Criss Jonathan S, Shields Carol L, Materin Miguel A, Reichel Elias, Eagle Ralph C, Shields Jerry A
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Cornea. 2006 Aug;25(7):863-5. doi: 10.1097/01.ico.0000220771.96530.2e.
To describe progressive enlargement of intralesional cavities within a mass that masqueraded clinically as an iris pigment epithelial cyst for 2 years but later proved to be a melanoma.
An 81-year-old woman developed asymptomatic focal elevation of the iris, and ultrasound biomicroscopy showed a fluid-filled mass that was interpreted as an iris pigment epithelial cyst. Over a 2-year period of observation, the cavity enlarged from 0.7 to 10 mm, and the solid component enlarged from approximately 6 to 16 mm basal dimension.
On referral, visual acuity was 20/400 in the right eye and 20/25 in the left eye. The affected right eye displayed a pigmented mushroom-shaped ciliary body mass with anterior chamber invasion, distorting the pupil and occupying 40% of the anterior chamber. Ultrasound biomicroscopy and B-scan ultrasonography revealed many cavities within the 14-mm-thick mass, suggestive of ciliary body melanoma. After enucleation, histopathology disclosed multiple cavities, some with granular eosinophilic material, within a mushroom-shaped mixed-cell melanoma.
Cavitation can occur in ciliary body melanoma and can lead to misinterpretation as a cyst. Cavitary melanoma should be considered in the differential diagnosis of cystic lesions of the anterior segment.
描述一例肿物内病灶性腔隙进行性扩大的病例，该肿物临床上伪装成虹膜色素上皮囊肿达2年之久，后来证实为黑色素瘤。
一名81岁女性出现虹膜无症状性局灶性隆起，超声生物显微镜检查显示一个充满液体的肿物，被诊断为虹膜色素上皮囊肿。在2年的观察期内，腔隙从0.7毫米扩大到10毫米，实性成分的基底尺寸从约6毫米扩大到16毫米。
转诊时，右眼视力为20/400，左眼视力为20/25。患侧右眼可见一个色素性蘑菇状睫状体肿物，侵犯前房，使瞳孔变形，占据前房的40%。超声生物显微镜检查和B超检查显示，在这个14毫米厚的肿物内有许多腔隙，提示为睫状体黑色素瘤。眼球摘除术后，组织病理学检查发现一个蘑菇状混合细胞黑色素瘤内有多个腔隙，有些腔隙内有颗粒状嗜酸性物质。
睫状体黑色素瘤可发生空洞形成，并可能导致误诊为囊肿。在前段囊性病变的鉴别诊断中应考虑有空洞的黑色素瘤。
