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Case Study: December 2013
History
- 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.
Questions
- What classicial apperance is shown in Fig 1
- What is the diagnosis and what does the immuno panel add?
Click to show answers
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- Classical signet ring cells containing blush mucin
- 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.
