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Hemangioma of the Ciliary Body
HEMANGIOMA OF T H E CILIARY BODY Report of a case RAY K. DAILY, M.D., F.A.C.S. H O U S T O N , TEXAS
A case of this rare condition is described clinically and histologically with illustrations.
Rodin 1 reported a case of angioma of the iris and in a review of the litera ture found nine other reported cases. After a study of those reports he con cluded that only in three was the diag nosis justified clinically. A review of the available literature, discloses a cav ernous angioma of the ciliary body re ported by Griffith.2 It appears therefore that tumors of this type are very rare. History: B. C. J., five months of age, was referred by his pediatrist, Dr. N. N. Allen, because the child was in se vere pain, apparently from an inflamed right eye. His general examination was negative. An intradermal tuberculin test, and Wassermann reaction were negative, as were also Wassermann re actions of both parents. The mother stated that the child was having recur rent hemorrhages into the anterior chamber, which began without any rea son, seven weeks ago. She consulted Dr. J. O. McReynolds, who after a study of the case advised observation. Dr. McReynolds stated in a personal com munication that he considered the pos sibility of a small intraocular tumor. Examination: When seen first, April 28th, 1929, the infant was in very obvi ous distress, crying constantly, except when his head was under his mother's arm. He had severe photophobia, lacrimation, and marked bulbar congestion. The tension was high to touch and the anterior chamber was full of blood, making a detailed examination impos sible. By April 30th, most of the blood was absorbed ; some was settled at the bottom of the anterior chamber. The lacrimation and photophobia were less marked, and the bulbar congestion had also disappeared, except nasally, where, in the angle of the anterior chamber was a very narrow dark brown growth. Examined under an anesthetic, it con sisted of a dark dense mass, with a
lighter colored fringe, the latter pre sumably clotted blood. The cloudy aqueous humor did not permit a satis factory examination of the. fundus. Transillumination was negative. Ten sion was 80 mm. of mercury (McLean).
653
Fig. 1. (Daily). Drawing made while the child was under anes thesia.
The child continued to be in severe pain. Instillation of levoglaukosan had no effect on the pain, although the ten sion came down. A diagnosis of recur-
Fig. 2. (Daily). Drawing of the bisected eyeball.
rent hemorrhages due to an intraocu lar growth was made, and enucleation advised. The eye was enucleated on May 5th, 1929, and the child made an uneventful recovery. On opening the eyeball, a dense neo-
654
RAY K. DAILY
plasm, partly white and partly brown was found in the ciliary body; it was 7 mm. long, the width of the ciliary body, and 1 1/2 mm. thick. It produced an iridodialysis, and a brownish portion of it projected into the anterior chamber at the filtration angle.
about 2 mm. This projection is necrotic and is the probable source of the hemor rhage. There is a dense infiltration, at the filtration angle, of macrophages containing blood pigment. There are deposits of blood pigment in the tumor and a recent hemorrhage separates the posterior portion and the anterior choroid from the sclera. Iris adjacent to
Fig. 3. ( D a i l y ) . Section t h r o u g h the an terior segment of the eyeball.
The report3 of the microscopic exam ination is as follows: There is a marked thickening of the ciliary body on one side of the sections, composed of nu merous capillary vessels between which are cords of rather large cells with ve sicular nuclei. This structure forms a diffuse tumor replacing the normal structure of the ciliary body and ex tends back to the ora serrata in the choroid. There are several small ne crotic areas infiltrated with leucocytes. The neoplasm projects into the anterior chamber at the filtration angle for
Fig. 4 ( D a i l y ) . Section of the tumor.
the tumor is short and thick and is in filtrated to a moderate degree with tumor cells. Mitoses are rare. Diagno sis: Capillary hemangioma of ciliary body. Recurrent hemorrhage. 1117 Medical Arts building.
References ' A r c h , of Ophth., D e c , 1929. 2 T h e Medical Chronicle, 1892, v. 16, pp. 5 and 6. 3 T h e pathological report is by Major G. R. Callender, R e g i s t r a r of the Division of O p h t h a l mic P a t h o l o g y of T h e American Registry of P a t h o l o g y at the A r m y Medical Museum
A case of this rare condition is described clinically and histologically with illustrations.
Rodin 1 reported a case of angioma of the iris and in a review of the litera ture found nine other reported cases. After a study of those reports he con cluded that only in three was the diag nosis justified clinically. A review of the available literature, discloses a cav ernous angioma of the ciliary body re ported by Griffith.2 It appears therefore that tumors of this type are very rare. History: B. C. J., five months of age, was referred by his pediatrist, Dr. N. N. Allen, because the child was in se vere pain, apparently from an inflamed right eye. His general examination was negative. An intradermal tuberculin test, and Wassermann reaction were negative, as were also Wassermann re actions of both parents. The mother stated that the child was having recur rent hemorrhages into the anterior chamber, which began without any rea son, seven weeks ago. She consulted Dr. J. O. McReynolds, who after a study of the case advised observation. Dr. McReynolds stated in a personal com munication that he considered the pos sibility of a small intraocular tumor. Examination: When seen first, April 28th, 1929, the infant was in very obvi ous distress, crying constantly, except when his head was under his mother's arm. He had severe photophobia, lacrimation, and marked bulbar congestion. The tension was high to touch and the anterior chamber was full of blood, making a detailed examination impos sible. By April 30th, most of the blood was absorbed ; some was settled at the bottom of the anterior chamber. The lacrimation and photophobia were less marked, and the bulbar congestion had also disappeared, except nasally, where, in the angle of the anterior chamber was a very narrow dark brown growth. Examined under an anesthetic, it con sisted of a dark dense mass, with a
lighter colored fringe, the latter pre sumably clotted blood. The cloudy aqueous humor did not permit a satis factory examination of the. fundus. Transillumination was negative. Ten sion was 80 mm. of mercury (McLean).
653
Fig. 1. (Daily). Drawing made while the child was under anes thesia.
The child continued to be in severe pain. Instillation of levoglaukosan had no effect on the pain, although the ten sion came down. A diagnosis of recur-
Fig. 2. (Daily). Drawing of the bisected eyeball.
rent hemorrhages due to an intraocu lar growth was made, and enucleation advised. The eye was enucleated on May 5th, 1929, and the child made an uneventful recovery. On opening the eyeball, a dense neo-
654
RAY K. DAILY
plasm, partly white and partly brown was found in the ciliary body; it was 7 mm. long, the width of the ciliary body, and 1 1/2 mm. thick. It produced an iridodialysis, and a brownish portion of it projected into the anterior chamber at the filtration angle.
about 2 mm. This projection is necrotic and is the probable source of the hemor rhage. There is a dense infiltration, at the filtration angle, of macrophages containing blood pigment. There are deposits of blood pigment in the tumor and a recent hemorrhage separates the posterior portion and the anterior choroid from the sclera. Iris adjacent to
Fig. 3. ( D a i l y ) . Section t h r o u g h the an terior segment of the eyeball.
The report3 of the microscopic exam ination is as follows: There is a marked thickening of the ciliary body on one side of the sections, composed of nu merous capillary vessels between which are cords of rather large cells with ve sicular nuclei. This structure forms a diffuse tumor replacing the normal structure of the ciliary body and ex tends back to the ora serrata in the choroid. There are several small ne crotic areas infiltrated with leucocytes. The neoplasm projects into the anterior chamber at the filtration angle for
Fig. 4 ( D a i l y ) . Section of the tumor.
the tumor is short and thick and is in filtrated to a moderate degree with tumor cells. Mitoses are rare. Diagno sis: Capillary hemangioma of ciliary body. Recurrent hemorrhage. 1117 Medical Arts building.
References ' A r c h , of Ophth., D e c , 1929. 2 T h e Medical Chronicle, 1892, v. 16, pp. 5 and 6. 3 T h e pathological report is by Major G. R. Callender, R e g i s t r a r of the Division of O p h t h a l mic P a t h o l o g y of T h e American Registry of P a t h o l o g y at the A r m y Medical Museum