Phthisis with a threat: imaging and histopathology of a ciliary body adenocarcinoma

Background: Adenocarcinoma is a rare malignancy derived from the pigmented or non-pigmented epithelium of the ciliary body and/or iris. Case presentation: A 35-year-old male with childhood left eye (LE) blindness developed throbbing pain and redness of LE for a few months. On examination, the LE showed conjunctival injection, chemosis, opaque cornea, and raised intraocular pressure. Computed tomography (CT) revealed LE phthisis bulbi and orbital cellulitis. Histopathology indicated a malignant epithelial tumour, likely adenocarcinoma of the ciliary body, with positive pancytokeratin immunohistochemistry. Contrast-enhanced CT showed an ocular mass without distant metastasis. Four months later, magnetic resonance imaging revealed residual tumour with local infiltration. The patient underwent exenteration and recovered well with a prosthesis. Conclusion: A high index of suspicion for malignancy, along with appropriate laboratory tests, histopathological evaluation, imaging, and surgical intervention are essential to alleviate symptoms and preserve life.