Intraocular Tumors – Melanocytic
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Differential Diagnosis of iris nodules
- Cyst, Epithelial invasion
- serous or solid cysts following surgery
- Trauma
- Retained foreign body -usually secondary pigmentation of iris → chronic iridocyclitis and PAS
- Fungal endophthalmitis -Irregular yellow-white mass, cell in AC, +/-hypopyon
- Iridocyclitis -Granulomatous nodules –superficial or deep–associated with
- sarcoidosis
- Koeppe nodules located at the pupillary border
- Busacca nodules located on anterior iris surface
- Iris freckle -stationary, light-dark, flat, anterior, with increased pigment, but no hyperplasia
- Iris Nevus -discretemass on anterior iris surface
- Composed of benign nevus cells.
- Increased incidence in neurofibromatosis-1
- Cogan-Reese iris nevus syndrome
- Acquired diffuse nevus: associated with
- Glaucoma
- Heterochromia
- PAS
- ICE syndrome
- Iris pigment epithelial cysts -encompass both layers of iris and produce localized stromal elevation. May need B-scan or trans-illumination to see.
- Iris pigment epithelial proliferation results from congenital or acquired (trauma/surgery) –composed of plaques of pigment epithelium –black, velvety color.
- Juvenile xanthogranuloma -yellow/grey iris lesions with orange skin
- Lesions in 1st yearof life.
- Assoc. 1. with spontaneous hyphema
- Secondary glaucoma
- Diffuse granulomatous reaction with lipid filled histiocytes and touton giant cells Regress spontaneously
- Leiomyoma
- localized or diffuse, pedunculated or flat
- Electron microscopy required to differentiate from amelanotic spindle cell melanoma
- Leukemia -very rare
- Nodularor diffuse milky lesions with intense hyperemia.
- Pseudohypopyon
- Iris loses architecture and becomes thickened.
- Lisch Nodules
- one of the diagnostic criteria for NF-1
- Multiple flat or raised tan to brown lesions
- Composed of collections of nevus cells
- Malignant melanoma
- Nodular of flat –usually peripheral
- 80% inferior + inferotemporal
- May have nutrient vessel, satellite pigmentation
- Pupil may dilate irregularly
- Melanocytosis
- Unilateral, heterochromia irides
- May have oculodermal form with eyelid + brow involved
- Has malignant potential
- Retinoblastoma
- White foci on iris surface or in angle
- May have pseudohypopyon
- Retinoblastoma present in posterior chamber
- Tapioca Melanoma
- Often associated with unilateral glaucoma.
- Tapioca-like nodules over part or all of iris
- Metastatic Carcinoma
- Gelatinous to white vascularized nodules on iris surface.
- May be associated with anterior uveitis, glaucoma, rubeosis, and hyphema.
17.09 Iris
Nervus | <5mm diameter | <2mm thick |
Small | 5-10mm | 2-3mm thick |
Medium | 10-15mm | 3-5mm |
Large | 15-20mm | 5-10mm |
Extra Large | >20mm | >10mm |
A | B | |
---|---|---|
Group I (very favorable) | solitary tumor <4DD | multiple tumors |
II | 4-10DD | multiple 4-10DD |
III | at equator or anterior | >10DD posterior |
IV | multiple tumors, some >10DD | anteriorto ora serrata |
V(least favorable) | massive tumor > ½ retina | vitreous seeding |
International Classification
A | Small(<3mm) | >3mm from fovea | >1.5mm from optic nerve |
B | (>3mm) | confined to retina | |
C | Localizedvitreous or subretinal seeding. | <6mm from tumor | |
D | Diffuse vitreous or subretinal seeding. | >6mm from primary | |
E | No visual potential or tumor in anteriorsegment, in or onciliary body, neovascular glaucoma,vitreous hemorrhage, phthisical eye, orbital extension/proptosis. |
d
Males | Females |
---|---|
Lung 40% | Breast 68% |
Unknown 29% | Lung 12% |
GI 9% | Unknown 12% |
Kidney 6% | Others 4% |
Prostate 6% | GI 2% |
Skin 4% | Skin 1% |
Others 4% | Kidney<1% |