背景:虹膜中的异位甲状腺组织,也被称为虹膜的甲状腺腺体上皮脉络膜瘤,在文献中只描述了两次。在这两种情况下,它仍然无症状。
方法:一名67岁女性患者于2017年年中首次出现角膜内皮代偿失调,有复杂白内障手术和ISent®植入的病史。裂隙灯显微镜显示内皮失代偿,假晶状体,前粘连和附着在内皮上的白色虹膜肿瘤。后者从小就存在。鉴于这些发现,手部运动知觉视力下降,眼压为23mmHg,我们在9点进行了角膜移植术联合虹膜肿瘤整块切除术,并在2019年底进行了部门虹膜切除术.虹膜肿瘤的组织学和免疫组织学检查意外发现甲状腺组织。在上述程序之后,患者视力增加,而移植物保持清晰,眼睛没有显示肿瘤复发或其他并发症的证据。
结论:我们报告了第三例虹膜异位甲状腺组织。之前的两个病例都没有症状,而在我们的案例中,异位甲状腺组织的大小和位置导致更复杂的白内障手术,导致内皮失代偿.因此,在这种情况下,应在白内障手术前提供适当的患者信息。此外,仔细的组织学检查和甲状腺检查对于排除恶性诊断(例如滤泡性甲状腺癌的转移)很重要。
BACKGROUND: Ectopic thyroid tissue in the iris, also known as a thyroid glandular epithelial choristoma of the iris, has only been described twice in the literature. In both cases it remained asymptomatic.
METHODS: A 67-year-old female patient presented for the first time in mid-2017 with corneal endothelial decompensation, with a history of complicated cataract surgery and IStent® implantation. Slit lamp microscopy showed endothelial decompensation, pseudophakia, anterior synechiae and a whitish iris tumour adhering to the endothelium. The latter had existed since childhood. Given these findings, reduced visual acuity of hand movement perception and an intraocular pressure of 23 mmHg, we performed a keratoplasty combined with an en bloc resection of the iris tumour at 9 o\'clock and sector iridectomy at the end of 2019. Histological and immunohistological examination of the iris tumour unexpectedly revealed thyroid tissue. After the procedure described above, the patient had an increase in visual acuity while the graft stayed clear and the eye showed no evidence of tumour recurrence or other complications.
CONCLUSIONS: We report a third case of ectopic thyroid tissue in the iris. Both previous cases remained asymptomatic, whereas in our case, size and location of the ectopic thyroid tissue contributed to a more complex cataract surgery resulting in endothelial decompensation. Therefore, in such cases appropriate patient information should be provided prior to cataract surgery. Furthermore, careful histological examination and examination of the thyroid is important to exclude malignant diagnoses such as a metastasis of a follicular thyroid carcinoma.