Vol 4 (2019): Continuous Publishing
Review paper
Published online: 2019-12-06

open access

Page views 764
Article views/downloads 598
Get Citation

Connect on Social Media

Connect on Social Media

Characteristics, management, and outcome of ocular medulloepithelioma: systematic review of literature and case report

Yacoub A. Yousef1, Shatha Hajja2, Hanood AbuRass3, Mays AlJboor1, Rashed Mustafa Nazzal4, Katarzyna Nowomiejska5, Hussam Haddad3, Iyad Sultan2
Ophthalmol J 2019;4:92-99.

Abstract

Background: Ocular medulloepithelioma (OM) is a rare ocular malignancy. This is a report of a rare case of medulloepithelioma that was misdiagnosed as retinoblastoma.

Material and methods: A case report and review of published, peer-reviewed, English language literature reporting on ocular medulloepithelioma.

Results: A seven-year-old girl presented with a white mass in the anterior chamber of her left eye. The initial diagnosis was retinoblastoma with anterior chamber invasion, and therefore it was enucleated. Microscopy showed a cellular tumour composed of malignant primitive cells forming sheets, rosettes, and tubular structures. Based on the presence of prominent pleomorphism the tumour was diagnosed as malignant teratoid medulloepithelioma. At last date of follow-up three years after enucleation, the patient was alive without metastasis. A systematic review of literature, analysed 177 cases of OM. The tumour was localised in the ciliary body in 134 (92%) cases, and 26 (23%) cases had extraocular extension. Primary management was enucleation in 84 (55%) cases, tumour resection in 32 (21%) cases, and radiation therapy in 20 (13%) cases. Histopathology disclosed benign features in 36 (22%) eyes, malignant features in 124 (78%) eyes, teratoid features in 72 (59%), and non-teratoid features in 51 (41%) eyes. At a mean follow-up of five years, 14 (8%) patients had metastasis, and six (6%) patients were dead.

Conclusions: Ocular medulloepithelioma most commonly affects children. The most common type is the malignant
teratoid type, but it has a favourable prognosis, and distant metastasis and mortality are relatively rare, at 8%
and 6%, respectively.

Article available in PDF format

View PDF Download PDF file

References

  1. Zimmerman LE. Verhoeff's "terato-neuroma". A critical reappraisal in light of new observations and current concepts of embryonic tumors. The Fourth Frederick H. Verhoeff Lecture. Am J Ophthalmol. 1971; 72(6): 1039–1057.
  2. Zimmerman LE, Broughton WLA. Clinicopathologic and follow up study of fifty-six cases of intraocular medulloepithelioma. In: Jakobiec FA. ed. Ocular Adnexal Tumors. Aesculapius Publishing, Birmingham, AL 1978: 181–196.
  3. Verhoeff FH. A rare tumor arising from the pars ciliaris retinae (terato-neuroma) of a nature hitherto unrecognized, and its relation to the so-called glioma-retinae. Trans Am Ophthalmol Soc. 1904; 10(Pt 2): 351–377.
  4. Vadmal M, Kahn E, Finger P, et al. Nonteratoid medulloepithelioma of the retina with electron microscopic and immunohistochemical characterization. Pediatr Pathol Lab Med. 1996; 16(4): 663–672.
  5. Takei H, Florez L, Moroz K, et al. Medulloepithelioma: Two unusual locations. Pathol Int. 2007; 57(2): 91–95.
  6. Shields J, Eagle R, Shields C, et al. Congenital Neoplasms of the Nonpigmented Ciliary Epithelium (medulloepithelioma). Ophthalmology. 1996; 103(12): 1998–2006.
  7. Broughton WL, Zimmerman LE. A clinicopathologic study of 56 cases of intraocular medulloepitheliomas. Am J Ophthalmol. 1978; 85(3): 407–418.
  8. Shields J, Eagle R, Shields C, et al. Congenital Neoplasms of the Nonpigmented Ciliary Epithelium (medulloepithelioma). Ophthalmology. 1996; 103(12): 1998–2006.
  9. Shields JA, Shields CL. Tumors of the nonpigmented ciliary epithelium. In: Shields JA, Shields CL. ed. Intraocular Tumors: An Atlas and Textbook. 2nd ed. Lippincott Williams and Wilkins, Philadelphia, PA 2008: 482–490.
  10. Kaliki S, Shields C, Eagle R, et al. Ciliary Body Medulloepithelioma. Ophthalmology. 2013; 120(12): 2552–2559.
  11. Priest JR, Williams GM, Manera R, et al. Ciliary body medulloepithelioma: four cases associated with pleuropulmonary blastoma — a report from the International Pleuropulmonary Blastoma Registry. Br J Ophthalmol. 2011; 95(7): 1001–1005.
  12. Fuchs E. Growths and tumors of the ciliary epithelium [in German]. Albrecht Von Graefes Arch Ophthalmol. 1908; 68: 534–87.
  13. Grinker RR. Gliomas of the retina including results of studies with silver impregnations. Arch Ophthalmol. 1931; 5: 920–935.
  14. Pendergrass TW, Davis S. Incidence of retinoblastoma in the United States. Arch Ophthalmol. 1980; 98(7): 1204–1210.
  15. Litricbin O. Latkovi_c Z. Malignant teratoid medulloepithelioma in an adult. Ophthalmologica. 1985; 191: 17–21.
  16. Floyd BB, Minckler DS, Valentin L. Intraocular medulloepithelioma in a 79-year-old man. Ophthalmology. 1982; 89(9): 1088–1094.
  17. Pushker N, Khuraijam N, Sen S, et al. Medulloepithelioma of the ciliary body associated with massive intravitreal hemorrhage in an adult. Can J Ophthalmol. 2008; 43(2): 253–254.
  18. Wolter JR, James BR. Adult type of medullo-epithelioma of the ciliary body. Am J Ophthalmol. 1958; 46(1 Pt 1): 19–26.
  19. Broughton WL, Zimmerman LE. A clinicopathologic study of 56 cases of intraocular medulloepitheliomas. Am J Ophthalmol. 1978; 85(3): 407–418.
  20. Kaliki S, Eagle RC, Grossniklaus HE, et al. Inadvertent implantation of aqueous tube shunts in glaucomatous eyes with unrecognized intraocular neoplasms: report of 5 cases. JAMA Ophthalmol. 2013; 131(7): 925–928.
  21. Alkatan H, Al-Amry M, Al-Hussain H, et al. Medulloepithelioma of the ciliary body: the delay in diagnosis and frequent initial mismanagement. Can J Ophthalmol. 2011; 46(5): 431–438.
  22. Sharma P, Shields CL, Turaka K, et al. Ciliary body medulloepithelioma with neoplastic cyclitic membrane imaging with fluorescein angiography and ultrasound biomicroscopy. Graefes Arch Clin Exp Ophthalmol. 2011; 249(8): 1259–1261.
  23. Shields JA, Eagle RC, Shields CL, et al. Fluorescein angiography and ultrasonography of malignant intraocular medulloepithelioma. J Pediatr Ophthalmol Strabismus. 1996; 33: 193–196.
  24. Shields JA, Shields CL, Schwartz RL. Malignant teratoid medulloepithelioma of the ciliary body simulating persistent hyperplastic primary vitreous. Am J Ophthalmol. 1989; 107(3): 296–298.
  25. Font RL, Rishi K. Diffuse retinal involvement in malignant nonteratoid medulloepithelioma of ciliary body in an adult. Arch Ophthalmol. 2005; 123(8): 1136–1138.
  26. Carrillo R, Streeten BW. Malignant teratoid medulloepithelioma in an adult. Arch Ophthalmol. 1979; 97(4): 695–699.
  27. Kivelä T, Summanen P. Possible shared pathogenesis of the retinoinvasive phenotype of malignant medulloepithelioma and malignant melanoma of the ciliary body. Arch Ophthalmol. 2006; 124(7): 1066; author reply 1067.
  28. Shields J, Eagle R, Shields C, et al. Acquired Neoplasms of the Nonpigmented Ciliary Epithelium (adenoma and adenocarcinoma). Ophthalmology. 1996; 103(12): 2007–2016.
  29. Monchy D, Jacquiot P, Dubourdieu D, et al. [Malignant teratoid medulloepithelioma of the ciliary body. Apropos of a case and review of the literature]. Arch Anat Cytol Pathol. 1993; 41(2): 107–112.
  30. Cassoux N, Charlotte F, Sastre X, et al. Conservative surgical treatment of medulloepithelioma of the ciliary body. Arch Ophthalmol. 2010; 128(3): 380–381.
  31. Ramasubramanian A, Shields CL, Kytasty C, et al. Resection of intraocular tumors (partial lamellar sclerouvectomy) in the pediatric age group. Ophthalmology. 2012; 119(12): 2507–2513.
  32. Meel R, Chawla B, Mohanti BK, et al. Ocular medulloepithelioma chemosensitivity. Ophthalmology. 2010; 117(12): 2440.e1–2440.e2.
  33. Hu HM, Zhang WL, Wang YZ, et al. [Clinical features, treatment and prognosis of retinoblastoma in distant metastasis stage]. Zhonghua Yan Ke Za Zhi. 2017; 53(2): 121–127.