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Nalcı Baytaroğlu H, Gündüz AK, Mirzayev I, Özalp Ateş FS. Factors affecting eye conservation and metastasis in posterior uveal melanomas. Eur J Ophthalmol 2023; 33:2024-2033. [PMID: 36762394 DOI: 10.1177/11206721231155054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE To determine the effect of patient and tumor features and different treatments on eye removal (enucleation or exenteration) and metastasis in posterior uveal melanoma (PUM). METHODS Retrospective analysis. Patient age (≤60 vs >60 years), sex (female vs male), visual acuity (VA, ≤20/40 vs >20/40), largest tumor basal diameter (LTBD), tumor thickness, tumor stage according to American Joint Committee on Cancer (AJCC) 8th edition, ciliary body involvement, distance to optic disc (OD)/fovea (≤3 mm vs >3 mm), OD involvement, and histopathology were evaluated. Primary treatment options were transpupillary thermotherapy, plaque radiotherapy, Cyberknife radiosurgery, exoresection, and eye removal. Risk factors for primary eye removal were determined using logistic regression test and those for secondary eye removal and metastasis with Cox regression analysis. RESULTS Of 387 cases, 153 (39.5%) underwent primary eye removal. Multivariable risk factors for primary eye removal included AJCC tumor stage (p = 0.001, OR:4.586; p < 0.001, OR:34.545; p < 0.001, OR:103.468 for stages T2, T3, and T4 vs stage T1, respectively), and VA≤20/40 (p = 0.014, OR:2.597). Multivariable risk factors for secondary eye removal were VA≤20/40 (p = 0.019, RR:2.817) and AJCC stage T3 vs T1 (p = 0.021, RR:2.666). Eye preservation rates in patients undergoing eye-conserving treatments were 80.3%, 69.6%, and 51.5% at 5, 10, and 15 years, respectively. Metastasis-free survival rates were 81.0%, 73.0%, and 56.7% at 5, 10, and 15 years, respectively. Multivariable risk factors for metastasis included eye removal as primary treatment (p = 0.005, RR:2.828) and mixed type histopathology (p < 0.001, RR:4.804). DISCUSSION Early diagnosis is crucial for both eye preservation and survival in PUM. Increasing AJCC tumor stage and lower VA were risk factors for eye removal in this study. Mixed type histopathology and primary eye removal were risk factors for metastasis.
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Affiliation(s)
- Hilal Nalcı Baytaroğlu
- Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Private Eye Clinic, Ankara, Turkey
| | - Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Çubuk State Hospital, Ankara, Turkey
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Asplund E, Fili M, Pansell T, Brautaset R, Nilsson M, Stålhammar G. The prognostic implication of visual acuity at the time of uveal melanoma diagnosis. Eye (Lond) 2023; 37:2204-2211. [PMID: 36434284 PMCID: PMC10366190 DOI: 10.1038/s41433-022-02316-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/15/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Visual outcomes after primary tumour treatment of uveal melanoma (UM) have been investigated repeatedly. This study evaluates the correlation between best-corrected visual acuity (BCVA) before treatment with clinicopathological factors and patient survival. SUBJECTS/METHODS Pre-treatment BCVA was examined in relation to tumour dimensions and location, and survival in a retrospective cohort of 1809 patients who underwent plaque brachytherapy. BCVA was also correlated to tumour histological factors in a second cohort of 137 enucleated eyes. RESULTS The mean BCVA of the tumour eye prior to plaque brachytherapy was LogMAR 0.42 (SD 0.46). Patients with low BCVA (LogMAR ≥ 1.00) did not differ in age (p = 0.19) and had similar frequency of ciliary body involvement (p = 0.99) but had tumours with greater apical thickness (p < 0.0001), greater diameter (p < 0.0001) and shorter distance to the optic disc and fovea (p < 0.0001). There were no significant relations between low BCVA and any of 13 examined tumour histological factors at a Bonferroni-corrected significance level (p > 0.004). Patients with low BCVA had greater incidence of UM-related mortality in competing risk analysis (p = 0.0019) and shorter overall survival (p < 0.0001). Low BCVA was also associated with increased hazard ratio (HR) for UM-related mortality in univariate analysis (HR 1.5, 95% confidence interval 1.2 to 1.9), but not in multivariate analysis with tumour size and location as covariates. CONCLUSIONS UM patients with low BCVA before primary tumour treatment have a worse prognosis, likely related to increased tumour dimensions. Future studies should examine the prognostic significance of BCVA in relation to macula-involving retinal detachment and genetic factors.
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Affiliation(s)
- Elin Asplund
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Unit of Optometry, Karolinska Institutet, Stockholm, Sweden
| | - Maria Fili
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Unit of Ocular Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- St. Erik Eye Hospital, Stockholm, Sweden
| | - Tony Pansell
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden
| | - Rune Brautaset
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Unit of Optometry, Karolinska Institutet, Stockholm, Sweden
| | - Maria Nilsson
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Unit of Optometry, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Unit of Ocular Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
- St. Erik Eye Hospital, Stockholm, Sweden.
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Lim JZ, Gokul A, Misra SL, Hadden PW, Cavadino A, McGhee CNJ. The Burden of Histologically Confirmed Uveal Melanoma in Aotearoa-New Zealand: A 21-year Review of the National Cancer Registry. Asia Pac J Ophthalmol (Phila) 2023; 12:384-391. [PMID: 37523430 DOI: 10.1097/apo.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/08/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE The burden of uveal melanoma (UM) in Aotearoa-New Zealand (NZ), a country with the highest global burden of cutaneous melanoma, is unknown. This first, large-scale study of UM in NZ investigates survival and risks of mortality in histologically confirmed UM. METHODS Deidentified epidemiological data on histologically confirmed UM between January 1, 2000, and December 31, 2020, were extracted from the NZ Cancer Registry. The main outcome measures were patient demographics, tumor characteristics, all-cause versus disease-specific survival, and risks of mortality. RESULTS Histologically confirmed UM constituted 1.5% (n=703) of all-body site melanomas in NZ (n=47,997). UM predominantly affected Europeans (95%), followed by NZ indigenous Māori (4%), Asians (<1%), and Pacific Peoples (<1%), with no eye or sex predilection. Three hundred eighteen (45%) were deceased at follow-up. Of the deceased, 50% died from UM. The 1-, 5-, and 10-year survival from all-cause mortality was 94%, 68%, and 51%, and disease-specific survival was 97%, 79%, and 71%, respectively. Increasing age at UM diagnosis (>60 y), UM arising from nonspecified sites, and mixed cell UM were associated with an increased risk of disease-specific mortality. No difference in disease-specific mortality was found between sex and ethnicity on multivariate and competing risks analysis. CONCLUSIONS Despite the government-funded public eye care and increasing research and awareness on UM globally, the burden of UM in the 21st century in NZ remains comparable to global studies. We continue to observe an earlier presentation of UM in non-European cohorts, particularly in our Māori population, and further studies on UM in NZ are warranted.
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Affiliation(s)
- Joevy Z Lim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Department of Ophthalmology, Auckland District Health Board, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Peter W Hadden
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Department of Ophthalmology, Auckland District Health Board, New Zealand
| | - Alana Cavadino
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Department of Ophthalmology, Auckland District Health Board, New Zealand
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Goesmann L, Refaian N, Bosch JJ, Heindl LM. Characterization and Quantitation of the Tumor Microenvironment of Uveal Melanoma. BIOLOGY 2023; 12:738. [PMID: 37237550 PMCID: PMC10215936 DOI: 10.3390/biology12050738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
Uveal melanoma (UM) is a highly malignant tumor of the eye. Metastatic spread of UM occurs almost exclusively via blood vessels and is of tremendous interest, as half of the patients with uveal melanoma die of metastasis in the long run. The tumor microenvironment consists of all cellular and non-cellular compounds of a solid tumor, except for the tumor cells. This study aims to provide a more detailed understanding of the tumor microenvironment of UM to build the foundation for new therapeutic targets. Fluorescence immunohistochemistry was performed to examine the localization of various cell types in the tumor microenvironment in UM. Furthermore, the presence of LAG-3 and its ligands Galectine-3 and LSECtin was examined to evaluate the potential efficacy of immune checkpoint inhibitor-based therapies. The main findings are that blood vessels are mainly located in the middle of the tumor, and that immune cells are mostly found in the outer section of the tumor. LAG-3 and Galectine-3 were found to be highly represented, whereas LSECtin barely occurred in UM. Both the predominant location of tumor-associated macrophages in the outer section of the tumor and the high presence of LAG-3 and Galectine-3 in the UM serve as attainable therapeutic targets.
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Affiliation(s)
- Lara Goesmann
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (L.G.); (J.J.B.); (L.M.H.)
| | - Nasrin Refaian
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (L.G.); (J.J.B.); (L.M.H.)
| | - Jacobus J. Bosch
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (L.G.); (J.J.B.); (L.M.H.)
- Center for Integrated Oncology (CIO) Aachen Bonn Cologne Duesseldorf, 50937 Cologne, Germany
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands
- Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Ludwig M. Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (L.G.); (J.J.B.); (L.M.H.)
- Center for Integrated Oncology (CIO) Aachen Bonn Cologne Duesseldorf, 50937 Cologne, Germany
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Stålhammar G, Gill VT. Digital morphometry and cluster analysis identifies four types of melanocyte during uveal melanoma progression. COMMUNICATIONS MEDICINE 2023; 3:60. [PMID: 37117276 PMCID: PMC10147908 DOI: 10.1038/s43856-023-00291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Several types of benign and malignant uveal melanocytes have been described based on their histological appearance. However, their characteristics have not been quantified, and their distribution during progression from normal choroidal melanocytes to primary tumors and metastases has not been reported. METHODS A total of 1,245,411 digitally scanned melanocytes from normal choroid, choroidal nevi, primary uveal melanomas, and liver metastases were entered into two-step cluster analyses to delineate cell types based on measured morphometric characteristics and expression of protein markers. RESULTS Here we show that a combination of the area and circularity of cell nuclei, and BAP-1 expression in nuclei and cytoplasms yields the highest silhouette of cohesion and separation. Normal choroidal melanocytes and three types of uveal melanoma cells are outlined: Epithelioid (large, rounded nuclei; BAP-1 low; IGF-1R, IDO, and TIGIT high), spindle A (small, elongated nuclei; BAP-1 high; IGF-1R low; IDO, and TIGIT intermediate), and spindle B (large, elongated nuclei; BAP-1, IGF-1R, IDO, and TIGIT low). In normal choroidal tissue and nevi, only normal melanocytes and spindle A cells are represented. Epithelioid and spindle B cells are overrepresented in the base and apex, and spindle A cells in the center of primary tumors. Liver metastases contain no normal melanocytes or spindle A cells. CONCLUSIONS Four basic cell types can be outlined in uveal melanoma progression: normal, spindle A and B, and epithelioid. Differential expression of tumor suppressors, growth factors, and immune checkpoints could contribute to their relative over- and underrepresentation in benign, primary tumor, and metastatic samples.
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Affiliation(s)
- Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden.
- St. Erik Eye Hospital, Stockholm, Sweden.
| | - Viktor Torgny Gill
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology, Vastmanland Hospital, Vasteras, Sweden
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Yarovaya VA, Shatskikh AV, Zaretsky AR, Levashov IA, Volodin DP, Yarovoy AA. [The prognostic value of uveal melanoma cell type]. Arkh Patol 2021; 83:14-21. [PMID: 34278756 DOI: 10.17116/patol20218304114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the prognostic value of a uveal melanoma (UM) cell type for the development of metastases (MTS). SUBJECTS AND METHODS The investigation enrolled 96 patients (96 eyes) with UM after enucleation. Forty-one patients without signs of MTS were included in this group, who were followed up for more than 36 months (mean, 70.5 months (36 to 105 months)), 55 patients with MTS who were followed up for an average of 21 months (2 to 44 months). The MTS and non-MTS groups were statistically homogeneous in age, gender, tumor size, location, and ciliary body involvement in the process, as well as in extrabulbar growth. RESULTS There were spindle cell, mixed cell, and epithelioid cell UMs in 44, 35, and 21% of patents, respectively. The tumors in patients without MTS were noted to be significantly more likely to have spindle cell-type UM (p<0.0001). Mixed cell and epithelioid cell UMs were more frequently detected in patients with MTS (p<0.0001), which was believed to be due to the presence of epithelioid cells in both cell types. A survival analysis showed that the 3- and 5-year survival rates for patients with spindle cell UM were significantly higher than that for those with epithelioid cell or mixed cell UM (p<0.001); the 3-and 5-year survival rates for spindle cell UM were 78 and 70%, respectively; those for mixed cell UM were 37 and 24%; and those for epithelioid cell UM were 50 and 31%. CONCLUSION The similar survival rates for patients with mixed cell or epithelioid cell type UM could conclude that it is advisable to use the binary principle - the presence or absence of epithelioid cells in the tumor, when assessing a UM cell type as a prognostic factor.
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Affiliation(s)
- V A Yarovaya
- Acad. S.N. Fyodorov «Eye Microsurgery» Interdisciplinary Scientific and Technical Complex of the Ministry of Health of Russia, Moscow, Russia
| | - A V Shatskikh
- Acad. S.N. Fyodorov «Eye Microsurgery» Interdisciplinary Scientific and Technical Complex of the Ministry of Health of Russia, Moscow, Russia
| | - A R Zaretsky
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - I A Levashov
- Acad. S.N. Fyodorov «Eye Microsurgery» Interdisciplinary Scientific and Technical Complex of the Ministry of Health of Russia, Moscow, Russia
| | - D P Volodin
- Acad. S.N. Fyodorov «Eye Microsurgery» Interdisciplinary Scientific and Technical Complex of the Ministry of Health of Russia, Moscow, Russia
| | - A A Yarovoy
- Acad. S.N. Fyodorov «Eye Microsurgery» Interdisciplinary Scientific and Technical Complex of the Ministry of Health of Russia, Moscow, Russia
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Ortega MA, Fraile-Martínez O, García-Honduvilla N, Coca S, Álvarez-Mon M, Buján J, Teus MA. Update on uveal melanoma: Translational research from biology to clinical practice (Review). Int J Oncol 2020; 57:1262-1279. [PMID: 33173970 PMCID: PMC7646582 DOI: 10.3892/ijo.2020.5140] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
Uveal melanoma is the most common type of intraocular cancer with a low mean annual incidence of 5‑10 cases per million. Tumours are located in the choroid (90%), ciliary body (6%) or iris (4%) and of 85% are primary tumours. As in cutaneous melanoma, tumours arise in melanocytes; however, the characteristics of uveal melanoma differ, accounting for 3‑5% of melanocytic cancers. Among the numerous risk factors are age, sex, genetic and phenotypic predisposition, the work environment and dermatological conditions. Management is usually multidisciplinary, including several specialists such as ophthalmologists, oncologists and maxillofacial surgeons, who participate in the diagnosis, treatment and complex follow‑up of these patients, without excluding the management of the immense emotional burden. Clinically, uveal melanoma generates symptoms that depend as much on the affected ocular globe site as on the tumour size. The anatomopathological study of uveal melanoma has recently benefited from developments in molecular biology. In effect, disease classification or staging according to molecular profile is proving useful for the assessment of this type of tumour. Further, the improved knowledge of tumour biology is giving rise to a more targeted approach to diagnosis, prognosis and treatment development; for example, epigenetics driven by microRNAs as a target for disease control. In the present study, the main epidemiological, clinical, physiopathological and molecular features of this disease are reviewed, and the associations among all these factors are discussed.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Santiago Coca
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
- Internal and Oncology Service (CIBER-EHD), University Hospital Príncipe de Asturias, Alcalá de Henares, 28805 Madrid
| | - Julia Buján
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Miguel A. Teus
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ophthalmology Service, University Hospital Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain
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Ma ST, Hsieh YT, Wei YH, Liao SL. A 45-year experience of uveal melanoma in Taiwan: Verification of American Joint Committee on Cancer staging system and prognostic factors. J Formos Med Assoc 2020; 120:1361-1368. [PMID: 33127270 DOI: 10.1016/j.jfma.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE To verify the staging system of the American Joint Committee on Cancer (AJCC) 8th edition for uveal melanoma, and to propose the prognostic factors of uveal melanoma by a 45-year cohort study. METHODS We collected patients who underwent operation with pathological proof from 1973 to 2017. The demographic data including gender, age, laterality, metastatic pattern, and histopathology type were recorded. The predictability for survival and monotonicity of gradients of the AJCC 8th edition were evaluated. The prognostic factors for survival were analyzed by univariate and multivariate analysis. RESULTS A total of 72 patients were collected. The median age was 55 year-old (range 24-100). No specific gender predilection was revealed in our study. About 75.9% of metastases events happened in the first five-year of follow-up, and hepatic involvement was the most common. By the AJCC 8th edition, the distribution for stage I: II: III was 8 (11.1%), 37 (51.4%), and 27 (37.5%). The prognostic staging groups manifested fair predictability and monotonicity of gradients for survival outcome. The tumors with epithelioid cell type and ciliary body involvements had higher tumor-related mortality. CONCLUSION The AJCC 8th edition prognostic staging groups for outcome prediction was validated. Periodic screening for metastases should be more frequent in the first five-year follow-up. The tumors with epithelioid cell pattern and ciliary body involvements were at risk of higher tumor-related mortality in Taiwanese patients.
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Affiliation(s)
- Shang-Te Ma
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
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9
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Badanes Z, Espinheira Gomes F, Ledbetter EC. Choroidal melanocytic tumors in dogs: A retrospective study. Vet Ophthalmol 2020; 23:987-993. [PMID: 33085213 DOI: 10.1111/vop.12839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe clinical features of dogs diagnosed with choroidal melanocytic tumors at a veterinary teaching hospital. ANIMALS STUDIED Retrospective case series of 13 dogs (14 melanocytic tumors) with choroidal melanocytic tumors. PROCEDURES Medical records of dogs evaluated by the Cornell University ophthalmology service with a clinical diagnosis of a choroidal melanocytic tumor between 2008 and 2020 were reviewed. A choroidal melanocytic tumor was clinically defined as any well-demarcated, raised pigmented choroidal lesion underlying the retina. Histopathology results were consulted when available. Signalment and clinical features were recorded, including fundoscopic location, histopathologic findings, treatment, and outcome. RESULTS Choroidal melanocytic tumors were identified in 14 eyes of 13 dogs. The mean (±standard deviation) of dogs was 8.6 (±3.5) years. Seven different breeds were represented, with Labrador/Labrador mix being the most common. Ten of the 14 melanocytic tumors were diagnosed incidentally. Four dogs presented for vision loss and ocular discomfort, and diagnosis was made on histopathology examination following enucleation. Pulmonary metastasis was suspected in one dog with an incidentally found choroidal melanocytic tumor OD. Fundoscopic location was available for 8 melanocytic tumors, with 6 (75%) located in the tapetal fundus. Histopathologic diagnosis was melanocytoma for 3 and malignant melanoma in 1 globe, with optic nerve head invasion in 50%. Local recurrence was not seen in any orbit following enucleation. CONCLUSION Choroidal melanocytic tumors are uncommon in dogs. Metastasis appears to be rare and was only suspected in one dog, but intraocular tumor growth can lead to retinal detachment, glaucoma, and necessitate enucleation.
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Affiliation(s)
- Zachary Badanes
- College of Veterinary Medicine, Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
| | - Filipe Espinheira Gomes
- College of Veterinary Medicine, Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
| | - Eric C Ledbetter
- College of Veterinary Medicine, Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
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10
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Herrspiegel C, See TRO, Mendoza PR, Grossniklaus HE, Stålhammar G. Digital morphometry of tumor nuclei correlates to BAP-1 status, monosomy 3, gene expression class and survival in uveal melanoma. Exp Eye Res 2020; 193:107987. [PMID: 32097618 DOI: 10.1016/j.exer.2020.107987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 12/22/2022]
Abstract
Cytologic features such as the shape and size of tumor cells can predict metastatic death in uveal melanoma and other cancers but suffer from poor reproducibility. In this study, we investigate the interobserver concordance of digital morphometry, and correlate the results with BRCA associated protein-1 (BAP-1) expression and BAP-1 gene mutation status, monosomy 3, gene expression classifications and patient survival in uveal melanoma. The average number of cells analyzed in each of 107 tumors, was 1957 (SD 349). Mean time consumption was less than 2.5 min per tumor. Identical morphometric classification was obtained for ≥85% of tumors in all twelve evaluated morphometric variables (κ 0.70-0.93). The mean nucleus area, nucleus perimeter, nucleus max caliper and nucleus to cell area ratio were significantly greater in tumors with low BAP-1 expression and gene expression class 2. Patients had significantly shorter survival if their tumors had low BAP-1 (Log-Rank p = 0.002), gene expression class 2 (p = 0.004), long nucleus perimeters (p = 0.031), long nucleus max calipers (p = 0.029) and high mean nucleus to cell area ratios (p = 0.041) as defined in a training cohort and then tested in a validation cohort. Long nucleus perimeters and long nucleus max calipers correlated with monosomy 3 (Pearson Chi-Square p = 0.006 and p = 0.009, respectively). Long nucleus perimeters also correlated with BAP-1 mutation (p = 0.017). We conclude that digital morphometry can be fast and highly reproducible, that for the first time, morphometry parameters can be objectively quantitated in thousands of cells at a time in sub-μm resolutions, and that variables describing the shape and size tumor nuclei correlate to BAP-1 status, monosomy 3, gene expression class as well as patient survival.
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Affiliation(s)
- Christina Herrspiegel
- St. Erik Eye Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thonnie Rose O See
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Pia R Mendoza
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Hans E Grossniklaus
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gustav Stålhammar
- St. Erik Eye Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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García Tirado A, Asencio Durán M, Berjón A, Ruiz Bravo-Burguillos E, Peralta Calvo J. Clinical and histopathological features of choroidal melanoma-related enucleated eyes in a Spanish tertiary hospital. ACTA ACUST UNITED AC 2019; 94:225-231. [PMID: 30904338 DOI: 10.1016/j.oftal.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study clinical and pathological variables leading to a poor prognosis in a sample of uveal malignant melanoma patients who required eyeball enucleation as final treatment approach. All patients were seen and treated in the same public tertiary hospital in Madrid (Spain) within a 6-year time-period. MATERIALS AND METHODS Longitudinal observational retrospective study. The presence of clinical and pathologic factors known to be linked to poor prognosis, as well as other features, was assessed in 30 malignant melanoma: 20 de novo-enucleated malignant melanoma eyes (group A), and 10 in eyes that received radiotherapy prior to enucleation (group B). The diagnostic reliability of magnetic resonance imaging was assessed by comparing it with the histology results (gold standard) as a means to detect scleral and extra-scleral extension. RESULTS Tumour size, Bruch's membrane rupture, scleral infiltration, and distance to the optic nerve were the most decisive factors for a poor prognosis in the study sample. In 93% of cases the condition was under control, with a 6% incidence rate of metastatic spread and a 100% rate of overall survival for a mean follow-up period of 3±1.5 (range 1.2-6) years. In the study population, the sensitivity of the magnetic resonance imaging to detect scleral infiltration was 27%, which increased to 100% for identifying extra-scleral involvement. CONCLUSIONS The analyses of the clinical and pathological data collected within the framework of this study justify enucleation as the treatment of choice for the patients of this study. Magnetic resonance imaging was not found to be an optimum screening method to detect scleral infiltration in this study sample.
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Affiliation(s)
- A García Tirado
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPaz, Madrid, España.
| | - M Asencio Durán
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPaz, Madrid, España
| | - A Berjón
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | | | - J Peralta Calvo
- Servicio de Oftalmología, Hospital Universitario La Paz, IdiPaz, Madrid, España
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12
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Seddon JM. Macular Degeneration Epidemiology: Nature-Nurture, Lifestyle Factors, Genetic Risk, and Gene-Environment Interactions - The Weisenfeld Award Lecture. Invest Ophthalmol Vis Sci 2018; 58:6513-6528. [PMID: 29288272 PMCID: PMC5749242 DOI: 10.1167/iovs.17-23544] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Johanna M Seddon
- Ophthalmic Epidemiology and Genetics Service, Tufts Medical Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States.,Sackler School of Graduate Biomedical Sciences and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States
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13
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Wang Z, Wang XY, Li J, Zhu WW. Prognostic and Clinicopathological Significance of BAP1 Protein Expression in Different Types of Cancer—A Meta-Analysis. Genet Test Mol Biomarkers 2018; 22:115-126. [PMID: 29266978 DOI: 10.1089/gtmb.2017.0176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Zheng Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Institutes of Cancer Metastasis, Fudan University, Shanghai, China
| | - Xiang-Yu Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Institutes of Cancer Metastasis, Fudan University, Shanghai, China
| | - Juan Li
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Institutes of Cancer Metastasis, Fudan University, Shanghai, China
| | - Wen-Wei Zhu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Institutes of Cancer Metastasis, Fudan University, Shanghai, China
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14
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Burris CKH, Papastefanou VP, Thaung C, Restori M, Arora AK, Sagoo MS, Cohen VML. Detection of extrascleral extension in uveal melanoma with histopathological correlation. Orbit 2018; 37:287-292. [PMID: 29313397 DOI: 10.1080/01676830.2017.1423083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Uveal melanoma is the most common primary intraocular malignancy. Extrascleral extension (ESE) is rare, but associated with an increased rate of orbital recurrence and an overall poor prognosis. Clinical studies show low rates when compared with histological studies. Due to the prognostic importance of ESE, we sought to compare our clinical, intraoperative, and histological detection rates. DESIGN A retrospective cross-sectional case series. METHODS A list of eyes enucleated for uveal melanoma was compiled from the admissions records of the London Ocular Oncology Service during the 28-month period, i.e. January 2010-April 2012. The surgical and clinical notes of patients with histopathology proven ESE were reviewed to determine when it was first diagnosed or suspected. The subsequent management of these cases is discussed. RESULTS A total of 16 out of 174 (9%) eyes had histologically proven ESE. Eight of 16 cases were detected preoperatively at clinical examination, including the use of ocular ultrasound, 3 of 16 were discovered intra-operatively, and 5 of 16 deemed microscopic ESE, were first detected on histological examination. Seven of 7 (100%) of cases with anterior ESE were detected clinically by slit lamp biomicroscopy, while only 1 out of 9 (11%) of cases with posterior ESE was detected preoperatively with ultrasound. CONCLUSIONS Slit lamp biomicroscopy is sensitive for detecting anterior ESE. Most posterior ESE is microscopic, but macroscopic posterior ESE may also be missed by B-scan ocular ultrasound. Orbital surgeons should be suspicious of clinically undetected posterior ESE, and consider adjuvant orbital radiotherapy in cases with macroscopic ESE.
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Affiliation(s)
| | - Vasilios P Papastefanou
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK
| | - Caroline Thaung
- d Eye Pathology , UCL Institute of Ophthalmology , London , UK
| | - Marie Restori
- c Ocular Oncology , Moorfields Eye Hospital , London , UK
| | - Amit K Arora
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK
| | - Mandeep S Sagoo
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK.,e National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust , London , UK
| | - Victoria M L Cohen
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK
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15
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Cheng Y, Li Y, Huang X, Wei W, Qu Y. Expression of EZH2 in uveal melanomas patients and associations with prognosis. Oncotarget 2017; 8:76423-76431. [PMID: 29100322 PMCID: PMC5652716 DOI: 10.18632/oncotarget.19462] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 06/13/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose To analyze the prognostic value and potential target for therapeutic intervention of enhancer of zeste homologue 2 (EZH2) in uveal melanomas (UM) patients. Method We analyzed EZH2 expression in 89 primary UM patients by immuno- histochemistry to observe the clinicopathological and prognostic value of EZH2. Results The high levels of mitoses count and Ki67 labeling index had significant correlation with overexpression EZH2 (R = 0.408, P. Conclusion Our critical finding is that overexpression EZH2 in UM can be served as predictive marker and is associated with adverse clinical outcomes. Further observation of EZH2 as a potential therapeutic target in UM is necessary.
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Affiliation(s)
- Ying Cheng
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Ying Li
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Huang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Wenbin Wei
- Beijing Tongren Hospital, Capital Medical University, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yi Qu
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
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16
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Abstract
Uveal melanoma is the most common primary malignant tumor of the eye in adults, predominantly found in Caucasians. Local tumor control of uveal melanoma is excellent, yet this malignancy is associated with relatively high mortality secondary to metastasis. Various clinical, histopathological, cytogenetic features and gene expression features help in estimating the prognosis of uveal melanoma. The clinical features associated with poor prognosis in patients with uveal melanoma include older age at presentation, male gender, larger tumor basal diameter and thickness, ciliary body location, diffuse tumor configuration, association with ocular/oculodermal melanocytosis, extraocular tumor extension, and advanced tumor staging by American Joint Committee on Cancer classification. Histopathological features suggestive of poor prognosis include epithelioid cell type, high mitotic activity, higher values of mean diameter of ten largest nucleoli, higher microvascular density, extravascular matrix patterns, tumor-infiltrating lymphocytes, tumor-infiltrating macrophages, higher expression of insulin-like growth factor-1 receptor, and higher expression of human leukocyte antigen Class I and II. Monosomy 3, 1p loss, 6q loss, and 8q and those classified as Class II by gene expression are predictive of poor prognosis of uveal melanoma. In this review, we discuss the prognostic factors of uveal melanoma. A database search was performed on PubMed, using the terms “uvea,” “iris,” “ciliary body,” “choroid,” “melanoma,” “uveal melanoma” and “prognosis,” “metastasis,” “genetic testing,” “gene expression profiling.” Relevant English language articles were extracted, reviewed, and referenced appropriately.
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Affiliation(s)
- Swathi Kaliki
- Institute for Eye Cancer, L V Prasad Eye Institute, Banjara Hills, Support provided by Operation Eyesight Institute for Eye Cancer (SK) and Hyderabad Eye Research Foundation (SK), Hyderabad, India
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17
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de Lange MJ, van Pelt SI, Versluis M, Jordanova ES, Kroes WGM, Ruivenkamp C, van der Burg SH, Luyten GPM, van Hall T, Jager MJ, van der Velden PA. Heterogeneity revealed by integrated genomic analysis uncovers a molecular switch in malignant uveal melanoma. Oncotarget 2016; 6:37824-35. [PMID: 26462151 PMCID: PMC4741968 DOI: 10.18632/oncotarget.5637] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022] Open
Abstract
Gene expression profiles as well as genomic imbalances are correlated with disease progression in uveal melanoma (UM). We integrated expression and genomic profiles to obtain insight into the oncogenic mechanisms in development and progression of UM. We used tumor tissue from 64 enucleated eyes of UM patients for profiling. Mutations and genomic imbalances were quantified with digital PCR to study tumor heterogeneity and molecular pathogenesis. Gene expression analysis divided the UM panel into three classes. Class I presented tumors with a good prognosis and a distinct genomic make up that is characterized by 6p gain. The UM with a bad prognosis were subdivided into class IIa and class IIb. These classes presented similar survival risks but could be distinguished by tumor heterogeneity. Class IIa presented homogeneous tumors while class IIb tumors, on average, contained 30% of non-mutant cells. Tumor heterogeneity coincided with expression of a set of immune genes revealing an extensive immune infiltrate in class IIb tumors. Molecularly, class IIa and IIb presented the same genomic configuration and could only be distinguished by 8q copy number. Moreover, UM establish in the void of the immune privileged eye indicating that in IIb tumors the infiltrate is attracted by the UM. Combined our data show that chromosome 8q contains the locus that causes the immune phentotype of UM. UM thereby provides an unique opportunity to study immune attraction by tumors.
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Affiliation(s)
| | | | - Mieke Versluis
- Department of Ophthalmology, LUMC, Leiden, The Netherlands
| | | | - Wilma G M Kroes
- Department of Clinical Genetics Laboratory for Diagnostic Genome Analysis (LDGA), LUMC, Leiden, The Netherlands
| | - Claudia Ruivenkamp
- Department of Clinical Genetics Laboratory for Diagnostic Genome Analysis (LDGA), LUMC, Leiden, The Netherlands
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Abstract
Uveal melanoma is the most common primary intraocular malignancy in adults. It is associated with a high rate of distant tumor spread and consequent mortality. Unlike retinoblastoma, for which treatment advances over the last few decades have resulted in a dramatic improvement in survival, outcomes for patients with uveal melanoma remain unchanged. Despite improvement in local control of this tumor, roughly 50% of patients develop metastatic disease within 15 years. Delays in diagnosis and marked vascularity of this tumor may underlie that situation. Tumor size, location, histopathologic appearance, cytogenetic abnormalities, and molecular profiling are used in prognostication. The revised 7th edition of the American Joint Committee on Cancer (AJCC) manual has presented new information that may improve that process as well. Herein, we review current knowledge on uveal melanoma.
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Affiliation(s)
- Seema Kashyap
- Department of Ocular Pathology, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Rachna Meel
- Department of Ophthalmology, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Lata Singh
- Department of Ocular Pathology, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mithalesh Singh
- Department of Ocular Pathology, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Liu YM, Li Y, Wei WB, Xu X, Jonas JB. Clinical Characteristics of 582 Patients with Uveal Melanoma in China. PLoS One 2015; 10:e0144562. [PMID: 26645696 PMCID: PMC4672905 DOI: 10.1371/journal.pone.0144562] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess clinical characteristics, treatment and survival of patients with uveal melanoma in China. METHODS The retrospective study included all patients with malignant uveal melanoma who were consecutively examined in the study period from January 2005 and June 2015 in the Beijing Tongren hospital. RESULTS The mean age of the 582 patients (295(50.7%) women) was 44.6±12.6 years (range: 5-77 years). The tumors were located most often in the superior temporal region (in 117(21.5%) patients) and least common in the inferior region (in 31(5.7%) patients). In 548(94.2%) patients, the tumors were located in the choroid, in 33(5.7%) patients in the ciliary body, and in one (0.2%) patient in the iris. Treatment included episcleral brachytherapy (415(71.3%) patients), local tumor resection (48(8.2%) patients) and primary enucleation (119(20.4%) patients). In 53 individuals out of the 415 patients with primary brachytherapy, episcleral brachytherapy was followed by enucleation, due to an increasing tumor size or due to uncontrolled neovascular glaucoma. Median follow-up time was of 30 months (range: 1-124 months; mean: 34.8 ± 24.4 months). Overall survival rate at 5 and 10 years was of 92.7% and 85.1%. Younger age (P = 0.017), tumor location in the nasal meridian(P = 0.004), smaller tumor size (P<0.001), hemispheric tumor shape (P = 0.025), histological tumor cell type (spindle-cell type versus epitheloid cell type;P = 0.014), and type of treatment (episcleral brachytherapy versus local tumor resection and versus primary enucleation; P<0.001) were significantly associated with the overall survival in univariate analysis, while in multivariate analysis only smaller tumor size was significantly (P<0.001; RR: 4.75; 95% confidence interval: 2.11,10.7) associated with better overall survival. CONCLUSIONS In this study on clinical characteristics of uveal melanoma of a larger group of patients from China, the onset age was considerably younger and survival rate better than in studies from Western countries. Tumor size was the most significant factor for survival.
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Affiliation(s)
- Yue Ming Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
- * E-mail:
| | - Xiaolin Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany
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Al-Moujahed A, Nicolaou F, Brodowska K, Papakostas TD, Marmalidou A, Ksander BR, Miller JW, Gragoudas E, Vavvas DG. Uveal melanoma cell growth is inhibited by aminoimidazole carboxamide ribonucleotide (AICAR) partially through activation of AMP-dependent kinase. Invest Ophthalmol Vis Sci 2014; 55:4175-85. [PMID: 24781943 PMCID: PMC4089421 DOI: 10.1167/iovs.13-12856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 04/13/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the effects and mechanism of aminoimidazole carboxamide ribonucleotide (AICAR), an AMP-dependent kinase (AMPK) activator, on the growth of uveal melanoma cell lines. METHODS Four different cell lines were treated with AICAR (1-4 mM). Cell growth was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay. Cell cycle analysis was conducted by flow cytometry; additionally, expression of cell-cycle control proteins, cell growth transcription factors, and downstream effectors of AMPK were determined by RT-PCR and Western blot. RESULTS Aminoimidazole carboxamide ribonucleotide inhibited cell growth, induced S-phase arrest, and led to AMPK activation. Aminoimidazole carboxamide ribonucleotide treatment was associated with inhibition of eukaryotic translation initiation factor 4E-BP1 phosphorylation, a marker of mammalian target of rapamycin (mTOR) pathway activity. Aminoimidazole carboxamide ribonucleotide treatment was also associated with downregulation of cyclins A and D, but had minimal effects on the phosphorylation of ribosomal protein S6 or levels of the macroautophagy marker LC3B. The effects of AICAR were abolished by treatment with dipyridamole, an adenosine transporter inhibitor that blocks the entry of AICAR into cells. Treatment with adenosine kinase inhibitor 5-iodotubericidin, which inhibits the conversion of AICAR to its 5'-phosphorylated ribotide 5-aminoimidazole-4-carboxamide-1-D-ribofuranosyl-5'-monophosphate (ZMP; the direct activator of AMPK), reversed most of the growth-inhibitory effects, indicating that some of AICAR's antiproliferative effects are mediated at least partially through AMPK activation. CONCLUSIONS Aminoimidazole carboxamide ribonucleotide inhibited uveal melanoma cell proliferation partially through activation of the AMPK pathway and downregulation of cyclins A1 and D1.
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Affiliation(s)
- Ahmad Al-Moujahed
- Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Fotini Nicolaou
- Pediatric Surgery Laboratories, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Katarzyna Brodowska
- Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Thanos D. Papakostas
- Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Anna Marmalidou
- Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Bruce R. Ksander
- The Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Joan W. Miller
- Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Evangelos Gragoudas
- Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Demetrios G. Vavvas
- Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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BAP1 protein loss by immunohistochemistry: A potentially useful tool for prognostic prediction in patients with uveal melanoma. Pathology 2013; 45:651-6. [DOI: 10.1097/pat.0000000000000002] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Werdich XQ, Jakobiec FA, Singh AD, Kim IK. A review of advanced genetic testing for clinical prognostication in uveal melanoma. Semin Ophthalmol 2013; 28:361-71. [PMID: 24010756 DOI: 10.3109/08820538.2013.825290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Uveal melanoma (UM) has a strong propensity to metastasize and the prognosis for metastatic disease is very poor. It has been suggested that occult micrometastases are already present, but undetectable, in many patients at the time when the primary ocular tumor is diagnosed and treated. To identify high-risk patients for close monitoring and early intervention with prophylactic adjuvant systemic therapy, an accurate predictive system is necessary for stratifying those patients at risk of developing metastatic disease. To date, many clinical and histopathological features, molecular pathway characteristics, and genetic fingerprints of UM have been suggested for disease prognostication. Among the newest of them, tumor genetics has received the most attention in demonstrating promise as a prognostic tool. Because of the plethora of recent developments, we summarize and compare in this review the important standard and more advanced cytogenetic prognostic markers. We further describe the variety of genetic tests available for prognostication of UM, and provide a critical assessment of the respective advantages and disadvantages of these tools.
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Affiliation(s)
- Xiang Q Werdich
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts , USA and
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Uveal melanoma: molecular pattern, clinical features, and radiation response. Am J Ophthalmol 2012; 154:227-232.e2. [PMID: 22541662 DOI: 10.1016/j.ajo.2012.02.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/15/2012] [Accepted: 02/16/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To characterize the clinical spectrum of class 1 and class 2 uveal melanomas and their relationship with intraocular proton radiation response. DESIGN Masked retrospective case series of uveal melanoma patients with fine needle biopsy-based molecular profiles. METHODS A total of 197 uveal melanoma patients from a single institution were analyzed for pathology, clinical characteristics, and response to radiation therapy. RESULTS A total of 126 patients (64%) had class 1 tumors and 71 (36%) had class 2 tumors. Patients with class 2 tumors had more advanced age (mean: 64 years vs 57 years; P = .001), had thicker initial mean ultrasound measurements (7.4 mm vs 5.9 mm; P = .0007), and were more likely to have epithelioid or mixed cells on cytopathology (66% vs 38%; P = .0004). Although mean pretreatment and posttreatment ultrasound thicknesses were significantly different between class 1 and class 2 tumors, there was no difference in the mean change in thickness 24 months after radiation therapy (mean difference: class 1 = -1.64 mm, class 2 = -1.47; P = .47) or in the overall rate of thickness change (slope: P = .64). Class 2 tumors were more likely to metastasize and cause death than class 1 tumors (DSS: P < .0001). CONCLUSIONS At the time of radiation therapy, thicker tumors, epithelioid pathology, and older patient age are significantly related to class 2 tumors, and class 2 tumors result in higher tumor-related mortality. We found no definitive clinical marker for differentiating class 1 and class 2 tumors.
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Houston SK, Murray TG. Microarray gene-expression analysis in ocular oncology: uveal melanoma and retinoblastoma. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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A multimodal approach to eye melanoma: patterns of care and related complications. Oncol Rev 2009. [DOI: 10.1007/s12156-009-0002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Landreville S, Agapova OA, Harbour JW. Emerging insights into the molecular pathogenesis of uveal melanoma. Future Oncol 2008; 4:629-36. [PMID: 18922120 DOI: 10.2217/14796694.4.5.629] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Uveal melanoma is the most common primary cancer of the eye, and often results not only in vision loss, but also in metastatic death in up to half of patients. For many years, the details of the molecular pathogenesis of uveal melanoma remained elusive. In the past decade, however, many of these details have emerged to reveal a fascinating and complex story of how the primary tumor evolves and progresses. Early events that disrupt cell cycle and apoptotic control lead to malignant transformation and proliferation of uveal melanocytes. Later, the growing tumor encounters a critical bifurcation point, where it progresses along one of two genetic pathways with very distinct genetic signatures (monosomy 3 vs 6p gain) and metastatic propensity. Late genetic events are characterized by increasing aneuploidy, most of which is nonspecific. However, specific chromosomal alterations, such as loss of chromosome 8p, can hasten the onset of metastasis in susceptible tumors. Taken together, this pathogenetic scheme can be used to construct a molecularly based and prognostically relevant classification of uveal melanomas that can be used clinically for personalized patient management.
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Affiliation(s)
- Solange Landreville
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
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Onken MD, Worley LA, Harbour JW. A metastasis modifier locus on human chromosome 8p in uveal melanoma identified by integrative genomic analysis. Clin Cancer Res 2008; 14:3737-45. [PMID: 18559591 DOI: 10.1158/1078-0432.ccr-07-5144] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify genes that modify metastatic risk in uveal melanoma, a type of cancer that is valuable for studying metastasis because of its remarkably consistent metastatic pattern and well-characterized gene expression signature associated with metastasis. EXPERIMENTAL DESIGN We analyzed 53 primary uveal melanomas by gene expression profiling, array-based comparative genomic hybridization, array-based global DNA methylation profiling, and single nucleotide polymorphism-based detection of loss of heterozygosity to identify modifiers of metastatic risk. A candidate gene, leucine zipper tumor suppressor-1 (LZTS1), was examined for its effect on proliferation, migration, and motility in cultured uveal melanoma cells. RESULTS In metastasizing primary uveal melanomas, deletion of chromosome 8p12-22 and DNA hypermethylation of the corresponding region of the retained hemizygous 8p allele were associated with more rapid metastasis. Among the 11 genes located within the deleted region, LZTS1 was most strongly linked to rapid metastasis. LZTS1 was silenced in rapidly metastasizing and metastatic uveal melanomas but not in slowly metastasizing and nonmetastasizing uveal melanomas. Forced expression of LZTS1 in metastasizing uveal melanoma cells inhibited their motility and invasion, whereas depletion of LZTS1 increased their motility. CONCLUSIONS We have described a metastatic modifier locus on chromosome 8p and identified LZTS1 as a potential metastasis suppressor within this region. This study shows the utility of integrative genomic methods for identifying modifiers of metastatic risk in human cancers and may suggest new therapeutic targets in metastasizing tumor cells.
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Affiliation(s)
- Michael D Onken
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Ramaiya KJ, Harbour JW. Molecular prognostic testing in uveal melanoma. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Harbour JW. Eye cancer: unique insights into oncogenesis: the Cogan Lecture. Invest Ophthalmol Vis Sci 2006; 47:1736-45. [PMID: 16638975 PMCID: PMC1769553 DOI: 10.1167/iovs.05-1291] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- J William Harbour
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Seddon JM, Young TA. Choroidal Melanoma: Prognosis. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mudhar HS, Parsons MA, Sisley K, Rundle P, Singh A, Rennie IG. A critical appraisal of the prognostic and predictive factors for uveal malignant melanoma. Histopathology 2005; 45:1-12. [PMID: 15228438 DOI: 10.1111/j.1365-2559.2004.01874.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H S Mudhar
- Department of Histopathology, University of Sheffield, Sheffield, UK.
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Abstract
Uveal melanomas may arise in the iris, ciliary body or choroid. Choroidal melanomas are the most common and usually display a discoid, collar-button or mushroom-shaped growth pattern. Uveal melanomas are composed of spindle and epithelioid cells and are classified histopathologically as either spindle-cell-type or mixed-cell-type tumours. The most important factors predicting clinical behaviour and underlying biology are cell type, cytomorphometric features, largest tumour dimension, scleral invasion and mitotic figures. Other valuable prognostic factors are tumour-infiltrating lymphocytes and macrophages, and the presence of vascular loops.
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Affiliation(s)
- Ian W McLean
- Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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Augsburger JJ, Khouri L, Roumeliotis A, Kersten RC, Kulwin DR, Schneider S. Enucleation versus preservation of blind eyes following plaque radiotherapy for choroidal melanoma. Can J Ophthalmol 2004; 39:372-9. [PMID: 15327102 DOI: 10.1016/s0008-4182(04)80008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Currently available information about patients with posterior uveal melanoma treated by plaque radiotherapy is insufficient to determine what to do about eyes that become blind as a consequence of the tumour and its treatment. Should they be enucleated, or is ocular preservation just as good in terms of survival? METHODS We performed a retrospective survival analysis of secondary enucleation versus ocular preservation in patients with a posterior uveal melanoma treated by plaque radiotherapy whose irradiated eye became completely blind following that treatment. Of the 79 patients who fulfilled defined inclusion criteria, 25 underwent secondary enucleation of the blind eye, and 54 retained their irradiated blind eye. RESULTS Most of the baseline demographic and tumour-related variables evaluated were similarly distributed between the subgroups. The 5-year, 10-year and 15-year all-cause death rates in the secondary enucleation subgroup were 24.7%, 51.5% and 52.0% respectively, and those in the ocular preservation subgroup were 7.4%, 32.9% and 48.1% respectively. In spite of the apparent slight difference between the curves, the difference was not statistically significant (p = 0.41, Mantel-Haenszel test). INTERPRETATION Although a retrospective study of this type has several limitations, our results suggest that secondary enucleation is not likely to substantially improve survival of patients whose irradiated eye becomes totally blind following plaque radiotherapy for choroidal or ciliochoroidal melanoma.
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Affiliation(s)
- James J Augsburger
- Oncology Service, Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0527, USA.
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Abstract
The most common anterior segment tumors are primary neuroepithelial cysts, uveal melanomas, metastatic tumors, and benign tumors. In the majority of cases, the diagnosis can be made utilizing a careful clinical history and ocular examination. Ultrasound examination (low and high frequency) has become an indispensable tool used to determine tumor extension and involvement of the surrounding structures. In particular, high-frequency ultrasound has been used to uncover iris pigment epithelial cysts, to allow for the diagnosis of small ciliary body melanomas, and to measure tumors for plaque radiation planning. Whereas fluorescein angiography and computerized tomography have come to play a limited role, fine-needle aspiration biopsy has been found to be quite helpful in selected cases. Once the diagnosis is established, treatment decisions depend on the tumors' location, size, local extension, patterns of growth, and secondary complications. Most anterior segment tumors can be observed for growth prior to treatment. Other options include local resection (iridectomy, lamellar sclerouvectomy, or eye-wall resection) and radiation (ophthalmic plaque or external beam). Enucleation is typically employed if these eye- and vision-sparing treatments are not possible and for uncontrollable secondary glaucoma. This review examines the unique role of high-frequency ultrasonography for the diagnosis and treatment of anterior segment tumors as well as an overview of clinical practice.
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Affiliation(s)
- Flavio A Marigo
- The New York Eye Cancer Center; The Federal University of Minas Gerais and Instituto da Visão, Belo Horizonte, Brazil
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Abstract
Uveal melanoma is the most common primary intraocular malignant tumour, with an annual incidence of approximately six cases per million per year. Approximately 40% of patients with posterior uveal melanoma develop metastatic melanoma to the liver within 10 years after initial diagnosis. Despite high accuracy of diagnosis and availability of various methods of treatment; the mortality due to uveal melanoma has remained unchanged. The prognosis in uveal melanoma depends on clinical, histopathological and cytological factors. Clinical factors that relate to prognosis include location, size, and configuration of the tumour. Uveal melanoma can arise in the iris, the ciliary body or the choroid. Iris melanomas have the best prognosis and ciliary body melanomas have the worst prognosis. Based on retrospective studies, the mortality rates for uveal melanoma for comparable sized tumours treated by enucleation or other globe conserving methods such as radiotherapy appear to be similar. Histopathological factors such as cell type, mitotic activity, microcirculation architecture, tumour-infiltrating lymphocytes and the presence of extrascleral extension are also significant predictors of survival. More recently, cytological factors such as cell proliferation, cytogenic, and molecular genetic prognostic markers have been identified with the hope of detecting high risk cases for adjuvant systemic immune therapy or chemotherapy. At present, the role of these therapeutic methods is not clearly established.
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Affiliation(s)
- A D Singh
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA
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Chiquet C, Grange JD, Ayzac L, Chauvel P, Patricot LM, Devouassoux-Shisheboran M. Effects of proton beam irradiation on uveal melanomas: a comparative study of Ki-67 expression in irradiated versus non-irradiated melanomas. Br J Ophthalmol 2000; 84:98-102. [PMID: 10611107 PMCID: PMC1723230 DOI: 10.1136/bjo.84.1.98] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To assess the cellular proliferation using the monoclonal antibody Ki-67, in paraffin embedded uveal melanomas irradiated by proton beam, as well as in non-irradiated uveal melanomas. METHODS 30 enucleated eyes were included for histopathological study and Ki-67 immunostaining. Patients were enucleated between 1991 and 1996 for uveal melanoma, 14 after proton beam irradiation and 16 without treatment (control group). The mean follow up period was 2.5 years after diagnosis and 1 year after enucleation. RESULTS A significant relation was found between Ki-67 score and mitotic index (r = 0.56, p = 0.001), histological largest tumour diameter (r = 0.38, p = 0. 03), fibrosis (r = -0.35, p = 0.05), absence of tumoral pigmentation (p = 0.05), and presence of vascular thrombosis (p = 0.03). The Ki-67 score was significantly higher in the non-irradiated group (p = 0.01) and in the group of patients whose cause of enucleation was tumoral evolution (p = 0.005) compared with the group of patients enucleated after neovascular glaucoma. The Ki-67 score was very high in a case of orbital recurrence of uveal melanoma and metastatic death. 70% of metastasised tumours showed a Ki-67 score higher than the median value. CONCLUSION Ki-67 labelling is a reliable method of estimating the proliferative activity in uveal melanomas after proton beam irradiation. The Ki-67 score is significantly correlated with prognostic variables (mitotic index and histological largest tumour diameter), and with radiation effects after proton beam irradiation.
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Affiliation(s)
- C Chiquet
- Department of Ophthalmology, Croix-Rousse Hospital, University of Lyons, France
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Bialasiewicz AA, Ma JX, Richard G. Alpha/beta- and gamma/delta TCR(+) lymphocyte infiltration in necrotising choroidal melanomas. Br J Ophthalmol 1999; 83:1069-73. [PMID: 10460778 PMCID: PMC1723174 DOI: 10.1136/bjo.83.9.1069] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To detect specific tumour infiltrating T cells (TIL) carrying antigen specific MHC-I restricted receptor genes on necrotising and non-necrotising malignant melanomas and to correlate the findings with clinical data. METHODS alpha/beta- and gamma/delta- TIL were determined by immunohistochemical staining in melanomas of patients with known follow up of more than 10 years. An antigen retrieval method was used to determine variable genes delta1 and gamma1 on TCR(+) cells by an anti-TCR Vdelta1 and anti-CrgammaM1, and of Valpha and Vbeta TCR(+) by an anti-pan-TCR(+) alpha/beta antibody. RESULTS Intratumoral TIL were present in 86 of 113 (76.1%) necrotising melanomas (NMM) v 21 of 100 (21%) in non-necrotising melanomas (MM); of these, Valpha/beta- TCR(+) cells were present in 52 of 74 (70.3%) TIL harbouring NMM v four of 21 (19%) MM; Vgamma1 in 29 of 74 (39.2%) NMM v two of 21 (10%) MM; and Vdelta1 in 39 of 74 (52.7%) NMM v three of 21 (14%) MM. Extratumoral lymphocytic infiltration was seen in 86 (76.1%) NMM including Valpha/beta TCR(+) cells in 10 (11.6%) cases, v five (5%) MM cases with no Valpha/beta TCR(+) cells detected. Vgamma1 and Vdelta1 TCR(+) cells were not found in extratumoral infiltrates. CONCLUSIONS In NMM, the median survival was 69.3 (range 6-237) months, 19 of 74 patients (25.7%) survived 5 years, and mortality was associated with advanced stage (p<0.001), patient age (p<0.023), and extent of necrosis (p<0.048). Survival was increased with evidence of Vgamma1 and Vdelta1 TCR(+) cells (p<0.026).
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Toti P, Greco G, Mangiavacchi P, Bruni A, Palmeri ML, Luzi P. DNA ploidy pattern in choroidal melanoma: correlation with survival. A flow cytometry study on archival material. Br J Ophthalmol 1998; 82:1433-7. [PMID: 9930278 PMCID: PMC1722442 DOI: 10.1136/bjo.82.12.1433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Paraffin embedded samples have provided an important source of material for retrospective cytofluorimetric studies, useful in establishing the predictive value of DNA content measurements. The aim of this study was to investigate the incidence and type of aneuploidy in choroidal malignant melanomas (CMM) and the significance in the clinical outcome (median follow up 55 months). METHODS DNA content was quantified by flow cytometry in 61 CMM from archival material. Non-tumour ocular tissue was used as the reference diploid standard. Cases in which the coefficient of variation (CV) of the diploid peak was > 8% were excluded. The CMM were classified as spindle A, spindle B, mixed spindle and epithelioid, epithelioid, and necrotic. RESULTS The frequency of the aneuploid DNA pattern was 38%. Necrotic tumours showed a worse clinical outcome independent of the ploidy pattern. Spindle A tumours were found to be diploid. Spindle B and mixed tumours showed a prevalent diploid and near diploid aneuploid pattern (DI < 1.3), yet aneuploidy was not correlated with a worse prognosis. The epithelioid tumours were prevalently diploid. However, 83% of the aneuploid tumours were hypodiploid (DI < 0.95), and showed the worst prognosis. CONCLUSION These results indicate that increasing DNA abnormalities in CMM, especially in the epithelioid histotype, were associated with an increasing mortality.
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Affiliation(s)
- P Toti
- Institute of Pathological Anatomy and Histology, University of Siena, Italy
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McNamara M, Felix C, Davison EV, Fenton M, Kennedy SM. Assessment of chromosome 3 copy number in ocular melanoma using fluorescence in situ hybridization. CANCER GENETICS AND CYTOGENETICS 1997; 98:4-8. [PMID: 9309111 DOI: 10.1016/s0165-4608(96)00405-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent reports have indicated that monosomy 3 is a marker of poor prognosis in uveal melanoma. Fluorescence in situ hybridization (FISH) was performed on fresh touch preparations from 17 uveal, and 5 conjunctival melanomas, using the chromosome 3 centromeric probe, D3Z1. Of the 17 uveal melanomas, all of which originated in the choroid, two cases revealed a monosomy of chromosome 3. One of the conjunctival melanomas contained a major clone that was trisomic for chromosome 3, and another conjunctival melanoma contained a tetrasomic population. FISH, using the alpha-satellite probe for chromosome 3 on uveal melanoma imprints, allows one to predict which patients are potentially at a higher risk of relapse. Multiplication, rather than deletion, of copies of chromosome 3 in conjunctival melanomas may be a nonspecific aberration, perhaps indicative of polyploidy, a characteristic of tumor progression.
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Affiliation(s)
- M McNamara
- Research Foundation, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Abstract
Histologic cell type, largest tumor diameter and tumor location have traditionally been regarded as the leading predictors of survival for uveal melanoma. Morphological cell typing is, however, subjective to variations in interpretation. More objective classification parameters have emerged from extensive cytomorphometrical and DNA flow cytometrical studies. For patients with uveal melanoma there is no effective therapy if metastases have developed, and the median survival after clinical diagnosis of hepatic metastases is extremely poor. Current research focuses on the mechanisms underlying the metastatic process, including tumor vasculature, cytogenetics, oncogene activation, immunology, melanoma-associated antigens and tumor cell migration (cell-cell and cell-matrix interaction). Several new prognostic parameters have emerged from these studies, such as closed vascular patterns, loss of one chromosome 3, and different indices of cell proliferation. Furthermore, considerable genotypical and phenotypical differences have been found between uveal and cutaneous melanoma. In prospective studies on large series of melanomas a combination of histopathological and/or clinical prognostic parameters might be selected with high sensitivity and specificity, providing a way of selecting patients at high risk of developing metastatic disease, who might be eligible for adjuvant therapy.
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Affiliation(s)
- C M Mooy
- Department of Pathology, Erasmus University Rotterdam, The Netherlands
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Coleman K, Baak JP, van Diest PJ, Mullaney J. Prognostic value of morphometric features and the callender classification in uveal melanomas. Ophthalmology 1996; 103:1634-41. [PMID: 8874437 DOI: 10.1016/s0161-6420(96)30452-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Cytomorphometric analysis of uveal melanoma has focused on nucleolar characteristics, although nuclear measurements are easier and more reproducible. In this study, we examine a restricted set of nuclear and nucleolar cytomorphometric variables in the search for the most quantifiable and reproducible prognostic parameter among these and discover a means of assessing the malignancy of tumors within the different Callender subgroups. METHODS Uveal melanomas from 94 patients with a minimum follow-up of 5 years underwent nuclear and nucleolar morphometric analysis using a digitized interactive video overlay system. Statistical analysis included univariate and multivariate survival analysis on morphometric variables and classic prognostic parameters (such as Callender cell type, size, etc.). RESULTS Univariate analysis of cytomorphometric parameters showed the standard deviation of nuclear area (NASD) to be the most significant variable (P < 0.0001: Mantel-Cox, 15.2). This was followed by the difference between nuclear and nucleolar areas (P < 0.002; Mantel-Cox, 9.5), the standard deviation of nucleolar area (SDNA) (P < 0.01; Mantel-Cox, 6.4), and the standard deviation of the shortest nuclear axis (P < 0.02; Mantel-Cox, 6.4). There was a trend for significance with the mean of the ten largest nucleoli (P < 0.07). Multivariate analysis of clinical and cytomorphometric variables showed improvement of prognostic prediction with a combination of the NASD, largest tumor dimension, and glaucoma (P < 0.0001; Mantel-Cox, 26.3). Callender cell type was strongly correlated with the NASD (P < 0.0002), the mean axis ratio of the nuclear area (P < 0.0007), and the mean of the ten largest nucleoli (P < 0.0007). CONCLUSION Cytomorphometric analysis of uveal melanoma should include nuclear area and may identify tumors of differing malignancy within the same Callender class.
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Affiliation(s)
- K Coleman
- Department of Research Pathology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Park SS, Li L, Korn TS, Mitra MM, Niederkorn JY. Effect of transforming growth factor-beta on plasminogen activator production of cultured human uveal melanoma cells. Curr Eye Res 1996; 15:755-63. [PMID: 8670784 DOI: 10.3109/02713689609003459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Human uveal melanoma cells have been shown to produce plasminogen activator (PA), an enzyme which can enhance tumor metastasis by promoting degradation of extracellular matrix. This study used cultured human uveal melanoma cells to determine whether the PA production of uveal melanoma cells could be modulated by transforming growth factor-beta2 (TGF-beta2), a mitogen present in the uvea. METHODS Five different cell lines of human uveal melanoma of differing cellular morphology (2 spindle, 2 epithelioid, 1 mixed) derived from tumors from different locations in the eye (3 choroidal, 1 ciliochoroidal, 1 orbital) were grown in serum-free media, in the presence or absence of TGF-beta2 (1ng/ml to 100ng/ml). After 24 hrs, the conditioned media were collected and quantitated for PA activity by measuring the radial diffusion in fibrin-agarose clot and for total PA concentration using an enzyme-linked immunoassay. RESULTS Among the cell lines studied, all produced PA. Cell lines derived from intraocular tumors secreted tissue-type PA (tPA), and TGF-beta2 stimulated tPA activity and secretion of cell lines containing epithelioid cells but had no effect on spindle cells. In contrast, tumor cells isolated from an orbital tumor secreted urokinase (uPA), activity and secretion of which was inhibited by TGF-beta2. CONCLUSIONS We conclude that cultured human uveal melanoma cells produce either tPA or uPA, and TGF-beta2 can have a variable effect on PA production of these cells.
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Affiliation(s)
- S S Park
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9057, USA
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Damato BE, Paul J, Foulds WS. Risk factors for metastatic uveal melanoma after trans-scleral local resection. Br J Ophthalmol 1996; 80:109-16. [PMID: 8814739 PMCID: PMC505400 DOI: 10.1136/bjo.80.2.109] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS This study reports the metastatic death rate after trans-scleral local resection of uveal melanoma and identifies relevant risk factors. METHODS Local resection was performed in 332 patients (mean age 51 years), with follow up ranging to 20.9 years (median for living patients 33 months). The tumours had a mean largest basal diameter of 13.1 mm and mean thickness of 7.5 mm, with 135 containing epithelioid cells. Risk factors were identified by Cox analysis and metastatic rates demonstrated using Kaplan-Meier curves. RESULTS There were 52 deaths from metastatic melanoma. The significant risk factors were (i) age more than 60 years at treatment (p = 0.001), (ii) mixed/epithelioid tumours (p = 0.003), (iii) superior location of mixed/epithelioid tumours (over and above (ii)) (p = 0.001), (iv) largest basal tumour diameter of 16 mm or more (p < 0.001), (v) lack of adjunctive radiotherapy (p = 0.031), (vi) secondary enucleation for bulky residual/recurrent tumour (p = 0.002), and (vii) secondary enucleation for small residual/recurrent tumour extraocularly (p = 0.019). Metastatic death was not significantly associated with (i) incomplete tumour excision (p = 0.163), and (ii) small residual/recurrent tumour treated by enucleation (p = 0.855). CONCLUSIONS Survival diminished from 92% at 15 years if less than two risk factors were present to less than 30% in 3.5 years if more than three risk factors were present.
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Affiliation(s)
- B E Damato
- Tennent Institute of Ophthalmology, Western Infirmary, University of Glasgow
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Fleming MG. Image analysis in dermatopathology. Skin Res Technol 1995; 1:163-72. [PMID: 27326717 DOI: 10.1111/j.1600-0846.1995.tb00038.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Image analysis in dermatopathology has been used for DNA ploidy analysis, morphometry, stereology, and quantitative immunohistochemistry. The object is to review image analysis in dermatopathology and evaluate these modalities and their application in pigmented lesion pathology, for elucidation of tumor behaviour and architecture and as an aid in tumor identification and prognostication. CONCLUSION Image analysis in dermapathology has a huge potential. The techniques are difficult and at present mainly used in specialized centres.
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Affiliation(s)
- M G Fleming
- Departments of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
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Mooy C, Vissers K, Luyten G, Mulder A, Stijnen T, de Jong P, Bosman F. DNA flow cytometry in uveal melanoma: the effect of pre-enucleation irradiation. Br J Ophthalmol 1995; 79:174-7. [PMID: 7696240 PMCID: PMC505051 DOI: 10.1136/bjo.79.2.174] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND For uveal melanoma it has been demonstrated that aneuploidy correlates with worse clinical outcome. However, a striking variation in incidence of aneuploidy is reported for uveal melanomas. METHODS Flow cytometry was used to study retrospectively DNA-ploidy of 132 uveal melanomas on paraffin embedded material. Thirty five patients received 2 x 4 Gy doses of irradiation 24 and 48 hours before enucleation. Correlation between DNA-ploidy and histopathological grading, largest tumour diameter, tumour height, tumour location, scleral invasion, and TNM classification was assessed. Survival analysis methods were used to investigate the predictive value of these variables on clinical outcome. RESULTS Of the tumours 37% were aneuploid and 63% were diploid. Intratumour ploidy heterogeneity was minimal (92% concordance). A strong correlation (p = 0.009) was found between DNA-ploidy and cell type. No correlation was found between DNA-ploidy and other conventional prognostic variables. Irradiated melanomas were significantly more aneuploid than non-irradiated tumours (p < or = 0.01). CONCLUSION In survival analysis DNA-ploidy and the largest tumour diameter were significant in predicting metastatic outcome (p < or = 0.03 and 0.01 respectively); histological cell type and tumour location were of borderline significance.
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Affiliation(s)
- C Mooy
- Department of Pathology, Erasmus University, Rotterdam, The Netherlands
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Pe'er J, Rummelt V, Mawn L, Hwang T, Woolson RF, Folberg R. Mean of the ten largest nucleoli, microcirculation architecture, and prognosis of ciliochoroidal melanomas. Ophthalmology 1994; 101:1227-35. [PMID: 8035986 DOI: 10.1016/s0161-6420(94)31184-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cytomorphometric measurements and the architecture of the microcirculation in tissue sections of eyes removed for ciliary body or choroidal melanomas have been identified independently as prognostically significant factors for survival. The relative significance of these two histologic features is addressed in this study. METHODS The same 234 cases used to assess the prognostic significance of the microcirculatory patterns of choroidal and ciliary body melanomas were examined by two independent observers who measured the largest diameter of melanoma cell nucleoli from digitized images at a high magnification (x 3000) using the laser scanning confocal microscope. The mean of the ten largest nucleoli was calculated for each tumor according to previously published methods. Intraobserver and interobserver reproducibility was assessed for these measurements. Several Cox multiple regression models were constructed which included this cytomorphometric variable with and without the inclusion of the microcirculatory patterns. RESULTS There is a high degree of intraobserver reproducibility but only a weak degree of interobserver reproducibility in measuring the mean of the ten largest nucleoli. Using multiple Cox regression models, the mean of the ten largest nucleoli from each observer failed to exert any effect on outcome after enucleation, regardless of whether the presence of networks of closed vascular loops was considered in the statistical formulation. The presence of networks of closed vascular loops was found to be the most statistically dominant histologic prognostic characteristic. CONCLUSION The authors have not been able to confirm the use of the mean of the ten largest nucleoli as a significant prognostic factor in the outcome of patients whose eyes have been removed for ciliary body or choroidal melanomas. Further investigation of this cytomorphometric technique by other laboratories is warranted.
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Affiliation(s)
- J Pe'er
- Department of Ophthalmology, University of Iowa, Iowa City 52242
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Li J, Resnick K, Tso M. Metastasis of malignant melanoma of the choroid and ciliary body to the contralateral choroid. Graefes Arch Clin Exp Ophthalmol 1993; 231:546-53. [PMID: 8224960 DOI: 10.1007/bf00921121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- J Li
- Georgiana Dvorak Theobald Ophthalmic Pathology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago 60612
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