|Year : 1975 | Volume
| Issue : 2 | Page : 13-14
Diktyoma of ciliary body
CS Kalidasan, K Natarajan
Government Ophthalmic Hospital, Madras-8, India
C S Kalidasan
Government Ophthalmic Hospital, Madras-8
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalidasan C S, Natarajan K. Diktyoma of ciliary body. Indian J Ophthalmol 1975;23:13-4
Tumours of the pars-ciliaris retinae are interesting and rare. Three types of tumours are known to arise from this area : (1) Benign epithelioma (2) medulloepithelioma embryonal type (Diktyoma) and (3) medulloepithelioma (adult type). Out of these the adult type is rarest. Very few cases have been reported so far in the world literature.
Although closely related to retinoblastoma, diktyomata have a very different natural history for they are neither bilateral, nor multicentric in origin and show no hereditary tendency.
This tumour occurs in young children with no sex predilection. It is usually detected three years after birth though congenital presence is not impossible. Its occurrance in older age groups has, however, been reported. A case of diktyoma with secondaries is being presented in view of its rarity and misdiagnosis.
| Case Report|| |
A 4 years old son of a sanitary worker came to the out patient department, Government Head Quarters Hospital, Coimbatore, with a complaint of opacity in cornea and pain in the right eye for one month.
The swelling of lids was present since 5 months for which he was taken to Madurai Erskine Hospital where the patient was treated for a week with injections and tablets. No surgery or radiotherapy was done there. [Figure - 1].
The child had an eruptive fever lasting for three days a year ago. Corneal opacity was noticed a week later. There was no history of diarrhoea or injury.
Family History : Younger sister of the child was normal.
Right eye : There was moderate degree of oedema of lids, chemosis and total leucoma. Tension was normal. There was no tenderness.
Left eye was normal.
General Examination did not reveal any abnormality.
He was given streptopenicillin intramuscular injections and tetracycline ointment for a few days to control the secondary infection. Parents were advised to get the eye removed for excluding intraocular tumour and also for relief of pain and swelling of that eye.
The right eye was enucleated under general anaesthesia and was sent for histopathology. At that time the orbit did not show any extra ocular spread. After a week the child was discharged and was advised to come for follow up.
The child was brought after about a month with a complaint of multiple swellings on the scalp. They were globular and soft. A possibility of pyaemic absesses was thought of and a course of Tetracycline 50 mg. IM twice a day was given for five days without any relief. An aspiration was done which drew only blood and no pus at all. After a few days the empty socket showed a soft swelling which gradually increased in size and firmness suggesting a recurrance of malignant tumour.
X rays showed widening of sutures and secondaries in the skull and in the right orbit.
Fundus of left eye had severe papilloedema.
Section showed areas of necrosis with haemorrhage.
Histopathology picture was that of medulloepithelioma (Diktyoma) arising from ciliary body with evidence of infiltration into the iris and scleral layers. Broad areas of necrosis and fibrillary areas were seen. There was evidence of infiltration with neutrophils depicting acute infection.
The child was discharged on against medical advise after he developed more metastases in the roof of that mouth and in the right radius bone. The swellings increased considerably with irregular fever.
| Discussion|| |
The above case was thought to be an early case of panophthalmitis and the diagnosis was obvious only after the pathology report and appearance of secondaries. Even the secondaries were mistaken to be due to pyaemia. A malignant tumour can resemble very closely to a picture of inflammation.
Another interesting and rare feature in this case was the rapid spread of metastasis which is very rare according to many authors.
| Summary|| |
A case of diktyoma with unusual presentation has been presented and discussed.
| Acknowledgment|| |
I am greatful to the Principal, Coimbatore Medical College, Coimbatore for reporting this case.
| References|| |
Duke. Elder. 1966. Diktyoma, System of Ophthalmology, Henry Kimpton, London IX: 790.
Keshavachar K.R. and Junnarkar R.V.: 199 Diktyoma Brit. J. Ophthal 44:
[Figure - 1], [Figure - 2]