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 Table of Contents    
CLINICAL IMAGE
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 257-258  

Pigmented ciliary body medulloepithelioma in a newborn infant


1 Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
2 PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
3 Department of Pathology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India

Date of Web Publication5-Oct-2017

Correspondence Address:
Parag K Shah
Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Avinashi Road, Coimbatore - 641 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_1_2017

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   Abstract 

Ciliary body medulloepithelioma is a nonpigmented tumor which presents during the first decade of life. It is rarely seen in newborn infants. We report a pigmented medulloepithelioma in a newborn infant, which showed a rapid growth. Ciliary body medulloepithelioma should be considered in the differential diagnosis in a newborn infant presenting with leukocoria.

Keywords: Ciliary body medulloepithelioma, neonate, pigmentation


How to cite this article:
Shah PK, Meeralakshmi P, Shanthi R, Saravanan V R, Kalpana N, Narendran V. Pigmented ciliary body medulloepithelioma in a newborn infant. Oman J Ophthalmol 2017;10:257-8

How to cite this URL:
Shah PK, Meeralakshmi P, Shanthi R, Saravanan V R, Kalpana N, Narendran V. Pigmented ciliary body medulloepithelioma in a newborn infant. Oman J Ophthalmol [serial online] 2017 [cited 2019 May 20];10:257-8. Available from: http://www.ojoonline.org/text.asp?2017/10/3/257/215985


   Introduction Top


Intraocular medulloepithelioma is a rare intraocular tumor arising from the nonpigmented cells of the ciliary epithelium.[1] This tumor most frequently arises from the ciliary body but can also arise from the retina, iris, and optic nerve.[1],[2] We report a rare case of pigmented ciliary body medulloepithelioma in a newborn child, which showed rapid growth.


   Case Report Top


A 15-day-old male child was brought to the hospital by his parents who had noticed a white reflex in the right eye of 4-day duration. On anterior segment examination, the right eye showed a vascularized whitish-yellow mass at the pupil extending behind the iris temporally [Figure 1]a. Posterior pole and the rest of the retina looked normal [Figure 1]b. The left eye was normal. B-scan examination of the right eye showed a moderate to high reflective mass temporally arising from the ciliary body with an attachment to the retina [Figure 1]c. Magnetic resonance imaging showed an enhancing lesion in the posterior aspect of the ciliary body projecting into the vitreous. A differential diagnosis of persistent hyperplastic posterior vitreous or medulloepithelioma was made.
Figure 1: (a) RetCam photograph of anterior segment of the right eye showing fibrovascular whitish-yellow mass behind the lens, temporally (white arrow). (b) RetCam photograph of posterior segment of the right eye showing the fibrous mass temporally (white arrow) with normal posterior pole. (c) B-scan of the right eye showing a moderate to high reflective mass (black arrow) with a thin stalk attached to the retina (white arrow). (d) Histopathology slide of enucleated specimen with ×40 magnification and hematoxylin and eosin staining showing necrotic and apoptotic cells (black arrow) with pigmentation (white arrow)

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Trans-scleral incision biopsy was performed under general anesthesia. Histopathology showed mild ciliary hyperplasia with no evidence of malignancy. At 1-month follow-up, there was an increase in the size of the mass, and after explaining poor visual prognosis to the family, the eye was enucleated. Histopathology report showed primitive neuroepithelial cells with mitosis and necrosis arranged in cords and rosettes with areas of pigmentation [Figure 1]d. The final diagnosis of malignant nonteratoid pigmented medulloepithelioma was made. Systemic examination by an oncologist was normal. The patient is now on regular follow-up and has a healthy socket with no evidence of recurrence.


   Discussion Top


Medulloepitheliomas can be histopathologically classified into teratoid and nonteratoid varieties and into benign and malignant varieties. Although there is no universally accepted criterion for determining the malignancy of the tumor, Zimmerman and Broughton standards are generally considered as a reasonable measure of malignancy of the tumor.[3] The features are sheets of poorly differentiated neuroblastic cells, sarcomatous areas, greater pleomorphism or mitotic activity, and extraocular extension. Biopsy specimen of this case did not show any of the above features of malignancy. The probable reason for the benign appearance could have been the possibility that the sample taken for biopsy was not representative of the entire mass.

Treatment options for ciliary body medulloepithelioma include cryotherapy for very small anterior tumors or recurrences, local excision of small tumors, brachytherapy of small-medium tumors, external beam radiotherapy, and enucleation.[3] Considering the size of the tumor and its rapid growth, we preferred enucleation. In this case, the medulloepithelioma was pigmented on histopathology. This is an extremely rare occurrence as most of these tumors are amelanotic. There are only few cases of pigmented medulloepitheliomas reported previously.[4] However, pigmented ciliary body medulloepithelioma has never been reported in a newborn. These patients should also be carefully followed for the development of pleuropulmonary blastoma.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Sosinska-Mielcarek K, Senkus-Konefka E, Jaskiewicz K, Kordek R, Jassem J. Intraocular malignant teratoid medulloepithelioma in an adult: Clinicopathological case report and review of the literature. Acta Ophthalmol Scand 2006;84:259-62.  Back to cited text no. 1
    
2.
Pradhan SB, Adhikari RC, Shrestha B, Sayami G, Dali S, Shrestha HG. Malignant teratoid medulloepithelioma in eye. Kathmandu Univ Med J (KUMJ) 2003;1:42-4.  Back to cited text no. 2
[PUBMED]    
3.
Elizalde J, De la Paz M, Barraquer RI. Tumors of the ciliary pigment epithelium. In: Singh AD, Demato BE, Pe'er J, Murphree AL, Perry JA, editors. Clinical Ophthalmic Oncology. Philadelphia: Saunders Elsevier; 2007. p. 366-71.  Back to cited text no. 3
    
4.
Gopal L, Babu EK, Gupta S, Krishnakumar S, Biswas J, Rao NA. Pigmented malignant medulloepithelioma of the ciliary body. J Pediatr Ophthalmol Strabismus 2004;41:364-6.  Back to cited text no. 4
[PUBMED]    
5.
Kaliki S, Shields CL, Eagle RC Jr., Vemuganti GK, Almeida A, Manjandavida FP, et al. Ciliary body medulloepithelioma: Analysis of 41 cases. Ophthalmology 2013;120:2552-9.  Back to cited text no. 5
    


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