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PHOTO ESSAY |
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Year : 2019 | Volume
: 67
| Issue : 12 | Page : 2046-2047 |
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Metastatic carcinoma masquerading as lens matter
Somanath Anjana, Sreedhar Rekha, Sivakumar R Rathinam
Department of Uvea, Aravind Eye Hospital, Madurai, Tamil Nadu, India
Date of Submission | 04-Apr-2019 |
Date of Acceptance | 28-Aug-2019 |
Date of Web Publication | 22-Nov-2019 |
Correspondence Address: Dr. Somanath Anjana Uvea Consultant, Department of Uvea, Aravind Eye Hospital, Madurai, Tamil Nadu India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/ijo.IJO_674_19
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 |
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
Click here to view | | 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 | | |
1. | |
2. | Planten JT. Iridic metastasis of a uterine carcinoma. Ophthalmologica 1981;182:55-8. |
3. | Capeáns C, Santos L, Sánchez-Salorio M, Forteza J. Iris metastasis from endometrial carcinoma. Am J Ophthalmol 1998;125:729-30. |
4. | Yoon KC, Oh HJ, Park SW, Lee KH, Lee JH. Bilateral iris metastasis from endometrial carcinoma. Jpn J Ophthalmol 2007;51:234-5. |
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. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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