm (P = .007). The most significant predictive factors for vitreous hemorrhage were visual acuity of 20/40 to 20/200 (P = .02) and intraocular pressure greater than 15 mm Hg (P = .02). The best subset of independent predictors of vision decrease were mushroom tumor shape (P = .002), age older than 61 years (P = .006), and superonasal meridian (P = .04). The risks for melanoma-related death were presence of metastasis (P<.001) and tumor thickness greater than 7 mm (P = .01). There was no group of significant variables predictive for radiation cataract, neovascular glaucoma, retinopathy, tumor recurrence, and metastasis in multivariate analysis. CONCLUSIONS: Plaque radiotherapy offers 92% 5-year local control rate for ciliary body melanoma. Metastasis occurs in 28% of the patients treated with this method by 5 years. Patients with tumors greater than 7 mm in thickness are at greater risk than patients with thinner tumors for metastatic disease and melanoma-related death. Major radiation complications include radiation cataract, neovascular glaucoma, retinopathy, and scleral necrosis.

Adenoma of the iris pigment epithelium: a report of 20 cases: the 1998 Pan-American Lecture.

BACKGROUND: Adenoma of the iris pigment epithelium (IPE) is an uncommon lesion that can simulate iris or ciliary body melanoma, melanocytoma, and pigment epithelial cyst. OBJECTIVES: To evaluate the clinical and pathological features and prognosis of adenoma of the IPE in patients managed by us and to elucidate the features that help to differentiate this tumor from iris melanoma and other similar conditions. PATIENTS AND METHODS: The medical records of 20 patients with adenoma of the IPE were reviewed, and the clinical and histopathologic features were tabulated. RESULTS: Ten patients were male and 10 were female, with a mean age of 60.0 years (range, 11-85 years). All patients were referred because of suspected iris or ciliary body melanoma. All lesions were solitary and unilateral. Sixteen were located in the peripheral iris; 2, in the midzone; and 2, near the pupillary margin. Clinically, all tumors were abruptly elevated, all but 1 were dark gray to black, and all had a smooth, but sometimes multinodular, surface. The tumors caused thinning or complete effacement of the overlying iris stroma, but they did not directly involve the stroma. They typically blocked light with transillumination. On ultrasound biomicroscopy findings, adenoma of the IPE shows a solid tumor pattern, sometimes with small cystoid spaces. The tumor was managed by local resection in 2 patients and observation in 18, all of whom have been stable, with follow-up ranging from 6 months to 9 years. Histopathologic examination revealed a tumor originating in the IPE consisting of cords of pigment epithelial cells separated by septae of connective tissue. CONCLUSIONS: Adenoma of the IPE usually has characteristic features that should differentiate it from iris melanoma, ciliary body melanoma, iris melanocytoma, and iris cyst. Adenoma of the IPE is a benign tumor that may remain relatively stable for years.

Iris mammillations as the only sign of ocular melanocytosis in a child with choroidal melanoma.

An 8-year-old girl had visual loss in her left eye over 2 months. Ocular examination showed that visual acuity was counting fingers in the left eye. The left iris was moderately pigmented and thickened with numerous confluent, dome-shaped elevations on its surface, consistent with iris mammillations arising from ocular melanocytosis. There was total retinal detachment and an inferiorly located large amelanotic choroidal mass compressing the optic nerve. A specimen from a fine-needle aspiration biopsy showed spindle and epithelioid melanoma cells. The eye was enucleated. Pathologic examination showed that the bland melanocytes comprising the anterior border layer of iris formed focal aggregates, corresponding to the iris mammillations observed clinically. The uvea was diffusely thickened. Arising from the posterior choroid and obscuring the optic nerve head was a moderately pigmented spindle and epithelioid cell choroidal melanoma with diffuse lymphocytic infiltration and high mitotic activity. This case demonstrates that iris mammillations can be the initial manifestation of ocular melanocytosis in the absence of scleral pigmentation.