Supplemental Material for: Case of a pigmented ciliary body adenoma successfully treated with local resection and determination of its protein expression and genetic basis

After the findings were discussed with the patient, a local excision was performed. During vitrectomy, intraocular illumination revealed a dark-brown, solid tumor. The tumor margin was identified by scleral compression and marked on the sclera.

A scleral flap was created with a 3 mm safety margin. A deep double scleral flap was created, and the tumor was completely excised along with the inner scleral flap. The tumor was a smooth-surfaced, brown, solid mass.

The outer scleral flap was sutured, and vitrectomy was performed concurrently with cataract surgery. Endophotocoagulation was applied to the ciliary epithelium and peripheral retina at the excision margin. After fluid-air exchange, silicone oil was injected.

Histologically, the tumor consisted of heavily pigmented polygonal cells. Immunohistochemically, the tumor cells were cytokeratin AE1/3(+), S-100(+), Melanin A (+), and SOX10(-). DNA sequencing confirmed a BRAF p.V600E mutation, and the tumor was diagnosed as a pigmented ciliary adenoma.

Three months later, the silicone oil was removed, and no local recurrence was noted. The visual acuity remains 20/20, and no additional therapy has been administered.</p><p dir="ltr">Conclusion: A pigmented ciliary body adenoma is a rare disorder requiring careful differential diagnosis. In our case, local excision preserved both the eye and the visual acuity.

Immunohistochemical analyses and DNA sequencing were useful in differentiating it from a uveal melanoma.</p>