title: Lymph node metastases arising from uveal melanoma.
abstract: Since the eye lacks lymphatic vessels, uveal melanomas primarily metastasize hematogenously. Here we report the case of a patient with ciliary body ring melanoma who developed lymph node metastases after a fistulating glaucoma operation. A 40-year-old female Caucasian patient presented with unilateral pigment dispersion. Pigment dispersion glaucoma was diagnosed and since the intraocular pressure could not be managed with topical medication, transscleral cyclophotocoagulation and two trabeculectomies had to be performed. Due to enlargement of the pigmented iris mass and cell deposits in the chamber angle, a ciliary body ring melanoma was presumed and the eye enucleated. Histology confirmed the diagnosis of "ciliary body ring melanoma". Six months after enucleation the patient presented multiple metastases including ipsilateral preauricular and submandibular lymph node metastases. The patient died two months later. Lymph node metastases arising from ciliary body melanomas are very rare. Tumor seeding through the trabeculectomy site into the bleb and then via conjunctival lymphatic vessels might be the crucial factor for this pathway of metastases. Therefore, in cases of unilateral pigment dispersion, malignancy should be excluded before fistulating operations are performed.
authors.affiliation: Department of Ophthalmology, Medical University Graz, Graz, Austria. navid.ardjomand@meduni-graz.at
authors.forename: Navid
authors.initials: N
authors.lastname: Ardjomand
authors.forename: Peter
authors.initials: P
authors.lastname: Komericki
authors.forename: Gerald
authors.initials: G
authors.lastname: Langmann
authors.forename: Dietmar
authors.initials: D
authors.lastname: Mattes
authors.forename: Murat
authors.initials: M
authors.lastname: Moray
authors.forename: Michael
authors.initials: M
authors.lastname: Scarpatetti
authors.forename: Yosuf
authors.initials: Y
authors.lastname: El-Shabrawi
mesh_terms: D000328:Adult; D000867:Anterior Chamber / Q000473:pathology; D002924:Ciliary Body / Q000473:pathology* / Q000601:surgery; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007498:Iris / Q000473:pathology; D008028:Light Coagulation; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008853:Microscopy; D009333:Neck; D009361:Neoplasm Invasiveness / Q000473:pathology; D009887:Ophthalmoscopy; D011183:Postoperative Complications / Q000473:pathology* / Q000601:surgery; D012086:Reoperation; D014129:Trabecular Meshwork / Q000473:pathology; D014130:Trabeculectomy; D014604:Uveal Neoplasms / Q000473:pathology* / Q000601:surgery