Leiomyom – tumor řasnatého tělesa. Kazuistika

Leiomyoma – Ciliary Body Tumor. A Case Report

Aim: To demonstrate a rare case of ciliary body leiomyoma in our patient

Case report: A 72-year-old female reported to our clinic for a preventive examination, upon which we found a dome-shaped grey-brownish mass on the retinal periphery. After completing gonioscopic and ultrasound examinations, we referred the patient to a specialist facility. Due to a finding of suspicious malignant melanoma, we completed the MRI scan and recommended enucleation of the eyeball. A histopathological examination showed a leiomyoma of the ciliary body.

Conclusion: The aim of this case report is to demonstrate the difficulty of intraocular leiomyoma diagnosis. Only immunohistochemical examination differentiated the tumor from malignant melanoma and determined the diagnosis of ciliary body leiomyoma. Perhaps because of the extreme rarity of this type of tumor, we often neglect to consider a diagnosis of leiomyoma.

Keywords:

melanoma – Leiomyoma – ciliary body – intraocular tumor

Autoři: Karolína Černá ¹; Zuzana Hlinomazová ¹; Johana Glezgová ²; Kateřina Ambrosová ^3,4
Působiště autorů: Lexum a. s. ¹; Oční klinika Všeobecné fakultní nemocnice v Praze a 1. lékařské fakulty Univerzity Karlovy ²; Oblastní nemocnice Mladá Boleslav, a. s., nemocnice Středočeského kraje ³; Laboratoř patologie a klinické cytologie Unilabs Pathology k. s., Laboratoř Praha ⁴
Vyšlo v časopise: Čes. a slov. Oftal., 80, 2024, No. Ahead of print, p. 1-6
Kategorie: Kazuistika
doi: https://doi.org/10.31348/2024/30

Souhrn

Cíl: Prezentovat vzácný případ leiomyomu řasnatého tělesa naší pacientky.

Kazuistika: 72letá pacientka přichází na preventivní vyšetření do naší ambulance, kde nalézáme v periferii sítnice kopulovitý šedo-hnědavý útvar. Po doplnění gonioskopického a ultrazvukového vyšetření posíláme pacientku na pracoviště vyššího typu. Pro nález suspektního maligního melanomu doplňujeme vyšetření magnetické rezonance a doporučujeme enukleaci bulbu. Histopatologické vyšetření prokazuje leiomyom řasnatého tělesa.

Závěr: Cílem kazuistiky je demonstrovat obtížnost diagnostiky nitroočního leiomyomu. Až imunohistochemické vyšetření odlišilo tumor od maligního melanomu a ukázalo na diagnózu leiomyomu řasnatého tělesa. Možná i pro extrémní vzácnost tohoto typu nádoru na diagnózu leiomyomu málo pomýšlíme.

Klíčová slova:

melanom – Leiomyom – řasnaté těleso – nitrooční nádor

Stránka z

Zdroje

Tomar AS, Finger PT, Iacob CE. Intraocular leiomyoma: Current concepts. Surv Ophthalmol. 2020 Jul;65(4):421-437.
Sadda SR, Wilkinson CP, Wiedemann P, Schachat AP, editors. Ryan’s Retina. Volume 3/ editor-in-chief SriniVas R. Sadda, MD (Professor of Ophthalmology, Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA). Sixth edition. London New York Oxford Philadelphia St Louis Sydney: Elsevier;2018. 1821 p.
Shields C, Shields J, Remmer M, Kaliki S, Eagle R. Giant leiomyoma of the ciliary body. Oman J Ophthalmol. 2014;7(2):81.
Biswas J, Kumar SK, Gopal L, Bhende MP. Leiomyoma of the Ciliary Body Extending to Anterior Chamber. Surv Ophthalmol. 2000 Jan;44(4):336-342.
Plesníková P, Jurenová D, Lysková D, Furdová A, Valášková J, Babál P. Ciliary Body Leiomyoma. Case Rep Ophthalmol. 2022 April 5;13(1):259-264.
Kim JM, Hall LB, Elia M, Ehrlich MS, Materin MA, Sinard JH. Acute Presentation of Mesectodermal Leiomyoma of the Ciliary Body. Ocul Oncol Pathol. 2017;3(4):304-309.
Fernandez de Castro JP, Syed NA. Clinicopathologic Correlation: Ciliary Body Leiomyoma. EyeRounds.org. Sept. 9, 2009; Available from: http://webeye.ophth.uiowa.edu/eyeforum/cases/ 64-Leiomyoma-Clinicopathologic.htm
Tomar AS, Fam A, Finger PT, Iacob CE. Doppelgänger dilemna: Leiomyoma versus uveal melanoma. AM J Ophthalmol Case Rep. 2021 Jun;22:101040.
Oh KJ, Kwon BJ, Han MH et al. MR imaging findings of uveal leiomyoma: three cases. AJNR Am J Neuroradiol. 2005 Jan;26(1):100-103.
Zhou N, Wei W, Xu X. Pathology features and the recults of treatment of two cases of posterior choroidal leiomyoma. BMC Ophthalmol. 2020 Dec;20(1):198.
Salmon JF, Kanski JJ. Kanski’s clinical ophthalmology: a systematic approach. 9th edition. Erscheinungsort nicht ermittelbar: Elsevier; 2020. p.941.
Kadaika A, Zhang J, Yao X, Zhou Q, Heiferman MJ. Ultrasound in ocular oncology: Technical advances, clinical applications, and limitations. Exp Biol Med. 2023 May 22;248(5):371-379.
Foti PV, Travali M, Farina R, et al. Diagnostic methods and therapeutic options of uveal melanoma with emphasis on MR imaging-Part I: MR imaging with pathologic correlation and technical considerations. Insights Imaging. 2021 Jun 3;12(1):66.
Medina CA, Plesec T, Singh AD. Optical coherence tomography imaging of ocular and periocular tumours. Br J ophthalmol. 2014 Jul 1;98(Suppl 2):ii40-46.
Kuchynka P. Oční lékařství. 2.vyd. Praha:Grada;2016.936. Czech.
Rusňák Š, Hecová L, Kasl Z, Sobotová M, Hauer L. Uveal Melanoma Biopsy. A review. Cesk Slov Oftalmol. 2020 Aug 30;76(6):247252.
Frizziero L, Midena E, Trainiti S, et al. Uveal Melanoma Biopsy: A Review. Cancers. 2019 Jul 30;11(8):1075.
Singh AD, Biscotti CV. Fine needle aspiration biopsy of ophthalmic tumors. Saudi J Ophthalmol. 2012 Apr 1;26(2):117-123.
Solnik M, Paduszyńska N, Czarnecka AM, et al. Imaging of Uveal Melanoma-Current Standard and Methods in Development. Cancers. 2022 Jan;14(13):3147.
Foti PV, Travali M, Farina R, et al. Diagnostic methods and therapeutic options of uveal melanoma with emphasis on MR imaging-Part II: treatment indications and complications, Insights Imaging. 2021 Jun 4;12(1):67.

Rusňák Š, Hecová L, Kasl Z, Sobotová M, Hauer L, Therapy of Uveal Melanoma. A Review. Cesk Slov Oftalmol. 2021 Aug 30;77(1):1-13.
Grossniklaus HE, Eberhart CG, Kivelä TT. WHO classification of tumours of the eye. 4th ed. Lyon: International agency for research on cancer;2018. (Worlh health organization classification of tumours).
Konstantinidis L, Damato B. Intraocular Metastases-A Review. Asia-Pac J Ophthalmol. 2017 Apr;6(2):208.
Jindal A, Kapatia G, Gupta G. Ocular metastasis from renal malignacies A comprehensive review. Indian J Ophthalmol. 2023 Oct;71(10):3281.
Yu Y, Cheng Y, Wang K, Sun K, Shen D, Liang J. Intraocular schwannoma: A case series of 3 patients. Oncol Lett. 2019 Jan;17(1):1274-1278.
Reidy JJ, Apple DJ, Steinmetz RL, et al. Melanocytoma: nomenclature, pathogenesis, natural history and treatment. Surv Ophthalmol. 1985;29(5):319-327.
Shields JA, Demirci H, Mashayekhi A, Eagle RC, Shields CL. Melanocytoma of the optic disk: A review. Indian J Ophthalmol. 2019 Dec;67(12):1949-1958.
Pecorella I, Ciocci L, Modesti M, Appolloni R. Adenoma of the non-pigmented ciliary epithelium: A rare intraocular tumor with unusual immunohistochemical findings. Pathol Res Pract. 2009 Dec 15;205(12):870-875.
Mansoor S, Qureshi A. Ciliary body adenoma of non-pigmented epithelium. J Clin Pathol. 2004. Sep;57(9):997-998.
Peshtani A, Kaliki S, Eagle RC, Shields CL. Medulloepithelioma: A triad of clinical features. Oman J Ophthalmol. 2014;7(2):93-95.
https://fyra.io. Retina Today. Bryn Mawr Communications; [cited 2024 March 13]. Choroidal Hemangioma Masquerading as Central Serous Chorioretinopathy. Available from: https://retinatoday. com/articles/2012-apr/choroidal-hemangioma-masquerading-as-central-serous-chorioretinopathy
Karimi S, Nourinia R, Mashayekhi A. Circumscribed Choroidal Hemangioma. J Ophthalmic Vis Res. 2015;10(3):320-328.