eMedicine Specialties > Ophthalmology > Iris & Ciliary Body

Leiomyoma, Iris: Differential Diagnoses & Workup

Author: Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Coauthor(s): Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic; C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institute
Contributor Information and Disclosures

Updated: Dec 27, 2007

Differential Diagnoses

Foreign Body, Intraocular
Juvenile Xanthogranuloma
Melanoma, Ciliary Body
Melanoma, Iris

Other Problems to Be Considered

Amelanotic melanoma of the iris
Foreign body in the iris
Peripheral anterior synechiae
Lymphoid hyperplasia
Iridoschisis
Iridic neovascularization
Atypical vessels of the iris
Hemangioma
Siderosis
Hemosiderosis
Iridic abscess

Workup

Imaging Studies

  • Ultrasound biomicroscopy (UBM) may be helpful for evaluating this tumor.
  • Electron microscopy shows the characteristic features of a smooth muscle neoplasm (thin basement membrane; plasmalemmal vesicles; and numerous, longitudinally aligned cytoplasmic filaments with scattered associated densities).
  • Fluorescein angiography
    • Hyperfluorescence is noted in the peripheral part of the tumor.
    • Reported as a preoperative mapping procedure in the 1970s, fluorescein angiography is perceived to be of limited value today.

Other Tests

  • Immunohistochemistry
    • The findings are consistent with a myogenic tumor.
    • The tumor cells are positive for smooth muscle actin and desmin.
    • The tumor cells are negative for S-100 and melanin.

Procedures

  • Fine-needle aspiration biopsy  
    • This test may be performed when clinical suspicion is high.
    • The sample may be sent for cytologic study with the use of electron microscopy and immunohistochemistry.
    • Its value may be limited because of the small sample obtained.
  • Transillumination
    • A leiomyoma transmits more light than a melanoma.
    • The more peripheral part of the tumor may be translucent.
    • Even amelanotic melanomas contain small amounts of melanin sufficient to cast a relative shadow.

Histologic Findings

Light microscopy shows the characteristic appearance of a leiomyoma with interlacing, densely packed, elongated, spindle-shaped cells, with long oval nuclei that tend to be arranged in a palisading manner, and granular eosinophilic cytoplasm of the cells and myofibrils.

More on Leiomyoma, Iris

Overview: Leiomyoma, Iris
Differential Diagnoses & Workup: Leiomyoma, Iris
Treatment & Medication: Leiomyoma, Iris
Follow-up: Leiomyoma, Iris
Multimedia: Leiomyoma, Iris
References
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References

  1. Ashton N, Wybar K. Primary tumours of the iris. Ophthalmologica. 1966;151(1):97-113. [Medline].

  2. Biswas J, Kumar SK, Gopal L, Bhende MP. Leiomyoma of the ciliary body extending to the anterior chamber: clinicopathologic and ultrasound biomicroscopic correlation. Surv Ophthalmol. Jan-Feb 2000;44(4):336-42. [Medline].

  3. Brovkina AF, Chichua AG. Value of fluorescein iridography in diagnosis of tumours of the iridociliary zone. Br J Ophthalmol. Mar 1979;63(3):157-60. [Medline].

  4. Campbell RJ, Min KW, Bolling JP. Skeinoid fibers in mesectodermal leiomyoma of the ciliary body. Ultrastruct Pathol. Nov-Dec 1997;21(6):559-67. [Medline].

  5. De Buen S, Olivares ML, Charlín C. Leiomyoma of the iris. Report of a case. Br J Ophthalmol. May 1971;55(5):353-6. [Medline].

  6. Eide N, Farstad IN, Røger M. A leiomyoma of the iris documented by immunohistochemistry and electron microscopy. Acta Ophthalmol Scand. Aug 1997;75(4):470-3. [Medline].

  7. Foss AJ, Pecorella I, Alexander RA, Hungerford JL, Garner A. Are most intraocular "leiomyomas" really melanocytic lesions?. Ophthalmology. May 1994;101(5):919-24. [Medline].

  8. Ishigooka H, Yamabe H, Kobashi Y, Nagata M. Clinical and pathological status of mesectodermal leiomyoma of the ciliary body. A case report and review of the literature. Graefes Arch Clin Exp Ophthalmol. 1989;227(2):101-5. [Medline].

  9. Jellie HG, Gonder JR, Willis NR, Green L, Tokarewicz AC. Leiomyoma of the iris. Can J Ophthalmol. Jun 1989;24(4):169-71. [Medline].

  10. Li ZY, Tso MO, Sugar J. Leiomyoepithelioma of iris pigment epithelium. Arch Ophthalmol. Jun 1987;105(6):819-24. [Medline].

  11. Lowe RF, Greer CH. Benign epithelioma of the iris. A clinico-pathological case report. Br J Ophthalmol. Nov 1971;55(11):773-6. [Medline].

  12. Noor Sunba MS, Rahi AH, Garner A, Alexander RA, Morgan G. Tumours of the anterior uvea. III. Oxytalan fibres in the differential diagnosis of leiomyoma and malignant melanoma of the iris. Br J Ophthalmol. Nov 1980;64(11):867-74. [Medline].

  13. Okamoto N, Sotani T, Shimo-Oku M, Sashikata T. A case with leiomyoma of iris extirpated with cryosurgery and its pathological findings. Acta Ophthalmol (Copenh). Apr 1982;60(2):183-9. [Medline].

  14. Orsoni JG, Daicker B, Cardillo Piccolino F. Mesectodermal leiomyoma of the ciliary body extending into the anterior chamber. Ophthalmologica. 1985;191(2):127-9. [Medline].

  15. Palm E, Linder B. Excision of tumours in the iris and the ciliary body. Acta Ophthalmol (Copenh). 1968;46(3):521-8. [Medline].

  16. Peyman GA, Alghadyan A, Peace JH. A contact Nd:YAG laser to resect large ciliary body and choroidal tumors. Int Ophthalmol. Oct 1987;11(1):55-61. [Medline].

  17. Price MJ, Bell RA, Willis WE, Whiteman DW. Tapioca melanoma of the iris: clinicopathological correlation with results of fluorescein angiography. Can J Ophthalmol. Oct 1981;16(4):195-9. [Medline].

  18. Sevel D, Tobias B. The value of fluorescein iridography with lleiomyoma of the iris. Am J Ophthalmol. Sep 1972;74(3):475-8. [Medline].

  19. Shields JA, Sanborn GE, Augsburger JJ. The differential diagnosis of malignant melanoma of the iris. A clinical study of 200 patients. Ophthalmology. Jun 1983;90(6):716-20. [Medline].

  20. Tuncer S, Peksayar G, Demiryont M, Gozum N. Longterm follow-up of a patient with iris leiomyoma treated with partial lamellar iridocyclectomy. Acta Ophthalmol Scand. Feb 2004;82(1):112-4. [Medline].

  21. Yu DY, Cohen SB, Peyman G, Tso MO. Mesectodermal leiomyoma of the ciliary body: new evidence for neural crest origin. J Pediatr Ophthalmol Strabismus. Nov-Dec 1990;27(6):317-21. [Medline].

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Further Reading

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Keywords

iris leiomyoma, leiomyoma of the iris, benign intraocular smooth muscle tumor

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Contributor Information and Disclosures

Author

Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Manolette R Roque, MD, MBA, DPBO, FPAO is a member of the following medical societies: American Academy of Ophthalmic Executives, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic
Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institute
C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, Sigma Xi, and Washington State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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