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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 12  |  Page : 2046-2047

Metastatic carcinoma masquerading as lens matter


Department of Uvea, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission04-Apr-2019
Date of Acceptance28-Aug-2019
Date of Web Publication22-Nov-2019

Correspondence Address:
Dr. Somanath Anjana
Uvea Consultant, Department of Uvea, Aravind Eye Hospital, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_674_19

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Keywords: Masquerade syndrome, iris metastasis, iris tumour, uterine carcinoma


How to cite this article:
Anjana S, Rekha S, Rathinam SR. Metastatic carcinoma masquerading as lens matter. Indian J Ophthalmol 2019;67:2046-7

How to cite this URL:
Anjana S, Rekha S, Rathinam SR. Metastatic carcinoma masquerading as lens matter. Indian J Ophthalmol [serial online] 2019 [cited 2019 Dec 9];67:2046-7. Available from: http://www.ijo.in/text.asp?2019/67/12/2046/271393



A 64-year-old female was treated elsewhere as a case of iritis with topical steroids and mydriatics. As her symptoms persisted, she presented to us for further management with complaints of redness and pain. On ocular evaluation, a white fluffy material resembling lens matter was seen [Figure 1]. Suspecting a delayed extrusion of lens matter in the anterior chamber, it was aspirated. During aspiration, surprisingly, a difficulty in the procedure was seen due to deep attachment with iris, hence the material was sent for histopathological evaluation which revealed carcinomatous infiltration [Figure 2]. On her second visit, a creamy white mass protruding anteriorly was seen at the same location with the iris adjacent to it [Figure 3].
Figure 1: Digital photograph of anterior segment of the right eye showing white fluffy matter resembling lens matter

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Figure 2: Anterior chamber fluid cytology showing tightly packed cell clusters with focal necrosis (arrow head).The cells are hyperchromatic and pleomorphic suggestive of malignancy. No evidence of pigmented cells

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Figure 3: Digital photograph of anterior segment of the right eye with recurrence of creamy white mass at the same location after aspiration

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She later revealed a history of endometrial carcinoma 4 years ago and had undergone hysterectomy and bilateral salpingo-opherectomy. As the histopathology report showed stage I endometrial adenocarcinoma, chemotherapy or radiotherapy was not advised. She was advised regular follow-up by her gynecologist but she was lost for follow-up.

Now, her CT chest showed mediastinal lymphadenopathy and lymphangitic carcinomatosis and CT abdomen showed retroperitoneal lymphadenopathy suggestive of metastasis [Figure 4]. She was treated with 6 cycles of chemotherapy. Her ocular evaluation showed the resolution of the white fluffy material over the iris [Figure 5]. However she later succumbed to the disease.

Endometrial carcinoma can be pathologically subdivided into type I adenocarcinoma and type II serous carcinoma.[1] Uterine endometrial adenocarcinoma is the most common and less aggressive. Uterine serous carcinoma is more aggressive endometrial carcinomas and can metastasize.
Figure 4: Computed Tomography scan of chest and abdomen showing lymphangitic carcinomatous changes in lungs with mediastinal and retroperitoneal lymphadenopathy (arrow head)

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Figure 5: Digital photograph of anterior segment of the right eye after the procedure

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Planten et al., Capeans et al., and Kyung-Chul Yoon et al. have reported iris metastasis in patients with endometrial carcinoma.[2],[3],[4] Smith et al. has reported a case of endometrial carcinoma metastasizing to the choroid.[5] Unusual difficulty in aspiration of lens matter due to deep attachment raised our concern and helped in early diagnosis of late metastasis.

Patient consent

The authors have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name will not be published and her identity will be concealed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Cancer Society. Key Statistics for Endometrial Cancer 2017. American Cancer Society. Atlanta, Ga. 2017. Available from: https://www. cancer.org/cancer/endometrial-cancer/about/key-statistics.html. [Last accessed on 2019 Aug 25].  Back to cited text no. 1
    
2.
Planten JT. Iridic metastasis of a uterine carcinoma. Ophthalmologica 1981;182:55-8.  Back to cited text no. 2
    
3.
Capeáns C, Santos L, Sánchez-Salorio M, Forteza J. Iris metastasis from endometrial carcinoma. Am J Ophthalmol 1998;125:729-30.  Back to cited text no. 3
    
4.
Yoon KC, Oh HJ, Park SW, Lee KH, Lee JH. Bilateral iris metastasis from endometrial carcinoma. Jpn J Ophthalmol 2007;51:234-5.  Back to cited text no. 4
    
5.
Smith SH, Arudra SKC, Mullen MM, Palisoul M, Dahiya S, Kumar Rao P, et al. Arare case of endometrial cancer metastatic to the uveal choroid. Gynecol Oncol Rep 2018;23:24-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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