fuchs ' adenoma is a benign tumor , which develops at the pars plicata of the ciliary body . it is believed to be a reactive age - related proliferation of the nonpigmented ciliary epithelium ; hence it is called age - related hyperplasia of the nonpigmented ciliary epithelium [ 1 , 2 , 3 , 4 ] . these are extremely common lesions , found in 2031% of eyes in two post mortem series , yet rarely encountered on clinical examination . fuchs ' adenomas are benign but can rarely cause iris protrusion , shallowing of the anterior chamber , or glaucoma and have also been mistaken as iris or ciliary body melanomas [ 3 , 5 ] . we here report a case of choroidal fuchs ' adenoma in a middle - aged female , a 54-year - old female was referred to our department with the possible diagnosis of choroidal hemangioma . the patient had already received three sessions of photodynamic therapy ( pdt ) , but there was no improvement and she was referred to our clinic . at that time , visual acuity was 20/60 in her left eye . slit lamp examination of the anterior segment was normal . non - contact lens fundoscopy revealed an amelanotic mass in the posterior pole , involving the macula and extending up to the superior temporal vascular arcade . the mass had some secondary changes and pigmentation in the inferior part and at the margins of the lesion ( fig . indocyanine green chorioangiography ( icg ) revealed a hypofluorescent choroidal lesion with hyperfluorescent margins ( fig . b - scan ultrasonography showed a bilobular choroidal mass with moderate reflectivity , compared to low reflectivity of choroidal melanoma , and measuring 9.5  8.6 mm with a prominence of 3.9 mm ( fig . 1d ) . another session of pdt was performed but the mass did not show any regression on follow - up . therefore , the decision of performing a biopsy of the lesion was made to establish the definitive diagnosis . histopathology of the obtained sample revealed compact interlacing cords of epithelial cells with fairly large amounts of amorphous extracellular matrix that stained positive with periodic acid - schiff ( pas ) stain ( fig . benign ciliary epithelioma or age - related hyperplasia of the nonpigmented ciliary epithelium was first described by fuchs in 1883 , and hence called fuchs ' adenoma . initially it was believed to be a rare tumor , generally found in eyes with a history of ocular inflammation or other abnormalities . but later , fuchs ' adenomas were found incidentally in autopsy series , unrelated to other ocular disorders . pathologically , the tumor is composed of proliferation of cords of nonpigmented ciliary epithelium embedded in a pas - positive basement membrane - rich stroma . the tumors are mostly asymptomatic ; however , they can mimic the clinical diagnosis of malignancy . so far cases of ciliary body fuchs ' adenoma confirmed on histopathology have been reported but our literature search disclosed no report of a choroidal fuchs ' adenoma [ 2 , 3 , 4 ] . in summary , we report a case of fuchs ' adenoma of the choroid presenting as a lesion at the posterior pole and showing no treatment response with pdt . fuchs ' adenoma can occur in the choroid and can simulate hemangioma or malignant melanoma .
we report the case of a 54-year - old female who was referred to us with an amelanotic mass on the posterior pole of the left eye involving the macula . 
 fundus fluorescein angiography revealed a hyperfluorescent choroidal mass . 
 indocyanine green chorioangiography revealed a hypofluorescent choroidal lesion with hyperfluorescent margins . 
 b - scan ultrasonography showed a choroidal mass with moderate reflectivity . 
 choroidal biopsy was performed , which revealed the diagnosis of fuchs ' adenoma .