Sun Yi, Chen Yuanyuan, Zhu Jing, Guo Juan, Wang Zhanfeng
The Third People's Hospital of Chengdu, 82 Qinglong Street, Chengdu City, Sichuan Province, 610031, China.
Diagn Pathol. 2025 May 15;20(1):60. doi: 10.1186/s13000-025-01646-x.
Distinguishing between benign iridociliary melanocytoma and malignant melanoma presents a diagnostic challenge, particularly given the potential overlap in tumor growth patterns and clinical manifestations, especially when patients present with secondary glaucoma. Misdiagnosis may induce severe clinical consequences, including enucleation. Therefore, the judicious selection of biopsy or surgical techniques is crucial in both diagnosing and managing the condition.
A 44-year-old female presented with uncontrolled elevated intraocular pressure (IOP) and a heavily pigmented iris lesion extending into the anterior chamber angle and adjacent ciliary body. Unexpectedly, standardized initial fine-needle aspiration biopsy (FNAB) yielded inconclusive results. Subsequent excisional surgery (partial iridocyclectomy and concurrent phacoemulsification) was performed to remove the tumor mass and treat cataract. Histopathological analysis confirmed the diagnosis as melanocytoma. Lens implantation followed upon normalization of IOP within 8 months. At the 2-year follow-up, the patient exhibited a satisfactory clinical outcome, with no tumor recurrence, achieving a best-corrected visual acuity of 20/40 and an intraocular pressure of 18.5 mmHg.
This case underscores the importance of obtaining adequate tumor specimens for accurate diagnosis via FNAB in iris and ciliary body tumors. Additionally, for patients with secondary glaucoma, partial iridocyclectomy emerges as a promising intervention, addressing anterior chamber angle obstruction to alleviate IOP while facilitating histopathological diagnosis for subsequent management.
鉴别良性虹膜睫状体黑色素细胞瘤和恶性黑色素瘤是一项诊断挑战，尤其是考虑到肿瘤生长模式和临床表现可能存在重叠，特别是当患者出现继发性青光眼时。误诊可能导致严重的临床后果，包括眼球摘除。因此，明智地选择活检或手术技术对于诊断和处理该病症至关重要。
一名44岁女性因眼压控制不佳就诊，虹膜有一个色素沉着严重的病变，延伸至前房角和相邻的睫状体。出乎意料的是，标准化的初始细针穿刺活检（FNAB）结果不明确。随后进行了切除手术（部分虹膜睫状体切除术并同时进行超声乳化术）以切除肿瘤块并治疗白内障。组织病理学分析确诊为黑色素细胞瘤。在8个月内眼压恢复正常后进行了晶状体植入。在2年的随访中，患者临床结果令人满意，无肿瘤复发，最佳矫正视力达到20/40，眼压为18.5 mmHg。
该病例强调了通过FNAB获取足够肿瘤标本以准确诊断虹膜和睫状体肿瘤的重要性。此外，对于继发性青光眼患者，部分虹膜睫状体切除术是一种有前景的干预措施，可解决前房角阻塞以降低眼压，同时便于进行组织病理学诊断以用于后续治疗。
