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Case Report
Metastatic Tumor in the Iris and Ciliary Body
Masquerading as a Granuloma in the Anterior Chamber
Dr. Sneha Giridhar and Dr. S.R.Rathinam, Aravind Eye Hospital, Madurai
Introduction
Metastatic tumours are the most common cause
of intraocular malignancies and the uveal tissue,
especially the choroid is the most common site.
They are usually bilateral, multiple foci are usually
involved. We report a rare case of a metastatic
tumor in the iris and ciliary body presenting as a
granuloma in the anterior chamber
Case Report
A 65 year old previously healthy female presented
to us with redness and pain in the left eye of 3 days
duration. She gave no history of defective vision/
trauma/fever/joint pains/foreign body/bathing in
pond/exposure to TB.
On ocular examination, her best corrected
visual acuity was 6/6(P) in the Left Eye and 6/6
in the Right Eye. Slit Lamp examination of the
anterior segment of LE showed circumcorneal
congestion, a 3mm hyphaema in the anterior
chamber with a whitish cauliflower shaped
granuloma at one o’clock position over the
periphery of the iris, close to the angle of the
chamber (Fig1). Ocular movements were normal
in both eyes.
Fig : 1
Anterior segment examination of the RE was
normal. Fundus examination with the indirect
ophthalmoscope through a dilated pupil was
normal in both eyes. Considering the presence of
a suspected granuloma in the angle of the anterior
chamber an Ultrasound Biomicroscopy of the
anterior segment was performed.
This showed a well defined mass measuring
4.90*4.59mm within the ciliary body with
moderate internal reflectivity (FIG 2).
Fig : 2
Routine systemic investigation including
complete blood count, platelet count, renal
functions was normal.
Computed Tomography Scan ie CT scan
showed a round lesion in the lower lobe of the right
lung with irregular spiky margins suggestive of
bronchogenic carcinoma. This was confirmed by
histopathological examination of tissue obtained
by a transbronchial biopsy of the lesion (FIG 3).
Whole body CT scan showed metastatic lesion
on the vault of the skull, adrenal glands, vertebrae
and pelvic regions. (FIG 3&4)
Discussion
In a survey of 520 eyes with uveal metastasis,
Shields, et al diagnosed a total of 950 uveal
Vol. XVII, No.1, January - March 2017
Fig : 3
Fig : 4
metastasis. Of the 950 metastatic foci, iris was
involved in 90 eyes (9%), ciliary body in 22 eyes
(2%) and choroid in the remaining eyes (88%).
The most common site for a primary tumor was
the breast (47%) followed by the lung (21%).
The diagnosis of ocular metastasis is based
primarily on clinical findings supplemented
by imaging studies. The diagnostic procedures
include ultrasonography, (UBM and Bscan),
computed tomography and MRI. Some may
be assisted with fine needle aspiration, or wedge
biopsy.
A metastasis in eye alone can be treated with
local therapy and for metastasis in eye along with
systemic metastasis, local therapy along with
systemic chemotherapy is given.
Our case report is therefore unusual for two
reasons:
a. Although there are reports of a choroidal
metastasis as the first sign of bronchogenic
carcinoma, to the best of our knowledge,
there are no published reports of a ciliary body
metastasis as a presenting sign of bronchogenic
carcinoma, as noticed in our case.
b. The metastatic lesion in the eye presenting as a
suspicious granuloma in the anterior chamber
has not been reported earlier to the best of our
knowledge.
The case also highlights the importance of
ultrasound biomicroscopy in such cases to detect
mass lesions in the angle of the anterior chamber
and ciliary region.
Conclusion
This is a rare case of metastatic tumor in iris
and ciliary body presenting as a suspicious
inflammatory mass in the anterior chamber.
This case demonstrates that a multidisciplinary
approach with a good history, careful ophthalmic
examination and systemic review is extremely
important.
References
1. Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE. Survey of 520 eyes with uveal metastases.
Ophthalmology. 1997 Aug; 104(8):1265-76.
2. Demirci H, Shields CL, Chao AN, Shields JA. Uveal metastasis from breast cancer in 264 patients. Am J
Ophthalmol. 2003 Aug; 136(2):264-71.
3. Aragão RE, Barreira IM, Gomes LM, Bastos AS, Beserra Fde F. Choroidal metastasis as the first sign of
bronchioloalveolar lung cancer: case report. Arq Bras Oftalmol. 2013 Jul-Aug; 76(4):250-2.