Diagnostic and management challenges of ciliary body tumor in an African-American patient

Abstract

Purpose: To discuss the diagnostic and management challenges of a ciliary body tumor in an African-American patient. Procedures: Our 52-year-old African-American female patient, referred with a nasal ciliary body tumor in the right eye, underwent investigations including A- and B-scan ultrasonography, Optos fundus photography and fundus fluorescein angiography at clinical consultation. A diagnostic fine-needle aspiration cytology and open flap biopsy were undertaken. Results: Histopathology and cytology confirmed a malignant melanoma, which is extremely rare in the African-American population. The patient was treated with brachytherapy with an iodine-131 plaque ensuring adequate coverage of the tumor site but, at the same time, taking special precaution not to disturb the biopsy site. Conclusions: The diagnosis of a ciliary body tumor, especially in an African-American patient, can be challenging despite advances in imaging systems, given the multitude of differential diagnoses. Uveal melanomas are extremely rare in African-Americans. On detailed questioning, our patient reported having mixed ancestry, with Caucasian ancestors on the mother's side and native Indian ancestors on the father's side. Information on true ethnicity should be specifically asked for as it alters the incidence rate. Biopsy provides the only option for a correct diagnosis and for developing a management plan. Fine-needle aspiration biopsy can be diagnostic, though an open flap biopsy is superior as it provides information on tissue architecture and the possibility of immunohistochemistry. Also, with plaque brachytherapy treatment, special care needs to be taken not to disturb the biopsy site to reduce the risk of seeding, and an innovative approach may need to be taken to ensure adequate radiation coverage of these anterior tumors.