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Photo Essay |

Ciliary Body Melanoma Simulating Multiple Iris Cysts

Jørgen Krohn, MD, PhD; Jarle Arnes, MD; Eyvind Rødahl, MD, PhD
Arch Ophthalmol. 2007;125(3):428-429. doi:10.1001/archopht.125.3.428.
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A 36-year-old man noticed mildly blurred vision in his left eye. At the pupillary margin, multiple dark-brown cysts were seen between the posterior surface of the iris and the anterior lens capsule (Figure 1 and Figure 2). A markedly elevated tumor, measuring 16 × 10 × 10 mm, was located superonasally behind the lens (Figure 3). The eye was enucleated and the histopathologic diagnosis was a mixed-cell melanoma of the ciliary body. Close behind the unaffected iris, numerous cysts arose from the ciliary processes on the tumor surface (Figure 4). The cysts were partly collapsed and the wall of each cyst consisted of a single layer of epithelial cells (Figure 5).

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Figure 1.

Anterior segment photograph of the patient's left eye before dilation of the pupil. Note the multiple dark-brown cysts at the pupillary margin between the 8- and 12-o’clock positions.

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Figure 2.

Slitlamp photograph after mydriasis shows transillumination of multiple cysts located between the iris and the anterior lens capsule. Note the gray-white, capsular, and subcapsular lens opacities adjacent to the cysts.

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Figure 3.

B-scan ultrasonography demonstrates a dome-shaped tumor with adjacent retinal detachment. A-scan ultrasonography shows a rapidly attenuating internal tumor echo pattern.

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Figure 4.

Histopathologic examination reveals multiple partly collapsed cysts arising from the ciliary processes on the tumor surface. A part of the ciliary body melanoma is seen in the lower left corner. The lens has been artifactitiously removed (hematoxylin-eosin, original magnification × 50).

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Figure 5.

High-power view of the cysts shown in Figure 4. The wall of each cyst consists of a single layer of either pigmented or nonpigmented epithelial cells (hematoxylin-eosin, original magnification × 200).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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