|Year : 1982 | Volume
| Issue : 4 | Page : 317-318
Metastatic tumor of the iris
Peter Wyzinski, Jack Rootman
Department of Ophthalmology and Pathology, University of British Columbia, Vancouver, Canada
Department of Ophthalmology and Pathology, University of British Columbia, Vancouver
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Wyzinski P, Rootman J. Metastatic tumor of the iris. Indian J Ophthalmol 1982;30:317-8
The great majority of ocular metastases are at the posterior pole, but sometimes they appear first on the iris and, in rare instances, a widely disseminated carcinomatosis can present by an iris mass.
| Case history|| |
A 67 year old housewife complained of a sore left red eye since three weeks without any history of prior eye problems. She had been feeling generally unwell for several months and was getting physiotherapy for widespread deep pain ascribed to arthritis. Past medical history included a partial colectomy for diverticulosis. She smoked cigarettes for thirty years and suffered numerous bouts of pneumonia over last few years. She had noticed no change in her breasts.
The patient was a tired looking white female with vital signs and no lymphadenopathy. Lungs were clear. Her breasts were of normal appearance and no masses were palpated although increased fibrous tissue was noted. Vision was 6/9 and 6/7.5 with an intraocular pressure of 20mm Hg bilaterally. The globes were normal except for plus I cell and an irregular 8mm pink gelatinous fleshy mass involving the inferotemporal quadrant of the left iris with several fingerlike extensions oil the posterior corneal surface.
With a tentative diagnosis of metastatic iris tumor, a thorough systemic investigation was undertaken. Initial chest radiographs were completely unremarkable; studies of the breasts and gastrointestinal tract demonstrated no neoplasm. Anterior chamber paracentesis showed cells consistent with adenocarcinoma. Bone scan revealed three probable metastatic lesions in the rib cage.
The eye became comfortable when treated with cycloplegic, topical steroid, and 3500 rads of cobalt radiation administered over ten days. Bone pain also required palliation by radiotherapy. Biopsy of a subcutaneous nodule which appeared over the spine a month later showed mucinous adnocarcinoma. Before the patient expired four months after her iris lesion was first noted, chest tomograms suggested an enlarging mass in the lateral aspect of the left upper lobe. At autopsy, this lesion was found to be a 2 cm well differentiated bronchogenic adenocarcinoma with metastases to the vertabrae, ribs and adrenal gland.
| Discussion|| |
As demonstrated in the present case, accurate diagnosis of a metastatic iris lesion can be difficult and may only be forthcoming after autopsy, especially if ocular inflammation has side tracked the investigations. With careful cytologic processing, tumor cells from retinoblastoma, breast carcinoma, and bronchogenic squamous cell carcinoma have been identified in the aqueous.
Radiotherapy of metastic lesions tends to result in damage to the lids, cornea and lens.
| Summary|| |
A patient with a metastatic tumor of the iris is presented.
| References|| |
Beattie, P.H., 1947, Brit. J. Ophthalmal. 31 : 649.
William, M. Eewalien, 1958, Arch. Ophthalmol. 59: 831
Jeseph, H. Grove, Murgery W. Shaw and Gria. brialle, E, 1961, Arch. Ophthalmol. 65 :81.
Shaffer, R.N. and Daniel L.W„ 1970, Congenital & Paediatric Glaucomas. Saint Louis, the C.V. mos. by Company.
Prederick, J.E., Maumenee, I.M., Kanneth, R.K. and Freday, 1977, Amer. J. Ophthalmol. 83: 718.
Cellahan, A., 1949, Amer. J. Ophthalmol, 32 : 20.
W.M. Grant and David S. Walton, 1974, Amer, J. Ophthalmol.