About OJO | Search | Ahead of print | Current Issue | Archives | Author Instructions | Reviewer Guidelines | Online submissionLogin 
Oman Journal of Ophthalmology Oman Journal of Ophthalmology
  Editorial Board | Subscribe | Advertise | Contact
https://www.omanophthalmicsociety.org/ Users Online: 205  Wide layoutNarrow layoutFull screen layout Home Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents    
LETTER TO THE EDITOR
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 132-134  

Papillary adenocarcinoma of ciliary body


Department of Pathology, S. R. T. R. Medical College, Ambajogai, Maharashtra, India

Date of Web Publication19-Aug-2013

Correspondence Address:
Sunil Y Swami
Bhagwanbaba Chowk, Gitta - Road, Shepwadi, Taluka, Ambajogai, Beed - 431 517, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.116663

Rights and Permissions

How to cite this article:
Bhandari AP, Swami SY, Gadkari RU. Papillary adenocarcinoma of ciliary body. Oman J Ophthalmol 2013;6:132-4

How to cite this URL:
Bhandari AP, Swami SY, Gadkari RU. Papillary adenocarcinoma of ciliary body. Oman J Ophthalmol [serial online] 2013 [cited 2020 Aug 10];6:132-4. Available from: http://www.ojoonline.org/text.asp?2013/6/2/132/116663

Sir,

Tumors arising from the pigmented and nonpigmented epithelia of the iris and ciliary body are extremely rare. [1]

In a review of 20 histopathologically proved cases of adenocarcinoma of the ciliary body or iris pigment epithelium, Dryja and his co-authors reported the mean age at diagnosis to be 45 years. [2]

We describe herein an adenocarcinoma of the ciliary body occurring in a 70-year-old female as an accidental finding. This tumor is clinically indistinguishable from a melanoma or medulloepithelioma.

A 70-year-old female presented with pain, tearing, diminution of vision, and photophobia of the right eye for a period of 2 months.

On right ocular examination, eyelids were edematous, conjunctiva was congested, and pupils were semidilated, fixed, showing yellowish reflex. Intraocular pressure was increased. Visual acuity showed no perception of light. On fundoscopy, media was hazy. Left eye examination was normal. General and systemic examination was unremarkable. Diagnosis of right eye endophthalmitis was made. Treatment advised was enucleation of right eye. During operation, tiny mass was found attached behind the iris in posterior chamber.

Grossly, tumor mass of size 0.5 × 0.5 cm attached posterior to iris with some cystic areas and an area of brownish black discoloration was received.

Microscopy showed tumor tissue near the iris [Figure 1], composed of cells arranged in papillary and tubular fashion [Figure 2]. Individual cells were round to oval cells with hyperchromatic nuclei, high nuclear cytoplasmic ratio, and scanty cytoplasm. Infiltration of sclera with tumor cells was present. Surrounding stroma showed desmoplastic reaction along with melanin pigment and sparse chronic inflammatory infiltrate deposition [Figure 3].
Figure 1: Ciliary body adenocarcinoma at the base of iris (H and E, ×5)

Click here to view
Figure 2: Tumor cells showing tubular and papillary pattern (H and E, ×10)

Click here to view
Figure 3: Higher magnification of round to oval tumor cells with vesicular nuclei, prominent nucleoli, scanty cytoplasm, and high N:C ratio (H and E, ×40)

Click here to view


Histopathological differential diagnosis included papillary adenocarcinoma of ciliary body, medulloepithelioma (adult variant), and malignant melanoma. Immunohistochemistry was done to confirm the diagnosis.

Immunohistochemistry showed immunopositivity for cytokeratin [Figure 4] and epithelial membrane antigen (EMA) [Figure 5].
Figure 4: Tumor cells showing positive cytokeratin staining (×10)

Click here to view
Figure 5: Epithelial membrane antigen staining positive (×10)

Click here to view


HMB-45 antibody (human melanoma black) [Figure 6] and neuron-specific enolase (NSE) [Figure 7] were negative, which confirms nonpigmented ciliary epithelium adenocarcinoma. Retrospective search for any primary tumor elsewhere in the body was negative.
Figure 6: Human melanoma black-45 staining negative (×40)

Click here to view
Figure 7: Neuron-specific enolase staining negative (×10)

Click here to view


Adenocarcinoma is a term that describes a tumor derived from the pigmented or nonpigmented epithelium of the ciliary body and/or iris that showed local invasion, cellular dedifferentiation, and the potential for distant metastasis. [3] Most patients with these tumors are between the ages of 30 and 70 years. [4] Ciliary body melanoma and medulloepithelioma (adult variant) were considered in the differential diagnosis of this pigmented mass.

A possible diagnosis of tumor metastatic to the eye like breast, lung, and gastrointestinal tract carcinomas were ruled out after careful history, physical examination, and appropriate laboratory studies. [5]

Adenocarcinoma of ciliary body is rare tumor with incidence of less than 3% of all ciliary body tumors. Clinically, it presents as ­incidental finding or causes subluxation of the lens, segmental cataract, or secondary glaucoma. Mostly they are localized in globe, but can exhibit extraocular extension. Generally it does not have tendency to metastasize.

This tumor needs to be reported as it has better prognosis than more common medulloepithelioma.


   Acknowledgment Top


We are thankful to Professor and Head, Department of Pathology, AFMC Pune for IHC and expert opinion.

 
   References Top

1.John JP, Kenichi A, Tatsuo H, Kasuo T, Kasuaki H, Daniel MA. Adenocarcinoma of the Ciliary Body Pigment Epithelium in a Child. Arch Ophthalmol 1984;102:100-3.  Back to cited text no. 1
    
2.Myron Y, Joseph WS. Ocular melanocytic tumors. In: Ocular pathology. 6 th ed. St Louis, MO: Mosby/Elsevier; 2009. p. 693.  Back to cited text no. 2
    
3.Streeten BW, McGraw JL. Tumor of the ciliary pigment epithelium. Am J Ophthalmol 1972;74:420-9.  Back to cited text no. 3
    
4.Wolter JR, James BR. Adult type of medulloepithelioma of the ciliary body. Am J Ophthalmol 1958;46:16-26.  Back to cited text no. 4
    
5.Wolfgang EL, Jerry AS, Carol LS, George LS. Mucinous adenocarcinoma metastatic to the iris, ciliary body and choroid. Br J Ophthalmol 1990;74:373-6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

Top
   
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Acknowledgment
    References
    Article Figures

 Article Access Statistics
    Viewed3140    
    Printed26    
    Emailed0    
    PDF Downloaded146    
    Comments [Add]    

Recommend this journal