title: Diagnostic surprise in an evisceration specimen.
abstract: OBJECTIVE
  To report a rare ocular tumor discovered incidentally after evisceration of a painful blind eye.
  
  
  METHODS
  Observational case report.
  
  
  RESULTS
  A 67-year-old Caucasian lady presented for elective evisceration of chronically irritable phthisical right eye. A history of bilateral retinal detachment surgery 34 years prior followed by phthisis of the right eye was noted. The patient was a smoker but otherwise fit and well. Intra-operatively, the ocular contents were felt to be unusual with hard deeply pigmented lumps being present in the eviscerated tissue. The specimen was sent for histopathology. This was reported as a primary adenocarcinoma of the retinal pigment epithelium after expert histological opinion. The possibilities of a secondary adenocarcinoma with possible primary sites as lung, breast or kidney were ruled out by immuno-histochemical techniques. The patient underwent extensive systemic screening including a whole body CT scan. Exhaustive investigations have not found any other tumor site.
  
  
  CONCLUSIONS
  In the absence of a recognizable source of metastasis, a diagnosis of primary ocular adenocarcinoma has been made with retinal pigment epithelium being the possible site of origin. Literature review shows that primary ocular adenocarcinoma arising from neuroepithelium is a rare but recognized occurrence especially in longstanding blind eyes. This case highlights the importance of routine histopathological examination of eviscerated ocular contents, especially in long standing blind eyes.
authors.affiliation: Department of Ophthalmology, Clarendon Wing, Leeds General Infirmary, Leeds, UK. musmansaeed@aol.com
authors.forename: Muhammad Usman
authors.initials: MU
authors.lastname: Saeed
authors.forename: Bernard Yp
authors.initials: BY
authors.lastname: Chang
authors.forename: Seema
authors.initials: S
authors.lastname: Anand
authors.forename: Arundhati
authors.initials: A
authors.lastname: Chakrabarty
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D003937:Diagnosis, Differential; D017234:Eye Evisceration; D005260:Female; D006801:Humans; D033162:Incidental Findings; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000473:pathology