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Biopsy of an Anterior Episcleral Nodule as an Aid in Managing a Ciliary Body Melanocytic Tumor

Jakobiec, Frederick A. MD; Gragoudas, Evangelos S. MD; Colby, Kathryn A. MD, PhD

doi: 10.1097/ICO.0b013e31829131f8
Case Report

Purpose: To demonstrate the value of a diagnostic biopsy of a fixed episcleral nodule overlying a uveal mass.

Method: Clinicopathologic report with immunohistochemical investigations.

Results: B-scan ultrasonographic biomicroscopy disclosed in a 67-year-old man an asymptomatic placoid ciliary body tumor measuring 1.28 mm in thickness underlying a poorly pigmented, fixed episcleral nodule 0.56 mm in thickness. Biopsy of the episcleral nodule displayed benign nevus-type spindle cells with small nuclei, punctate nucleoli, no mitoses, and scattered melanophages. Immunohistochemistry demonstrated that the tumor cells were Ki67 negative (proliferation index, 0) and MART-1, HMB-45, and microphthalmia-associated transcription factor positive, all melanocytic markers. The melanophages but not the tumor cells were CD68 positive, a histiocytic marker.

Conclusions: The results from biopsying an episcleral nodule can help to select among therapeutic options in managing an associated ciliary body tumor. A 1-year follow-up study and 3 sequential ultrasonographic studies in the current patient have failed to document the growth of the intraocular tumor, further confirming that it is a nevus. The excised epibulbar tumor has not recurred.

*David G. Cogan Laboratory of Ophthalmic Pathology;

Retina Service; and

Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Reprints: Frederick A. Jakobiec, David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received December 21, 2012

Accepted March 08, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.