|Year : 1999 | Volume
| Issue : 4 | Page : 255-256
Malignant melanoma of ciliary body: A case report
SS Jain, S Thomas, SA Motware, A Hamidani
Department of Ophthalmology, Lokmanya Tilak Municipal Medical College, Mumbai, India
S S Jain
Department of Ophthalmology, Lokmanya Tilak Municipal Medical College, Mumbai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain S S, Thomas S, Motware S A, Hamidani A. Malignant melanoma of ciliary body: A case report. Indian J Ophthalmol 1999;47:255-6
Ocular malignant melanomas are infrequently seen in Indian patents and most them involve the choroid. Ciliary body malignant melanoma is rather rare. This case report illustrates an occurrence in an Indian patient.
The case reported here is rare in terms of: (a) site -isolated involvement of ciliary body without involvement of the choroid; (b) racial incidence - brown eyes have a significantly lower risk; and (c) mode of presentation - surgery. This condition has been described sparingly. To our knowledge this is the first reported case in India; other reported cases were of malignant melanomas involving the choroid.
| Case Report|| |
A 65-year-old Indian woman was referred to our hospital with decreased vision in the left eye. She had undergone cataract surgery in the left eye 6 months prior to referral. During surgery there was spontaneous vitreous loss with vitreous haemorrhage. Subsequently the vitreous haemorrhage cleared and she had a visual acuity of 6/18 with + 11.00 D. Five months after cataract surgery, she complained of decreased vision and a blackish mass in the same eye. There were no systemic complaints. On ophthalmologic examination, the left eye vision was counting fingers at 2 feet, with conjunctival and ciliary congestion and a ciliary staphyloma ( 3 mm x 4 mm x 1 mm) 4 mm from limbus at 2 o' clock position. Slitlamp examination showed shallow anterior chamber on the temporal side, normal colour and pattern of the iris, aphakia, and presence of a mass behind the iris occupying the temporal portion of pupillary area. This was brownish in colour with blood vessels on its surface. Gonioscopy showed increased pigmentation of the trabecular meshwork. Fundus examination showed a brownish mass in the temporal ciliary body and pars plana region with localized elevation of peripheral temporal retina. The intraocular tension was normal. A clinical diagnosis of malignant melanoma involving the ciliary body was made. Visual acuity in the right eye was 6/12, J1 with an immature cataract and fundus was normal. Systemic examination was normal.
Ultrasonography B-scan [Figure - 1]a revealed a 12 x 11 mm irregular nodular mass in region of the ciliary body, temporally with a cystic lesion within the mass. The optic nerve and retro-orbital space were normal. On limited Magnetic Resonance Imaging of orbits, this lesion was hyperintense on T1 weighted images [Figure - 1]b and turned extremely hypointense on T2 weighted images [Figure - 1]c. Colour doppler revealed moderate flow within the mass with a resistivity index (R.I.) of 0. 67. Chest x-ray and ultrasonography of abdomen were normal.
Enucleation of the left eye was performed with the patient's consent. Pathologically, gross examination of the cut section of the eyeball [Figure - 2]a revealed the ciliary body region occupied temporally by a 10 mm x 10 mm, apparently circumscribed tumor nodule. Microscopic examination [Figure - 2]b and [Figure - 2]c revealed a mixed cell type of malignant melanoma containing predominantly epithelioid cells with few spindle cells interspersed. The tumor invaded the entire thickness of the sclera in one area. The cornea, iris, choroid, retina, and optic nerve were not involved.
At the 2-year follow up of this patient, there was no evidence of any local or systemic metastatsis. The right eye, later operated for cataract, showed no evidence of any similar pathology.
| Discussion|| |
Melanomas of the ciliary body are not recognised early because of their location and, as a consequence, may become quite large before being clinically diagnosed. The growth commences as a lenticular tumor and assumes nodular or diffuse growth patterns or various combinations of the two. Extra-ocular extension along the perforating scleral vessels and nerves is usually early and obvious. In retrospect, the spontaneous vitreous loss, in the above case, could have been secondary to the ciliary body tumor.
Amongst the non-invasive procedures, in addition to direct ophthalmoscopic visualisation, ultrasonography remains an important diagnostic tool. The hallmark of malignant melanoma on A and B scan is low to medium reflectivity of its inner tumor spikes at tissue sensitivity (5-60% in small and up to 80% in large tumors) combined with solid consistency (no after movement of the surface tissue spikes during kinetic echography) and regular structure.
A number of ocular lesions or pseudomelanomas can clinically simulate malignant melanomas of the ciliary body. These include aphakic cyst of ciliary body, melanocytoma of ciliary body, tumours of non-pigmented ciliary epithelium, conjunctival nevi and melanoma and ciliary staphyloma.
Malignant melanomas spread by direct extension, local metastasis, or generalised metastasis. Current management can range from periodic observation and fundus photography of selected small lesions that appear dormant to photocoagulation, radiotherapy, or local resections that is, iridocyclectomy in case of growing tumors in eyes with useful or salvageable vision. In cases where the tumor is far advanced and there is no hope for useful vision, enucleation is often inevitable. In our patient enucleation appeared inevitable due to size of the tumor.
| References|| |
Manohar S, Ramakrishnan R, Das TP, Namperumalsamy P. Malignant melanoma of choroid. Indian J Ophthalmol
Shields JA. Posterior uveal melanomas:clinical and pathologic features. In:Shields JA, editor. Diagnosis and Management of Intraocular Tumors
. St.Louis:CV Mosby Company; 1983. p 144-69,171-93,210-53,322-59,595-16.
Duke-Elder S, Perkins ES. Cysts and tumors of the uveal tract. In:Duke-Elder S, editor. System of Ophthalmology
. St. Louis:CV Mosby Company; Reprint 1977. Vol 9. p 843-911.
Diamond JG, Ossoinig KC. Contact A-Scan and B-scan ultrasonography in the diagnosis of intraocular lesions. In:Peyman GA, Apple DJ, Sanders DR, editors. Intraocular Tumors
. New York: Appleton/Century/Crafts; 1977. p 35-49.
Pavan-Langston D. Uveal tract:iris, ciliary body and choroid. In:Pavan-Langston D, editor. Manual of Ocular Diagnosis and Therapy
. 4th ed. Boston; Little, Brown and Company; 1996. pp 181-227.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]