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Case Reports
. 2021 Mar 6:22:101040.
doi: 10.1016/j.ajoc.2021.101040. eCollection 2021 Jun.

Doppelgänger dilemma: Leiomyoma versus uveal melanoma

Ankit Singh Tomar  1 , Anthony Fam  1 , Paul T Finger  1   2 , Codrin E Iacob  2
Affiliations
Case Reports

Doppelgänger dilemma: Leiomyoma versus uveal melanoma

Ankit Singh Tomar et al. Am J Ophthalmol Case Rep. .

Abstract

Background: Ciliary body tumors can remain undetected and achieve large dimensions. Pigmented ciliary body tumors include: melanoma, leiomyoma and melanocytoma, however correct diagnosis may require tissue diagnosis with immunohistochemical stains.

Case presentation: Two men presented with identical ciliochoroidal tumors. Both had darkly pigmented dome-shaped anterior uveal masses, exudative retinal detachments and transillumination shadowing. Ocular PET-CT imaging revealed that both were metabolically active consistent with a diagnosis of cancer. However, immunohistochemical examination revealed one a leiomyoma and the other melanoma.

Conclusion: Uveal leiomyoma can be an indistinguishable doppelgänger to ciliochoroidal melanoma, where the diagnosis can only be established by immunohistopathology.

Keywords: Benign; Immunohistochemistry; Leiomyoma; Melanoma; Uvea.

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Figures

Fig. 1
Fig. 1
(A–D): A: A 30-year-old man with nasal ciliary body tumor, B: Note the dysmorphic fovea. C: A 45-year-old man with temporal ciliary body tumor, D: Note the dysmorphic fovea.
Fig. 2
Fig. 2
(A–D): A, B: A 30-year-old man with nasal ciliary body tumor. B-scan ultrasound shows a dome-shaped, moderately low reflective choroidal tumor. Note the small secondary retinal detachment adjacent to the tumor. C, D: A 45-year-old man with temporal ciliary body tumor. B-scan shows a dome-shaped, moderately reflective choroidal tumor. Note the secondary retinal detachment adjacent to the tumor.
Fig. 3
Fig. 3
(A–D): A, B: Leiomyoma pathology analysis reveals: 3A (Hematoxylin-Eosin stain, original magnification × 100) shows spindle mesenchymal cells, with cigar-shaped nuclei and vesicular chromatin. 3B Immunohistochemistry of this tumor shows positive immunoreactivity for smooth muscle actin (SMA) (original magnification × 100). C, D: Uveal melanoma pathology reveals: 3C (Hematoxylin-Eosin stain, original magnification × 100) shows histopathologically similar spindle-shaped cells with marked nuclear enlargement and prominent nucleoli. 3D In contrast, immunohistochemistry shows positive immunoreactivity for HMB-45 (original magnification × 100).
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References

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