Sarcoid granuloma simulating amelanotic melanoma of the iris: a case report

We report the case of a unilateral vascular iris tumor in a 24-year-old patient. Clinically, the iris lesion appeared similar to amelanotic melanoma. A systemic work-up (initial check-up), including an angiotensin-converting enzyme determination, provided the diagnosis of sarcoid granuloma. A biopsy confirmation was not needed. We concluded that iris granuloma can be the only ocular manifestation of sarcoidosis and this context is likely to be confused with amelanotic melanoma and metastatic carcinoma.     

Aspergillus iris granuloma in a young male: a case report with review of literature

Endogenous aspergillosis is a rare occurrence. Endogenous Aspergillus endophthalmitis is a rare but devastating infection usually associated with disseminated aspergillosis or with intravenous drug abuse. We report a case of an isolated Aspergillus iris granuloma in a young immunocompetent male patient with review of the literature.     

Iris granulomas of unknown aetiology

BACKGROUND: Non-pigmented tumours of the iris are rare and their clinical classification can be difficult, especially in the absence of systemic manifestations. HISTORY AND SIGNS: We report the case of a unilateral vascular, non-pigmented iris tumour in a 47-year-old patient. Clinically, the iris lesion showed progressive growth and tumour vascularisation. THERAPY AND OUTCOME: A systemic work-up failed to reveal any underlying systemic disease. Biopsy showed a non-necrotising granuloma. The lesion responded well to systemic corticosteroid therapy. CONCLUSIONS: Isolated granulomas of the iris are rare and clinically often indistinguishable from malignant tumours like melanoma. Due to the clinical course and the regression under corticosteroid therapy we concluded that this iris granuloma may be an isolated ocular manifestation of sarcoidosis.     

Iris melanoma in a ten-year-old boy with Familial Atypical Mole-Melanoma (FAM-M) syndrome

A ten-year-old boy was referred with an enlarging amelanotic iris tumor and secondary glaucoma in the left eye. After excisional biopsy it proved histopathologically to be an iris melanoma. The patient also had multiple nevi on his trunk, scalp, and buttocks suggestive of familial atypical mole melanoma (FAM-M) syndrome and confirmed histopathologically. To the authors' knowledge, this is the first report of iris melanoma in association with FAM-M syndrome. The young age at tumor onset is suggestive of a predisposing condition such as FAM-M syndrome. The association of uveal melanoma with FAM-M syndrome is discussed.     

Annular elastolytic giant cell granuloma of conjunctiva: A case report

Annular elastolytic giant cell granuloma is a condition characterized histologically by damaged elastic fibers associated with preponderance of giant cells along with absence of necrobiosis, lipid, mucin, and pallisading granuloma. It usually occurs on sun-damaged skin and hence the previous name actinic granuloma. A similar process occurs on the conjunctiva. Over the past three decades only four cases of conjunctival actinic granuloma have been documented. All the previous patients were females with lesions in nasal or temporal bulbar conjunctiva varying 2-3 mm in size. We report a male patient aged 70 years presenting with a 14 mm × 7 mm fleshy mass on right lower bulbar conjunctiva. Clinical differential diagnoses were lymphoma, squamous cell carcinoma in situ and amyloidosis. Surgical excision followed by histopathology confirmed it to be a case of actinic granuloma. This is the first case of isolated conjunctival actinic granuloma of such a large size reported from India.     

颌面深部巨大真菌性肉芽肿1例报告并文献复习

目的:报告l例罕见的颌面深部巨大真菌性肉芽肿的临床表现及诊治过程,提高对真菌性肉芽肿的临床认识,减少漏诊误诊。方法:结合病例复习文献。结果:真菌性肉芽肿的临床和影像学表现缺乏特异性,容易漏诊误诊,确诊需行组织病理学检查及细菌培养。结论:提高对本病的认识可减少漏诊或误诊,有利于正确及时的治疗。     

Pseudomelanoma of the iris in herpes simplex keratoiritis

A 37-year-old white man with a long history of recurrent herpetic keratitis presented with a rapidly enlarging pigmented iris lesion. The primary diagnostic concern was that the lesion might be a malignant melanoma. A biopsy of the mass was done and proved it to be a granuloma with granulomatous arteritis and infarction of the iris. In a patient with a history of recurrent ocular inflammation, such a hypersensitivity granuloma should be considered in the differential diagnosis of iris melanoma.     

Thirty-five years of follow-up before enucleation for malignant choroidal melanoma. A case report

We report the case of a patient with a unilateral chorioretinal lesion that evolved over 35 years before enucleation provided the diagnosis of amelanotic choroidal melanoma. This case is quite unusual in regards the long-term follow-up of this tumor before treatments were initiated. The patient showed no evidence of locoregional failure or distant metastasis at 30 months of follow-up.     

Iris mammillations as the only sign of ocular melanocytosis in a child with choroidal melanoma

An 8-year-old girl had visual loss in her left eye over 2 months. Ocular examination showed that visual acuity was counting fingers in the left eye. The left iris was moderately pigmented and thickened with numerous confluent, dome-shaped elevations on its surface, consistent with iris mammillations arising from ocular melanocytosis. There was total retinal detachment and an inferiorly located large amelanotic choroidal mass compressing the optic nerve. A specimen from a fine-needle aspiration biopsy showed spindle and epithelioid melanoma cells. The eye was enucleated. Pathologic examination showed that the bland melanocytes comprising the anterior border layer of iris formed focal aggregates, corresponding to the iris mammillations observed clinically. The uvea was diffusely thickened. Arising from the posterior choroid and obscuring the optic nerve head was a moderately pigmented spindle and epithelioid cell choroidal melanoma with diffuse lymphocytic infiltration and high mitotic activity. This case demonstrates that iris mammillations can be the initial manifestation of ocular melanocytosis in the absence of scleral pigmentation.     

Melanoma of the iris and pregnancy

Iris melanoma is a malignant melanocytic tumor, making up 1.2%-6.6% of uveal malignant melanomas. The growth of choroidal melanoma during pregnancy is described and a hormonal influence is suggested. We present a case of iris melanoma occurring during pregnancy. A 32-year-old woman, in the 28(th) week of her fifth pregnancy, was referred to the ophthalmologist with a 2-month history of blurred vision and pain in her left eye. The visual symptoms became progressively worse with decreasing vision. Her visual acuity was 20/70 in her left eye, with a temporal, pigmented, prominent iris mass extending into the trabecular meshwork and the corneal endothelium. Elsewhere other pigmented localizations were found in the iris and in the trabecular meshwork. There was secondary glaucoma with intraocular pressure of 36mmHg and C/D=0.9. The right eye was normal. A general physical examination found no pigmented lesions. Chest radiography and hepatic ultrasonography revealed no metastasis. The diagnosis of iris malignant melanoma was made from the diffuse involvement extending into the trabecular meshwork and the advanced secondary glaucoma; an enucleation was performed and histopathological examination confirmed the diagnosis of iris melanoma with involvement of the trabecular meshwork. The patient had no further problems (follow-up of 11 months). From this case report, we discuss the differential diagnosis of iris melanoma and the hormonal influence on its growth.     

Pyogenic granuloma of the lacrimal sac

In this report, we describe three adult patients diagnosed with lacrimal sac pyogenic granuloma. The presenting symptoms were acute dacryocystitis, lacrimal mass, and bloody tears. The nasolacrimal drainage pathway was obstructed in all cases. Radiologic evaluation performed in one patient revealed the presence of a well-defined mass in the sac with homogenous contrast uptake. Histopathologic examination revealed capillary proliferation and inflammatory cells in a fibromyxoid stroma. The patients were followed up for 11–23 months after external dacryocystorhinostomy without recurrence of the tumor or nasolacrimal obstruction. Pyogenic granuloma may develop from the lacrimal sac mucosa and may cause bloody epiphora. Such a tumor is visualized as a hemorrhagic mass lesion, and it may not have a negative effect on the outcome of DCR.     

Xanthogranuloma of the iris simulating melanoma in an adult

PURPOSE: To report a case in an adult of xanthogranuloma of the iris that clinically simulated iris melanoma. DESIGN: Observational case report. METHODS: Clinical and histopathologic examination of iris mass obtained from a 77-year-old white woman. RESULTS: High-frequency ultrasonography of the right eye revealed a small, echodense lesion involving the iris root. The mass revealed histopathologic features identical to juvenile xanthogranuloma (JXG), including histiocytes and lymphocytes mixed with multinucleated giant cells, and eosinophilic leukocytes. The histiocytes stained positive for CD68, CD45, and factor XIIIa and negative for S-100 and CD1a. CONCLUSIONS: Xanthogranuloma of the iris can occur in elderly patients. Such lesions should be considered in the differential diagnosis of iris melanoma.     

COVID-19-associated rhino-orbital- cerebral mixed mycoses with intracranial fungal granuloma – An aggressively managed rare entity

Rhino-orbital-cerebral mucormycosis (ROCM) with intracranial extension is a fatal disease. A case of extensive ROCM, with rare intracranial fungal granuloma, seen in a COVID-19 positive young male is described. A successful therapy consisting of a multidisciplinary approach for sinuses debridement, orbital exenteration, and intracranial granuloma excision was done. Nonseptate hyphae of Mucor and septate filamentous Aspergillus grew concurrently from exenterated orbital specimen.     

Pyogenic granuloma of the cornea

Background: Ocular pyogenic granulomata are uncommon and are often associated with a chalazion or previous ocular and adnexal surgery. The avascular nature of the cornea may explain the rarity of pyogenic granulomata at this site. We report on a case of corneal pyogenic granuloma following previous corneal surgery.
Methods: Ophthalmologists who had treated the patient previously were contacted and earlier clinical notes and histopathological examinations were reviewed. The clinical course following excision of the pyogenic granuloma is described, as are the histopathological findings.
Results: Histological examination confirmed the diagnosis of pyogenic granuloma. Excision was followed by a clinical recurrence at a different site with spontaneous resolution.
Conclusions: Pyogenic granulomata of the cornea are rare. However, the present case illustrates the importance of considering benign inflammatory causes in the differential diagnosis of a corneal mass lesion so as to avoid unnecessarily aggressive intervention. To our knowledge, spontaneous resolution of a corneal pyogenic granuloma has not been previously described.     

Cholesterol granuloma of the orbit: An atypical presentation

Cholesterol granuloma is a rare, well-defined lesion of the orbit. In the orbit, diploe of the frontal bone is involved almost exclusively. We report an atypical case of cholesterol granuloma involving superomedial quadrant of orbit. A 42-year-old male presented with progressive, painless, proptosis with infero-temporal displacement of left eye. A large mass was felt beneath the bony orbital margin in the superomedial quadrant of the left orbit. Computerized tomography (CT) scan revealed an extraconal superomedial, heterogeneous enhancing mass which was isodense with brain and pushing the globe inferolaterally and anteriorly. Excision biopsy of the tumor revealed the typical features of a cholesterol granuloma without any epithelial elements. Cholesterol granuloma of the orbit is a rare entity, but it can be diagnosed and differentiated from other lesions of the superior orbit by its characteristic clinical, radiological and histopathological features. An appropriate intervention in time carries a good prognosis with almost no recurrence.     

Endogenous bacterial endophthalmitis masquerading as an intraocular tumor

A 40-year-old female patient referred for a possible intraocular tumor was found to have an endogenous bacterial endophthalmitis in her right eye. Fundus examination revealed an amelanotic dome shaped choroidal mass and an exudative retinal detachment. Enhanced Depth Imaging-Optical Coherence Tomography (EDI-OCT), fundus autofluorescence (FAF) and ultrasounds were suggestive of a possible choroidal melanoma. A multimodal imaging approach and a thorough anamnesis were instrumental in establishing the correct diagnosis.     

Benign lymphoid infiltrate of the iris simulating a malignant melanoma

PURPOSE: To report a clinicopathologic correlation of an unusual benign lymphocytic iris mass in a patient who had no systemic lymphoproliferative disease. METHODS: Case report. RESULTS: A 49-year-old man developed a circumscribed, tan lesion in his left iris. The lesion was suspected clinically to be an atypical iris melanoma. Histopathologic studies of the resected mass revealed a solid tumor that was comprised of lymphocytes and histiocytes. Immunohistochemical studies identified that most of the cells were T lymphocytes. The histopathologic diagnosis was atypical lymphoid infiltrate. Workup for systemic lymphoma and Epstein-Barr virus infection was negative. CONCLUSION: Lymphoid infiltrate can manifest as a solitary mass that can simulate an iris melanoma.     

Bilateral diffuse melanocytic proliferation associated with ovarian carcinoma and metastatic malignant amelanotic melanoma

PURPOSE: To report a case of metastatic malignant amelanotic melanoma to the skin from a patient diagnosed with bilateral diffuse uveal melanocytic proliferation (BDUMP). This dermatological finding is a unique phenomenon associated with BDUMP. DESIGN: Retrospective case report. METHODS: We studied the case of a 66-year-old Caucasian woman with gradual onset of blurred vision in her right eye followed by her left eye. She had previously been diagnosed with ovarian carcinoma, and findings of funduscopic examinations were consistent with BDUMP. Metastatic examination revealed no evidence of liver involvement. Clinical and histopathological examinations of both enucleated eyes were consistent with BDUMP. RESULTS: The hematoxylin and eosin, S-100, and HMB-45 stains were consistent with metastatic malignant amelanotic melanoma to the skin. CONCLUSIONS: Although believed to have a low potential for metastasis, patients should be monitored and evaluated regularly to detect any new lesions not associated with their primary inciting carcinoma.     

Cholesterol granuloma of the orbit – pathogenesis and surgical management

Background: Cholesterol granuloma of the orbit is a rare entity, and its pathogenesis is still poorly understood. We report on 6 cases including one patient who had been examined by X-ray prior to the tumor's clinical manifestation. Patient data: All tumors were located in the superior temporal orbit. Histologically, they revealed the typical features of a cholesterol granuloma without any epithelial elements. They infiltrated the bone but left the soft tissues largely intact. Complete surgical removal of the granulomatous mass was attempted in each case, and particular attention was given to thorough abrasion of the bone. Only 2 patients reported a previous trauma. In one of them, retrospective evaluation of the X-ray scan taken a few hours after his accident revealed no definite changes in the orbital bone at the site of the future tumor. The only recurrence developed in a patient in whom the bony base of the tumor had not been drilled out completely. Conclusions: The origin of orbital cholesterol granuloma remains unknown. According to our data and those available in the literature, trauma is not a precondition but may accelerate growth. Some non-epithelial malformation in the bone, with a predelection in the temporal upper quadrant, might be the origin. To prevent a recurrence it appears essential to totally erase the tumor from its bony bed. This revised version was published online in September 2006 with corrections to the Cover Date.     

Adenoma of the nonpigmented ciliary epithelium

PURPOSE: To report the clinicopathologic features of an adenoma of the nonpigmented ciliary epithelium. DESIGN: Single interventional case report. METHODS. A nonpigmented iris and ciliary body tumor was diagnosed in a 66-year-old woman who complained of blurred vision related to a unilateral cataract. A combined cataract surgery and partial lamellar sclerouvectomy was performed. RESULTS: Histopathologic findings disclosed an adenoma of the nonpigmented ciliary epithelium. CONCLUSIONS: Unilateral cataract in an adult patient can be rarely related to a tumor growing from the ciliary epithelium. Adenoma of the non pigmented ciliary epithelium may mimic an amelanotic melanoma. Partial lamellar sclerouvectomy is an effective method to manage this condition and to confirm the diagnosis.