Intraocular leiomyoma: Current concepts

Abstract

leiomyoma actin melanoma immunohistochemistry benign uvea a b s t r a c tIntraocular 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, highfrequency 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.

Micro-incision, trans-iridal aspiration cutter biopsy for ciliary body tumours

“…One was a melanocytoma and 1 was eventually found to be a leiomyoma after enucleation. 5 In 5 of 6 procedures, 3 passes were required to achieve specimen. Two surgeries for a total of 10 passes were required for 1 patient (case #4) with leiomyoma (Table 2).…”

“…This case emphasizes the difficulty diagnosing pigmented ciliary body leiomyomas by anything but gross tissue staining for smooth muscle actin. 5 No sutures were required to close the corneal entry wounds.…”

“…As is common, the 1 tumour that was not diagnosed by this method was not a melanoma but rather found to be a leiomyoma after enucleation. 5 No patients experienced post-treatment elevations of intraocular pressure. Four cases (66.7%) experienced transient hyphemas, which cleared within 7À10 days.…”

Inflammatory Myofibroblastoma Tumor of Intraocular Ciliary Body: A Case Report and Literature Review

“…Leiomyomas are rare benign tumors and commonly found in the uterus and alimentary tract [14].Light microscopically, the tumors are typically composed of interlacing bundles of spindle cells with blunt-ended oval nuclei, moderate amounts of eosinophilic brillation cytoplasm, and intracellular myoglial brils [15]. Leiomyomas are most consistently reactive to SMA and uniformly negative for staining with ALK, S-100, and HMB-45 [16].…”

Pathology features and the results of treatment of two cases of posterior choroidal leiomyoma

“…Posterior choroidal leiomyoma is extremely rare and is very difficult to be differentiated clinically, especially the amelanotic melanoma. Even with the magnetic resonance imaging (MRI), A-and B-scan ultrasonography [9] and fluorescein angiogram, CL still difficult to distinguish from amelanotic choroidal melanoma, RPE adenoma or metastasis. Thus far, there are less than 10 cases reported the neoplasm was located exclusively in the posterior choroid [1][2][3][4][5][6][7].…”