Lieb W E, Shields J A, Shields C L, Spaeth G L
Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Br J Ophthalmol. 1990 Jun;74(6):373-6. doi: 10.1136/bjo.74.6.373.
A 67-year-old woman presented with signs of severe intraocular inflammation and secondary glaucoma. The initial diagnosis was uveitis, and an anterior chamber paracentesis with cytological study of the aspirate failed to establish an aetiological diagnosis. After three trabeculectomies had failed to control the intraocular pressure, the blind eye was enucleated. On histopathological examination a mucinous adenocarcinoma was found to cover diffusely the iris surface and to involve the ciliary body and peripheral choroid. The patient subsequently developed evidence of widespread metastatic disease and died shortly thereafter. Although a primary tumour was never found, histochemical and immunohistochemical studies of the enucleated eye suggested that the lesion originated in the gastrointestinal tract. In cases of intractable glaucoma and anterior chamber inflammation, metastatic carcinoma should be included in the differential diagnosis, and efforts should be made to substantiate the diagnosis by a systemic examination or a biopsy.
一名67岁女性出现严重眼内炎症和继发性青光眼的症状。初步诊断为葡萄膜炎，前房穿刺并对吸出物进行细胞学检查未能确立病因诊断。在三次小梁切除术未能控制眼压后，患眼被摘除。组织病理学检查发现黏液腺癌弥漫性覆盖虹膜表面，并累及睫状体和周边脉络膜。该患者随后出现广泛转移的证据，不久后死亡。尽管从未发现原发性肿瘤，但对摘除眼球的组织化学和免疫组织化学研究表明，病变起源于胃肠道。对于难治性青光眼和前房炎症病例，鉴别诊断应包括转移性癌，应努力通过全身检查或活检来证实诊断。
