|Year : 1995 | Volume
| Issue : 2 | Page : 76-78
Glioma of ciliary body presenting as episcleral nodule
KS Kumar, K Bhujang Shetty
From Narayana Nethralaya, Bangalore, India
K S Kumar
Narayana Netralaya, 121/C, Chord Road, Rajajinagar 'R' Block, Bangalore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar K S, Shetty K B. Glioma of ciliary body presenting as episcleral nodule. Indian J Ophthalmol 1995;43:76-8
Gliomas of the ciliary body are extremely rare tumours [1,2] and are diagnosed from symptoms relating to local invasion of the iris, ciliary body, trabecular meshwork or sclera. Pathologic studies reveal proliferation of elements. There has been only one case report of this lesion presenting as an episcleral nodule. We report the case of a patient who presented with an enlarging pinkish episcleral nodule that was diagnosed as glioma of the ciliary body after excision.
| Case report|| |
In September 1992, a healthy 24-year-old male presented to us with complaints of noticing a growth in his right eye. On examination, he had a best-corrected visual acuity of 6/6; N6 in each eye. The right eye showed a pearly pink episcleral nodule in the inferonasal aspect with a sentinel vessel [Figure:l]. The rest of the anterior segment, the intraocular pressure and the fundus in the right eye were normal. The left eye was normal. Echographic examination and a computed tomography scan revealed a cystic lesion in the ciliary body of the right eye. Systemic examination and a routine haemogram were remarkable. It was decided to observe this lesion closely.
Two months later, the patient presented with reduced visual acuity in his right eye due to an induced astigmatism. The externally visible nodule had increased in size and fundus examination revealed a mass in the region of the pars plana corresponding to the external mass. The ora serrata was easily seen without depression as it was pushed posteriorly. Because of manifest growth it was decided to excise the tumour.
| Surgical Procedure|| |
A 360-limbal peritomy was done and a prophylactic scleral buckle was placed in the region of the retina behind the mass. A partial-thickness scleral flap was raised to expose the tumour, following which, a piecemeal excision of the tumour was done as it was friable. A scleral patch graft was placed to cover the underlying defect and the conjunctiva was sutured back. Postoperatively,. the patient had an uneventful course and showed no recurrence one year later.
| Pathology|| |
Gross examination revealed a tan-coloured lesion. Sections of the tumour were stained with both haematoxylin and eosin (H & E), and phosphotungstic acid haematoxylin (PTAH). A glial neoplasm with dense gliosis was seen with no neuronal component [Figure - 2]. There was no evidence of any malignancy.
| Discussion|| |
Neuroepithelial tumours of the ciliary body are relatively rare and to the best of our knowledge only four cases of glioneuroma are reported in the literature.[1-3] Although usually located within a coloboma, it was within the substance of the ciliary body in our patient. Pressure effect on adjacent structures was conspicuously absent. Zimmerman et al have classified gliomas into the congenital variety of neuroepithelial tumours and previous reports have been of congenital origin. However, in our patient, the presentation was in the third decade. This unique case adds to the existing knowledge of glial tumours of the ciliary body.
| References|| |
Manz HJ, Rosen DA, Macklin RD, et al. Neuroec-todermal tumour of anterior lip of the optic cup. Glioneuroma transitional to teratoid medulloepithelioma. Arch Ophthalmol 89:382-386, 1973.
Spencer WH, Jesberg DO. Glioneuroma (Choristomatous malformation of the optic cup margin). Arch Ophthalmol 89:387-391, 1973.
Kuhlenback H, Haymaker W. Neuroectodermal tumours containing neoplastic neuronal elements; Ganglioneuroma, spongioneuroblastoma and glioneuroma with a clini-copathological report of eleven cases, and discussion of their origin and classification. Milit surg 99:272, 1946.
Hogan MJ, Zimmerman LE. Ophthalmic pathology: An atlas and text. Philadelphia, WB Saunders Co, 1964.
[Figure - 1], [Figure - 2]