Ankit Singh Tomar, Paul T. Finger, Codrin E. Iacob
Intraocular leiomyoma is a benign smooth muscle tumor. First recognized before the era of immunohistochemistry, uveal leiomyomas have been described in case reports and small case series. We add 3 new cases, for a total of 80. Of these, there were 29 men and 51 women. The mean and median ages were 35.8 and 30.5 years respectively, with a range of 8 to 80 years. Curiously, ciliary body tumors were more common in females, whereas iris and posterior choroidal leiomyomas were more prevalent in males. Infrequently associated with systemic fibroids, nuclear expression of sex steroid receptors was inconsistent. Iris and posterior choroidal leiomyoma were predominantly amelanotic, while 40% of ciliary body leiomyomas were brown. Two-thirds of the leiomyomas blocked transillumination partially or completely, a feature shared by uveal melanoma. In general, low-frequency ultrasound imaging reveals low to moderate internal reflectivity; however, high-frequency anterior uveal ultrasound was used to localize a leiomyoma as resident in the suprachoroidal space with an overlying layer of intact choroid. In the few cases examined by physiologic imaging, increased metabolic activity (typically associated with malignancy and inflammation) has been noted. We found that pigmented uveal leiomyomas can be clinically identical to melanoma. Therefore, histopathology with immunohistochemical staining for smooth muscle actin was the most reliable diagnostic method to differentiate pigmented uveal leiomyoma from melanoma. Treatment is governed by the clinical diagnosis, tumor size and location, as well as prognosis for vision and globe preservation.
Infante-Cossio, Pedro; Infante-Cossio, Monica; Herce-Lopez, Javier; Rollon-Mayordomo, Angel
A 31-year-old man presented with a 6-month history of a progressive enlargement over the medial right supraorbital margin with intermittent dull pain. His ophthalmologist had diagnosed a sebaceous cyst while the lesion had gradually increased in size. Physical examination revealed a firm, movable mass covered by erythematous skin (Fig. 1A). MRI revealed a 2.5-cm well-circumscribed medial right supraorbital mass showing contrast enhancement with a hyperintense central portion on T2-weighted images and hypointense on T1-weighted images (Fig. 1B,C). Through a skin incision hidden in the eyebrow, the tumor was easily removed sparing the eyelid (Fig. 2A). Histologic examination with hematoxylin and eosin stain showed a solid, well-circumscribed tumor, consisting of bundles of spindle-shaped cells. The immunohistochemical study revealed intense positivity for muscle-specific actin and smooth muscle actin. With all these findings, a diagnosis of leiomyoma was made (Fig. 2B). At 5-year follow up, the patient is doing well and has had no recurrence (Fig. 2C). This case is presented to raise awareness of leiomyomas, although it is extremely rare in the periorbital region and difficult to distinguish. The histopathological and immunohistochemical features are essential for diagnosis. While complete excision is the usual outcome, long-term follow up is strongly recommended.
Hyun Ju Park, Ji Hwan Lee, Eunkyung Kim and Sung Chul Lee
No abstract available for this article
Arpine Barsegian, MD, Arslan Ahmad, MD, Roman Shinder, MD, FACS
A 58-year-old woman presented with a 6-week history of foreign body sensation from a growing left lower eyelid lesion. Physical examination showed a 1.0×0.8-cm, well-circumscribed, smooth, soft tissue mass of the medial left inferior palpebral conjunctiva distinct from the caruncle (Fig 1A). Excisional biopsy revealed intersecting eosinophilic fascicles of bland spindle cells showing blunt-ended and elongated nuclei with fine chromatin and indistinct nucleoli without mitotic activity, atypia, or pleomorphism (Fig 1B). Immunohistochemistry showed positivity to muscle specific actin (Fig 1C) and negativity to desmin, CD34, and S100 stains confirming a diagnosis of conjunctival leiomyoma.