TUMOR IRIS

The iris : a thin, circular organ within the eye

which constricts (gets smaller) or dilates (gets
bigger) in order to control the amount of light
that reaches the retina.
A patients eye color is the color of the iris
which can be blue, gray, green, hazel, brown,
or any combination of these.

 Iris masses:
benign grown : cysts, freckles (known as nevi),
growths of blood vessels, and others.
Malignant tumors : iris or iridiociliary melanomas
or metastases (cancers that spread to the iris from
other parts of the body) can also develop.

 Iris nevi and melanomas are the most

common primary tumors of the iris,
with an incidence ranging from 5070% of all iris tumors
Melanomas arise from malignant
proliferation of the neuroectodermally
derived iris stromal melanocytes,
which replaces the normal iris stromal
architecture..

 Most iris melanomas are believed to arise from active

growth in preexisting nevi. Epidemiologic studies
suggest that sunlight exposure plays a role in their
pathogenesis. Chromosomal mutations may be
involved.
Secondary glaucoma in iris melanomas may result
from several different mechanisms, including the
following:
Invasion of malignant cells into the trabecular meshwork
Decreased aqueous outflow due to pigment-ingesting
macrophages blocking the angle
Angle closure
Neovascularization

 Many patients provide a history of a

nevus existing since childhood that
has suddenly undergone rapid
growth.
Some patients may experience pain
as a result of increased intraocular
pressure.

 Iris freckles :
brown, yellow, or grayish in color.
Can be small and flat or small and elevated.
Sometimes have cysts (fluid-filled spaces) in them
which can be detected on ultrasound.

The freckles occur at the bottom half of the iris.

Many of them never change or grow or some
grow very slowly. Rarely, they can grow into
an iris melanoma, a malignant tumor of the iris.

According to Shields, criteria for a clinical diagnosis of

melanoma are as follows:
The size is greater than 3 mm in diameter and 1 mm in
thickness.
It replaces the stroma of the iris.
Three of the following 5 features are present: photographic
documentation of growth, secondary glaucoma, secondary
cataract, prominent vascularity, or ectropion irides.

Differential Diagnosis
The differential diagnosis includes the
following:
Leiomyoma, Iris
Other problems to consider include the following:
Metastatic disease
Nevi
Iris cysts
Iridocorneal endothelial syndrome
Koeppe or Busacca nodules
Lisch nodules
Primary iris pigment epithelial tumors

 Medical care
Patients are observed through periodic
examinations, photographic
documentation, and ultrasonographic
biomicroscopy (UBM). Glaucoma can be
controlled by medication if no tumor
infiltration of the angle structures is
present.

 Surgical care
For iris melanoma, treatment consists of surgery
to remove the tumor, radiation, or sometimes
even just observation. Iris tumors tend to be
small and grow much more slowly and
metastasize less often than malignant tumors
that arise from other parts of the eye.
Metastasis to the eye (cancer which arises in
another part of the body and travels to the eye)
are relatively rare and often regress when the
underlying cancer is treated with systemic
(intravenous) chemotherapy.

Prognosis
Most primary tumors of the iris are benign. Iris
melanomas are considered to be much less aggressive
than melanomas of the choroid and the ciliary body.
Metastases occur in 2%-10% of all iris melanomas; a
higher rate of metastasis is observed in cases of ciliary
body involvement. Clinical features that may predict
metastasis from iris melanoma include the following:
Increasing age at diagnosis
Elevated intraocular pressure
Posterior tumor margin at angle or iris root
Extraocular extension
Prior surgical treatment of the tumor elsewhere before
referral