Journal of the Royal Society of Medicine Volume 84 March 1991

Mucinous cystadenocarcmomas are not reported to benefit from chemotherapy and/or radiotherapy2. Total excision provides a long-term survival in the majority of patients. In summary, all mucinous cystic neoplasms ofthe pancreas should be regarded as malignant and total excision must be employed whenever possible with the hope for cure in patients without distant metastasis. Acknowledgments: The authors would like to thank Dr F A Doslu from the Department of Pathology, Springfield Community Hospital, Springfield, Ohio, USA for his help to confirm the diagnosis of the patient and his comments. References 1 Hodgkinson DJ, Remine WH, Wehand LH. A clinicopathological study of 21 cases of pancreatic cystadenocarcinoma. Ann Surg 1978;188:679-84

2 Kerlin DL, Frey CF, Bodai BI, Twomay PL, Ruebner B. Cystic neoplasms of the pancreas. Surg Gynecol Obstet 1987;166: 475-8 3 ReMine SG, Frey CF, Rossi RL, Munson L, Braasch JW. Cystic neoplasms of the pancreas. Arch Surg 1987;122:443-6 4 Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenoma and cystadenocarcinoma) a clinicopathologic study of 41 cases. Am J Clin Pathol 1978;69:573-80 5 Yamaguchi K, Enjoji M. Cystic neoplasms of the pancreas. Gastroenterology 1987;92:1934-43

(Accepted 14 February 1990)

Detached iris cyst presenting as an intraocular foreign -body

M T Watts FRcs I G Reniie ncs Department of Ophthalmology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF Keywords: iris cyst; pseudomelanoma; intraoculaI foreigh body

Iris cysts, which are uncommon, can present diagnostic difficulties. An iris cyst is most commonly misdiagnosed as an iris melanoma, which has led to the inappropriate enucleation of a number of eyes'. We present a case of an iris cyst which detached to lie in the inferior iridocorneal angle of the eye, and was initially misdiagnosed as an intraocular foreign body. Recognition of the condition is important in order to avoid unnecessary surgery. Case history A 26-year-old man presented to another unit with a superficial corneal foreign body, and associated rust ring. He had been hammering rusty metal at the time of injury. He gave a history of a number of previous corneal foreign bodies, requiring removal in hospital, The foreign body was removed and an eye pad applied together with chloramphenicol ointment. He was asked to return the following day for removal of the rust ring, at which time further examination revealed a small particle lying in the inferior iridocorneal angle of the eye. A presumptive

Figure 1. The iri cyst lying in the iridocorneal angle

Figure 2. The iris cyst floating in the anterior chamber following movement of the globe

diagnosis of intraocular foreign body was made and plain X-rays of the orbit were taken. Unfortunately these were of poor quality and further views were planned. At this point the patient, fearing a long period of hospitalization, requested that he be transferred to a unit closer to his own home. He presented to our hospital the following day, where repeat X-rays failed to demonstrate any radioopaque foreign body. The corneal ulceration had by this time healed, and, though there were several faint superficial scars representing old injury, there was no sign of any previous full thickness penetration. The anterior chamber was completely quiet, and the iris normal; in particular it demonstrated no rnllu tn defects ofthe pigment epithelium. Visual acuity was normal (6/5) and fundoscopy unremarkable. He gav,e no histoy of prior topical miotic therapy. A small darkly pigmented particle measuring 0.5 mm in diampter was noted in the inferior iridocorneal angle (Figure 1), which floated freely in the anterior chamber on movement of the globe (Figure 2). A diagnosis of detached iris pigment cyst was made.

Discussion Intraocular foreign body is a serious, sight threatening condition, and incidents of missed diagnosis are all too frequent. The effects are often not apparent until some years later, w hen the retino-toxic effects of retained metal become anifest, by which time they are irreversible. A common scenario is the diagnosis of an intraocular foreign body some time after the injury, when the patient presents with a new corneal foreign body. At this time the eye is usually quiet, and may well not show the typical features of metallosis2. A high index of suspicion is therefore required.


030171-0?$02.0.0/0 o 1991 The Royal Society of


Journal of the Royal Society of Medicine Volume 84 March 1991 Primary iris cysts are rare. They may present as anterior bulging of the iris stroma, which can be mistaken for melanoma of the iris or ciliary body3. They usually arise from the iris pigment epithelium, often in, response to either trauma or prolonged use of miotic drops4. Histology of the cysts has suggested that they are formed by a process of closure of a proliferating evagination of the iris pigment epithelium5. Detachment of a cyst is rare6, but is described following surgery7. The detachment of the iris cyst in this patient may have been precipitated by his recent, or any previous injury. The condition requires no intervention, in contradistinction to a retained intraocular foreign body, which must be removed immediately. The morbidity ofsuch surgery is considerable, and the case therefore illustrates the importance of the recognition of the condition which may mimic not only a melanoma of the iris, as previously described', but also an intraocular foreign body.


References 1 Ferry AP. Lesions mistaken for malignant melanoma of the iris. Arch Ophthalmol 1965;74:9-18 2 Neubauer H. Ocular metallosis. 7rans Ophthalmol Soc UK

1979;99:502-10 3 Shields -JA, Sanborn GE, Augeberger JJ. The differential diagnosis of malignant melanoma of the iris. Ophthalmology 1983;90:716-20 4 Abraham SV. Intra-epithelial cysts of the iris: their production in young persons and possible significance. Am J Ophthalmol 1954;37:327-31 5 Fine BS. Free-floating-pigmented cyst in the anterior chamber. Am J Ophthalmol 1969;67:493-500 6 Yanoff M, Zimmerman LE. Pseudomelanoma of the anterior chamber caused by implantation of iris pigment epithelium. Arch Ophthalmol 1965;74:302-5 7 Char DH. Clinical ocular oncology. New York: Churchill Livingstone, 1989

(Accepted 13 March 1990)

Meeting reports The Medicines Control Agency: the response to the Evans/Cunliffe report Keywords: Medicines Act; Medicines Control Agency; licensing regulation; European harmonization

In the 1980s the pharmaceutical industry was extremely critical of the Medicines Division and, by implication, of the Minister of State for Health, for the delays in processing their applications for product licences. In 1987, the average time taken to approve a licence application for a new chemical entity (NCE) was 18 months and for amendments to product licences was 8 months'. The Government's response to this mounting criticism by the pharmaceutical industry was the usual one of setting up an enquiry, in this case to examine the processing of product licence applications and of other work undertaken by the Medicines Division, as it then was. John Evans and Peter Cunliffe were chosen for the enquiry, started their work in April 1987 and issued their report2, known colloquially as the Evans/Cunliffe Report, in December of the same year, a commendably rapid reaction. In April 1988, the Minister of State for Health announced his decision on the recommendations made in the report. This meeting of the Library (Scientific Research) Section was held to review the background to the report, its recommendations and their implementation. The Evans/Cunliffe report The first speaker, Mr Brian Rayner (Deputy Secretary in the Department of Health) has many years of experience as a civil servant and was eminently qualified to give the background to the Evans/Cunliffe Report. He became involved with relationships between the pharmaceutical industry and the Department of Health in October 1984, at about the time that Mr Norman Fowler proposed the introduction of limited lists. -Perhaps the concern

and the debate over this contentious topic, and the subsequent negotiations on -the Pharmaceutical Price Regulation Scheme (PPRS), concealed the pharmaceutical industry's disquiet about licensing delays because he claimed not to have detected any marked anxiety at that time. However, it was not long before the pharmaceutical industry's problems of loss of patent life, with consequent effect on investment and profits, and loss of exports were being stressed as repercussions of the delays in granting product licences. The growing criticism affected morale in the Medicines Division, who were also concerned about the possibility that useful medicines were being denied to patients. A major factor contributing to the delays was the increase in licensing work, which was estimated at a compound rate of 5% between 1976 and 1987, without any corresponding increase in resources. Although the Medicines Division had increased its productivity, an unacceptable backlog of product licence applications developed. An increase of 10% in the professional staff of the Medicines Division was agreed but this was never implemented owing- to the reductions in staffing levels, of about 20% over 3 years, imposed on the civil service in the 1980s. The impossible situation of an increasing workload of product licence applications and restrictions on the recruitment of professional staff was a strong influence on the decision to seek independent advice on resolving the problem. The choice of John Evans and Peter Cunliffe brought in knowledge and experience of commercial operations in the private sector and familiarity with the problems of the pharmaceutical industry in their dealings with the Medicines Division. Their terms of reference were to examine the issues for the Department of Health arising from the continued increase in product licence and other work in the Medicines Division and to recommend ways to deal expeditiously with this work while maintaining adequate standards for the safety, efficiency and quality of human medicines in the United Kingdom.

Report of meeting of Library (Scientific Research) Section, 25 October 1990

0141-0768/91/ 030173-03/402.00/0 © 1991 The Royal Society of Medicine

Detached iris cyst presenting as an intraocular foreign body.

172 Journal of the Royal Society of Medicine Volume 84 March 1991 Mucinous cystadenocarcmomas are not reported to benefit from chemotherapy and/or r...
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