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Mesectodermal Suprauveal Iridociliary Leiomyoma: Transscleral Excision Without Postoperative Iris Defect

Lubna Razzaq, MD; Ekaterina A. Semenova, PhD; Marina Marinkovic, MD; Rob J. W. de Keizer, MD; Sjoerd G. Van Duinen, MD; Gregorius P. M. Luyten, MD, PhD
Arch Ophthalmol. 2011;129(12):1635-1637. doi:10.1001/archophthalmol.2011.342.
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Mesectodermal leiomyoma of the ciliary body is a rare tumor originating from smooth muscle, having both muscular and neural differentiation.1 The first case was reported in 1977, and so far 24 cases have been reported.1 It should be considered in the differential diagnosis of an amelanotic melanoma, especially in young people. Herein, we report a case of mesectodermal iridociliary leiomyoma in a young man, showing the results of ultrasound biomicroscopy, 3-T magnetic resonance imaging, histology, and immunohistochemistry. The tumor was excised en bloc by a transscleral approach and later treated with ruthenium 106 plaque brachytherapy.

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Figure 1. Preoperative slitlamp photograph, ultrasound biomicroscopy image, and magnetic resonance images. A, Slitlamp photograph shows a vascular lesion in the nasal iris of the right eye pushing the normal iris tissue centrally. B, Ultrasound biomicroscopy shows a low reflective solid mass arising from the ciliary body and involving the iris. C, Axial magnetic resonance image shows a well-defined mass (arrow) in the ciliary body and iris of the right eye. The lesion is hyperintense to the vitreous on the T1-weighted image with fat suppression. D, A T1-weighted magnetic resonance image shows the same lesion (arrow) with marked enhancement after gadolinium administration.

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Figure 2. Histologic findings and postoperative slitlamp photograph. A, The tumor removed in this case had elongated spindle cells with oval nuclei (hematoxylin-eosin, original magnification ×40). B, Tumor cells had immunoreactivity for CD56 antigen (original magnification ×40). C, Tumor cells had positive staining with neuron-specific enolase (original magnification ×40). D, Slitlamp photograph of the same eye 20 days after the excision of tumor shows no iris defect.




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