PMC4209779_01
Slit lamp photograph of the left eye 1 month after initial presentation showing a nasal anterior scleral bulge reaching the limbus with prominent dilated episcleral vessels.
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Our initial working diagnosis was ocular toxocariasis (OT) and the patient was advised a 30-day course of oral albendazole as well as local excision of the scleral mass (Figure 1).
The anterior scleral mass of the left eye has grown in all dimensions and invaded the cornea. Photograph was taken in the operating room 3 months after Figure 1.
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Three months after presentation, the bulge of the sclera was mimicking clinically a ciliary body tumor, namely, medulloepithelioma (Figure 2).
B-scan of the eye shows an intraocular homogeneous mass behind the posterior lens capsule and involving the retina and vitreous. The mass has medium to high reflectivity.
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B-scan (Figure 3) revealed a large intraocular mass of medium to high reflectivity behind the posterior capsule extending to the peripheral retina.
Magnetic resonance imaging scan demonstrates an anterior scleral mass behind the iris plane and with nasal scleral bulge.
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MR orbit (Figure 4) revealed 12 x 13 x 9 mm lesion arising from the medial aspect of the iris to the medial canthus which was isointense on T1 and hypointense on T2 along with intense enhancement after gadolinium injection suggestive of medulloepithelioma or melanoma.
Gross view of the eyeball with nasal mass involving cornea and anterior sclera.
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The globe was enucleated (Figure 5).
Inflammatory cell infiltration of the peripheral anterior vitreous base, sclera, and medial rectus insertion (hematoxylin and eosin stains).
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The medial rectus muscle was lost during isolation of the muscle as the insertion was very friable overlying the scleral mass (Figure 6).
Homogeneous mass in the ciliary body area pressing on the posterior iris plane consisting of a dense population of lymphocytes with histiocytic aggregates (hematoxylin and eosin stains).
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The mass measured 13 mm by 13 mm by 5 mm (horizontal x vertical x height) (Figures 7 and 8).
Nasal mass has invaded part of the limbal cornea and most of the sclera (extreme scleral thinning) (hematoxylin and eosin stains).
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The mass measured 13 mm by 13 mm by 5 mm (horizontal x vertical x height) (Figures 7 and 8).
Giant cells (a), histiocytic aggregates (b), and eosinophils (c) are seen within the mass.
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The whole mass consisted of lymphocytes, clusters of histiocytes, scattered giant cells, and few eosinophils (Figure 9).