Ocular Cytopathology

An atlas that features the cytologic findings of the normal features and diseases of the eye.

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Wednesday, September 28, 2005

chapter-5-page3-Iris, Ciliary Body, Melanoma

IRIS AND CILIARY BODY MELANOMA

Melanomas in the eye most commonly occur in the choroids (see Chapter 9). However, about 3% to 16% (41% in children) of ocular melanomas arise in the iris and 9% to 10% arise in the ciliary body. [30, 31, 32, 33] Clinically, iris melanomas are highly vascular, pigmented lesions that usually occur inferiorly in the iris. [34, 35] The Callender classification of uveal melanomas as spindle or epithelioid does not apply to iris melanomas. [36, 37, 38] Iris melanomas have a much better prognosis than their ciliary body and choroidal counterparts. [39] Occasionally, malignant melanomas extend circumferentially about the ciliary body, yet clinically only a focus iris lesion is present (Figure 5-16). Determination of cell type in these cases may be helpful to document the presence of nucleoli suggesting a more atypical type of melanoma (Figure 5-17). Fine needle may be quite helpful in determining the presence of a ring melanoma of the ciliary body if the aspirate is performed away from the apparent lesion (Figure 5-18 and 5-19). Fine needle aspiration has been used to diagnosis iris masses and, specifically, to help determine if a pigmented lesion in the iris or ciliary body is focal, multiple, or diffuse. [40] However, on cytologic criteria alone, it is not possible to determine the original site of melanomas.

REFERENCE


30. Jensen OA. Malignant melanoma of the human uvea. Acta Ophthalmol (Suppl.) 1963;75:17-215.
31. Raivio I. Uveal melanomas in Finland; an epidemiological, clinical, histological and prognostic study. Acta Ophthalmol (Suppl.) 1977;133:1-64.
32. Apt L. Uveal melanomas in children and adolescents. Int Ophthalmol Clin 1963;2:403-410.
33. Holland G. Clinical features and pathology of pigment tumours of the iris. Klin Monatsbl Augenheikd 1967;150:350-370.
34. Rones B, Zimmerman LE. The prognosis of primary tumors of the iris treated by iridectomy. Arch Ophthalmol 1958;60:193-205.
35. Shields JA, Sanborn GE, Augsburger JJ. The differential diagnosis of malignant melanoma of the iris. A clinical study of 200 patients. Ophthalmol 1983;90:716-720.
36. Callender GR. Malignant melanotic tumors of the eye. A study of histologic types in 111 cases. Trans Am Acad Ophthalmol Otolaryngol 1931;36:131.
37. Jakobiec FA, Silbert G. Are most iris “melanomas” really nevi? Arch Ophthalmol 1981;99:2117-2132.
38. Arentsen JJ, Green WR. Melanoma of the iris: report of 72 cases treated surgically. Ophthalmic Surg 1975;6:23-37.
39. Ashton N. Primary tumours of the iris. BR J Ophthalmol 1964;48:650-668.
40. Char DH, Crawford JB, Gonzales, Miller T. Iris melanoma with increased intraocular pressure. Differentiation of focal solitary tumors from diffuse or multiple tumors. Arch Ophthalmol 1989;107:548-551


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