Multicavitary ciliary body melanoma presenting as a cyst
A 66-year-old Caucasian female was referred to the Ocular Oncology Service at Wills Eye Institute for a “cystic” ciliary body mass in the right eye (OD). On examination, visual acuity was 20/20 in both eyes. Anterior and posterior segment examination of the left eye oculus sinister (OS) was normal. Slit lamp evaluation of the right eye revealed anterior bulging of the iris temporally at 9:00 []. On pupillary dilation, a pigmented ciliary body mass was noted, estimated to be 7 millimeters (mm) in base and 4 mm in thickness. Transillumination disclosed a shadow 7 mm in diameter, corresponding to the mass. On UBM, a multinodular ciliary body mass with solid tumor in the posterior and basal region was noted. Large areas of acoustically empty cavities were present and lined tissue walls measured 100–500 μm []. The cavities occupied approximately 80% of the tumor volume. A clinical diagnosis of cavitary ciliary body melanoma OD was made and complete tumor resection with partial lamellar sclero iridocyclectomy was performed.\nGrossly, the sectioned tumor showed an irregular pigmented mass with numerous irregular cystic cavities []. Histopathology disclosed a ciliary body tumor composed of low-grade amelanotic spindle-shaped melanoma cells with round or oval nuclei and containing finely dispersed chromatin [ and ]. The tumor displayed extensive cavitary degeneration with multiple empty and proteinaceous fluid-filled cavities separated by trabeculae comprised of melanoma cells. There was no epithelial lining of the cavities. Only one mitotic figure was counted in 40 high power fields. Immunohistochemistry with melanoma markers indicated positivity with microphthalmia transcription factor-2, confirming the diagnosis of low-grade spindle melanoma of the ciliary body []. At 3 years follow-up, there was no recurrence locally or systemically. Visual acuity was reduced to hand motions secondary to later retinal detachment, probably secondary to a retinal tear that was successfully treated.