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Ryu C, Havens SJ, Chen J, DiMaio DJ, Rishi P. A Case of Bilateral Diffuse Uveal Melanocytic Proliferation Followed by Massive Unilateral Uveal Proliferation. Ocul Immunol Inflamm 2024:1-7. [PMID: 38771975 DOI: 10.1080/09273948.2024.2355577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) followed by massive unilateral uveal proliferation. METHODS Retrospective case report. RESULTS A 47-year-old female with history of metastatic ovarian carcinoma initially presented with bilateral vision loss and multifocal red patches on posterior poles consistent with BDUMP. Five years later, she presented with bilateral neovascular glaucoma and unilateral iris and ciliary body mass concerning for malignancy. Enucleation revealed diffuse uveal growth involving almost the entirety of the uveal tract. CONCLUSIONS BDUMP can rarely be associated with uveal proliferation. Routine examinations are recommended to monitor for any changes concerning malignancy.
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Affiliation(s)
- Christine Ryu
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shane J Havens
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jie Chen
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dominick J DiMaio
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Pukhraj Rishi
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Kalogeropoulos D, Afshar F, De Salvo G, Rennie CA, Lotery AJ. Diagnostic and therapeutic considerations in patients with bilateral diffuse uveal melanocytic proliferation. Int Ophthalmol 2024; 44:149. [PMID: 38502258 DOI: 10.1007/s10792-024-03087-9] [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] [Received: 12/07/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up, and therapeutic approach of bilateral diffuse uveal melanocytic proliferation (BDUMP). METHODS A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items. Our search strategy utilized the following keywords: "bilateral diffuse uveal melanocytic proliferation", "BDUMP", and "Paraneoplastic Syndrome". Articles were considered based on their relevance, with the search spanning publications up to 2023. Studies were excluded if they did not contribute pertinent information or lacked methodological rigor. A critical appraisal of included studies was conducted, assessing study design, sample size, methodology, and potential bias, ensuring a thorough and transparent review process. RESULTS BDUMP is a rare and potentially sight-threatening condition characterized by the bilateral proliferation of melanocytes within the uvea. BDUMP is typically observed in middle-aged or elderly individuals and is often associated with an underlying malignancy, most commonly of gastrointestinal origin. BDUMP is frequently misdiagnosed as a benign nevus or choroidal metastasis, leading to delayed diagnosis and treatment. The ophthalmic symptoms and signs typically precede the diagnosis of a systemic malignancy, emphasizing the crucial role of ophthalmologists in the recognition of BDUMP. Several diagnostic modalities can aid in the diagnosis of BDUMP, including ophthalmic examination, imaging studies such as optical coherence tomography, fluorescein angiography, and indocyanine green angiography, and biopsy of the uveal tissue. Treatment of BDUMP is directed towards the underlying malignancy and may include chemotherapy, radiotherapy, or surgical resection. Additionally, strict monitoring with regular follow-ups may contribute to the detection of new lesions and the reduction in the size of existing ones. CONCLUSIONS BDUMP can be considered a potential biomarker in the management of malignancies, especially when the primary underlying tumor has not been detected. Further research is needed to better understand the pathogenesis of BDUMP and its association with malignancy.
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Affiliation(s)
| | - Farid Afshar
- Southampton Eye Unit, University Hospital Southampton, Tremona Rd, Southampton, SO16 6YD, UK
| | - Gabriella De Salvo
- Southampton Eye Unit, University Hospital Southampton, Tremona Rd, Southampton, SO16 6YD, UK.
| | - Christina A Rennie
- Southampton Eye Unit, University Hospital Southampton, Tremona Rd, Southampton, SO16 6YD, UK
| | - Andrew John Lotery
- Southampton Eye Unit, University Hospital Southampton, Tremona Rd, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Parakh S, Maheshwari S, Das S, Kumar V, Agrawal R, Gupta V, Mruthyunjaya P, Luthra S. Presumed bilateral diffuse uveal melanocytic proliferation – A case report and review of literature. Am J Ophthalmol Case Rep 2022; 27:101582. [PMID: 35619994 PMCID: PMC9127154 DOI: 10.1016/j.ajoc.2022.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 10/26/2022] Open
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Breazzano MP, Bacci T, Wang H, Francis JH, Yannuzzi LA. Bacillary Layer Detachment in Bilateral Diffuse Uveal Melanocytic Proliferation Masquerading as Neovascular AMD. Ophthalmic Surg Lasers Imaging Retina 2021; 51:413-417. [PMID: 32706900 DOI: 10.3928/23258160-20200702-07] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/08/2020] [Indexed: 01/26/2023]
Abstract
Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare and unusual paraneoplastic ocular syndrome with generally poor prognosis. The authors present a case of BDUMP in a patient with bladder cancer, examined with current multimodal imaging. In the clinical setting with drusen and exudative macular detachments, the fundus simulated neovascular age-related macular degeneration, warranting standard-of-care therapy. The imaging actually showed the typical manifestations of BDUMP, but also newly recognized, associated manifestations, including the bacillary layer detachment, a gravitating retinal detachment, and multifocal choroidal hyperpermeability, but no evidence of neovascularization. Recognition of these associated manifestations is of value in appreciating the pathophysiology of this paraneoplastic disorder. Based on the imaging, the correct diagnosis was possible along with a better understanding of the nature of the clinical features in the posterior fundus. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:413-417.].
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Ocular Paraneoplastic Syndromes. Biomedicines 2020; 8:biomedicines8110490. [PMID: 33182708 PMCID: PMC7698240 DOI: 10.3390/biomedicines8110490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/28/2020] [Accepted: 11/08/2020] [Indexed: 12/12/2022] Open
Abstract
Ocular-involving paraneoplastic syndromes present a wide variety of clinical symptoms. Understanding the background pathophysiological and immunopathological factors can help make a more refined differential diagnosis consistent with the signs and symptoms presented by patients. There are two main pathophysiology arms: (1) autoimmune pathomechanism, which is presented with cancer-associated retinopathy (CAR), melanoma-associated retinopathy (MAR), cancer-associated cone dysfunction (CACD), paraneoplastic vitelliform maculopathy (PVM), and paraneoplastic optic neuritis (PON), and (2) ectopic peptides, which is often caused by tumor-expressed growth factors (T-exGF) and presented with bilateral diffuse uveal melanocytic proliferation (BDUMP). Meticulous systematic analysis of patient symptoms is a critical diagnostic step, complemented by multimodal imaging, which includes fundus photography, optical coherent tomography, fundus autofluorescence, fundus fluorescein angiography, electrophysiological examination, and sometimes fundus indocyjanin green angiography if prescribed by the clinician. Assessment of the presence of circulating antibodies is required for diagnosis. Antiretinal autoantibodies are highly associated with visual paraneoplastic syndromes and may guide diagnosis by classifying clinical manifestations in addition to monitoring treatment.
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Comprehensive Review of Treatments for Bilateral Diffuse Uveal Melanocytic Proliferation: A Focus on Plasmaphereis. Int Ophthalmol Clin 2016; 57:177-194. [PMID: 27898623 DOI: 10.1097/iio.0000000000000156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Naysan J, Pang CE, Klein RW, Freund KB. Multimodal imaging of bilateral diffuse uveal melanocytic proliferation associated with an iris mass lesion. Int J Retina Vitreous 2016; 2:13. [PMID: 27847631 PMCID: PMC5088479 DOI: 10.1186/s40942-016-0038-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/27/2016] [Indexed: 12/30/2022] Open
Abstract
Background Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare, paraneoplastic syndrome characterized by bilateral painless visual loss and proliferation of choroidal melanocytes in association with an underlying systemic malignancy. We report a case of bilateral diffuse uveal melanocytic proliferation associated with an underlying gynecological malignancy that also features the infrequent finding of an iris mass lesion, using multimodal imaging including ultra-widefield imaging, spectral domain and swept-source optical coherence tomography. Case presentation A 59-year-old white female with a prior history of gynecological malignancy in remission presented with progressive bilateral visual loss over several weeks. The patient was noted to have a focal iris mass lesion in her right eye. Ultra-widefield color fundus photography showed a characteristic bilateral ‘giraffe pattern’ of pigmentary changes extending into the periphery as well as multiple discrete deeply pigmented lesions. Ultra-widefield autofluorescence was useful for visualizing the full extent of involvement. Indocyanine green angiography helped to demarcate the discrete pigmented choroidal lesions. Swept-source OCT clearly delineated the alternating zones of retinal pigment epithelium (RPE) thickening and RPE loss, as well as the prominent choroidal infiltration and thickening. Conclusions BDUMP is an important diagnosis to consider in the presence of multiple discrete melanocytic choroidal lesions, diffuse choroidal thickening, characteristic RPE changes, iris mass lesions and exudative retinal detachment. Ultra-widefield imaging may demonstrate more extensive lesions than that detected on clinical examination or standard field imaging. Imaging with SS-OCT shows choroidal and RPE characteristics that correlate well with known histopathology of this entity.
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Affiliation(s)
- Jonathan Naysan
- The Vitreous Retina Macula Consultants of New York, 460 Park Avenue, Fifth Floor, New York, NY 10022 USA ; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY USA ; Department of Ophthalmology, New York University School of Medicine, New York, NY USA ; Department of Ophthalmology, North Shore - Long Island Jewish Health System, New York, NY USA
| | - Claudine E Pang
- The Vitreous Retina Macula Consultants of New York, 460 Park Avenue, Fifth Floor, New York, NY 10022 USA ; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY USA
| | - Robert W Klein
- The Vitreous Retina Macula Consultants of New York, 460 Park Avenue, Fifth Floor, New York, NY 10022 USA ; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY USA ; Department of Ophthalmology, New York University School of Medicine, New York, NY USA
| | - K Bailey Freund
- The Vitreous Retina Macula Consultants of New York, 460 Park Avenue, Fifth Floor, New York, NY 10022 USA ; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY USA ; Department of Ophthalmology, New York University School of Medicine, New York, NY USA ; Department of Ophthalmology, North Shore - Long Island Jewish Health System, New York, NY USA
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NEAR-INFRARED AUTOFLUORESCENCE IN BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION ASSOCIATED WITH ESOPHAGEAL CARCINOMA AND CHOROIDAL METASTASIS. Retin Cases Brief Rep 2016; 10:254-8. [PMID: 26807495 DOI: 10.1097/icb.0000000000000244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the advantage of near-infrared autofluorescence (787 nm) for the detection of melanocytic lesions in a patient with bilateral diffuse uveal melanocytic proliferation in association with esophageal carcinoma complicated by most likely unilateral choroidal metastasis. METHODS In this retrospective case report, a 55-year-old woman referred for the evaluation of sudden visual loss underwent normal ophthalmological evaluation and, in addition, was examined with near-infrared reflectance, near-infrared autofluorescence, fundus autofluorescence (Heidelberg Retina Angiograph II [HRA2; Heidelberg Engineering]), spectral domain optical coherence tomography (Spectralis OCT; Heidelberg Engineering), and multifocal electroretinography (RetiScan; Roland Consult). RESULTS The patient had been diagnosed with esophageal carcinoma 3 months before the onset of visual symptoms. The visual acuity was 20/40 in the right eye and 20/20 in the left eye. Bilateral patchy melanocytic proliferation was detected on ophthalmoscopy. The extent of lesions was best detected with near-infrared reflectance and near-infrared autofluorescence, whereas fundus autofluorescence and spectral domain optical coherence tomography did not reveal alterations of the outer retina or retinal pigment epithelium in this early stage of bilateral diffuse uveal melanocytic proliferation. The right eye showed in addition to the findings on the left eye choroidal folds in the fovea and an elevated lesion inferotemporal of the fovea suspicious of a choroidal metastasis. In the B-scan ultrasonography, a homogenous lesion was seen. Spectral domain optical coherence tomography demonstrated a mild accumulation of subretinal fluid adjacent to and over the choroidal metastasis. Transretinal biopsy of this elevated lesion revealed a low differentiated carcinoma of squamous epithelium, compatible with choroidal metastasis of the esophageal carcinoma. The choroidal metastasis increased within 3 months after the first visit. The visual acuity dropped in both eyes. The patient died 6 months after her first visit. CONCLUSIONS Bilateral diffuse uveal melanocytic proliferation can be associated with esophageal carcinoma as a systemic malignancy. Near-infrared imaging can be helpful to detect early stages of BDUMP and can help offer recently reported treatment options at an early stage of disease.
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Mittal R, Cherepanoff S, Thornton S, Kalirai H, Damato B, Coupland SE. Bilateral Diffuse Uveal Melanocytic Proliferation: Molecular Genetic Analysis of a Case and Review of the Literature. Ocul Oncol Pathol 2015; 2:94-9. [PMID: 27171825 DOI: 10.1159/000440766] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/28/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE OF THE STUDY To describe the clinicopathological features, mutational and chromosomal copy number analysis, and 8-year follow-up of a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) associated with clear-cell carcinoma of the endometrium. METHODS Histological evaluation, multiplex ligation-dependent probe amplification (MLPA) analysis and GNAQ/11 mutational analysis were performed in a 67-year-old female patient with the diagnosis of BDUMP. RESULTS Histological evaluation revealed proliferation of bland spindle cells, diffusely replacing the uveal tract, which showed a proliferation index of less than 1%. There was absence of mutations involving the codon 209 and 183 of GNAQ, and of GNA11. MLPA analysis showed disomy 3 with polysomy 8q for both eyes. The patient died 8 years later of an unrelated condition. CONCLUSIONS Although BDUMP is considered to be a benign proliferative disease, copy number alterations of unknown significance may occur in these lesions.
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Affiliation(s)
- Ruchi Mittal
- Dalmia Ophthalmic Pathology Services, L.V. Prasad Eye Institute, Bhubaneswar, India
| | | | - Sophie Thornton
- Pathology, Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Helen Kalirai
- Pathology, Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Bertil Damato
- Ocular Oncology Service, University of California, San Francisco, Calif., USA
| | - Sarah E Coupland
- Pathology, Department of Clinical and Molecular Cancer Medicine, University of Liverpool, Liverpool, UK
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Shalchi Z, Shunmugam M, Mahroo OA, McDonald RJ, Dogramaci M, Laidlaw DAH, Stanford M, Mohamed M. Spectral domain optical coherence tomography findings in a case series of patients with bilateral diffuse uveal melanocytic proliferation. Ocul Immunol Inflamm 2014; 22:490-3. [PMID: 24988007 DOI: 10.3109/09273948.2014.926935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Zaid Shalchi
- Department of Ophthalmology, St Thomas' Hospital , London , UK
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Rahimy E, Sarraf D. Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management. Surv Ophthalmol 2013; 58:430-58. [DOI: 10.1016/j.survophthal.2012.09.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/27/2012] [Accepted: 12/04/2012] [Indexed: 12/29/2022]
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