Case Study: December 2013


  • 70 year old male.
  • Cream lesion on iris over 3 clock hours.
  • No other complaints.
  • The iris mass is biopsied.
  • Fig 1-H&E
  • Fig 2-CK7 immuno
  • Fig3-CDX2 immuno.


  1. What classicial apperance is shown in Fig 1
  2. What is the diagnosis and what does the immuno panel add?
Click to show answers
  1. Classical signet ring cells containing blush mucin
  2. Metastatic adenocarcinoma to the iris. The combination of CK7 and nuclear CDX-2 positivity would suggest an upper gastrointestinal primary.
  • The patient turned out to have a primary at the gastro-oesophageal junction.
  • In 25% of cases, the ophthalmologists are the first to make a diagnosis of disseminated malignancy.