Metastatic carcinoma masquerading as lens matter.

A 64-year-old female was treated elsewhere as a case of iritis with topical steroids and mydriatics. As her symptoms persisted, she presented to us for further management with complaints of redness and pain. On ocular evaluation, a white fluffy material resembling lens matter was seen [Fig. 1]. Suspecting a delayed extrusion of lens matter in the anterior chamber, it was aspirated. During aspiration, surprisingly, a difficulty in the procedure was seen due to deep attachment with iris, hence the material was sent for histopathological evaluation which revealed carcinomatous infiltration [Fig. 2]. On her second visit, a creamy white mass protruding anteriorly was seen at the same location with the iris adjacent to it [Fig. 3].

Figure 1

Digital photograph of anterior segment of the right eye showing white fluffy matter resembling lens matter

Figure 2

Anterior chamber fluid cytology showing tightly packed cell clusters with focal necrosis (arrow head). The cells are hyperchromatic and pleomorphic suggestive of malignancy. No evidence of pigmented cells

Figure 3

Digital photograph of anterior segment of the right eye with recurrence of creamy white mass at the same location after aspiration

She later revealed a history of endometrial carcinoma 4 years ago and had undergone hysterectomy and bilateral salpingo-opherectomy. As the histopathology report showed stage I endometrial adenocarcinoma, chemotherapy or radiotherapy was not advised. She was advised regular follow-up by her gynecologist but she was lost for follow-up.

Now, her CT chest showed mediastinal lymphadenopathy and lymphangitic carcinomatosis and CT abdomen showed retroperitoneal lymphadenopathy suggestive of metastasis [Fig. 4]. She was treated with 6 cycles of chemotherapy. Her ocular evaluation showed the resolution of the white fluffy material over the iris [Fig. 5]. However she later succumbed to the disease.

Figure 4

Computed Tomography scan of chest and abdomen showing lymphangitic carcinomatous changes in lungs with mediastinal and retroperitoneal lymphadenopathy (arrow head)

Figure 5

Digital photograph of anterior segment of the right eye after the procedure

Endometrial carcinoma can be pathologically subdivided into type I adenocarcinoma and type II serous carcinoma.[1] Uterine endometrial adenocarcinoma is the most common and less aggressive. Uterine serous carcinoma is more aggressive endometrial carcinomas and can metastasize.

Planten et al., Capeans et al., and Kyung-Chul Yoon et al. have reported iris metastasis in patients with endometrial carcinoma.[234] Smith et al. has reported a case of endometrial carcinoma metastasizing to the choroid.[5] Unusual difficulty in aspiration of lens matter due to deep attachment raised our concern and helped in early diagnosis of late metastasis.

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