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Masoumeh H, Tunay D, Demet ÖA, Samuray T, Hülya Y. Exploring of miR-155-5p, miR-181b-5p, and miR-454-3p Expressions in Circulating Cell-Free RNA: Insights from Peripheral Blood of Uveal Malignant Melanoma Patients. Biochem Genet 2024:10.1007/s10528-024-10849-8. [PMID: 38914847 DOI: 10.1007/s10528-024-10849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/22/2024] [Indexed: 06/26/2024]
Abstract
The identification of novel non-invasive biomarkers is imperative for the early diagnosis and monitoring of malignant melanoma. The objective of this study is to examine the expression levels of miR-155-5p, miR-181b-5p, and miR-454-3p in circulating cell-free RNA obtained from plasma samples of the 72 uveal malignant melanoma patients and to compare these levels with those of 72 healthy controls. The analysis showed that the expression level of the miR-181b-5p has increased 9.25 fold, and expression level of miR-155-5p has increased 6.67 fold, and miR-454-3p expression level has increased 4.14 fold in the patient group compared with the levels in the healthy control group (p = 0.005). It was found that the high expression levels of the three miRNAs were statistically significant in patients compared with in the healthy control group. The statistical evaluations between miRNA expression levels and clinical data showed that miR-155-5p had significant association with radiation therapy (p = 0.040), and miR-454-3p showed a significant association with smoking and alcohol use respectively (p = 0.009, and p = 0.026). The significantly elevated expression levels of miR-181b-5p, miR-155-5p, and miR-454-3p in the circulating cell-free RNA of plasma from uveal melanoma patients, in comparison to those in the healthy control group, suggest the potential usefulness of these biomarkers for both early diagnosis and disease monitoring. However, more extensive and future studies are needed to use these molecules in early diagnosis and disease monitoring.
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Affiliation(s)
- Hassani Masoumeh
- Cancer Genetics Division, Oncology Institute, İstanbul University, Çapa-Fatih, 34093, Istanbul, Türkiye
| | - Doğan Tunay
- Cancer Genetics Division, Oncology Institute, İstanbul University, Çapa-Fatih, 34093, Istanbul, Türkiye
- Department of Medical Pathology, Faculty of Medicine, Istinye University, Cevizlibağ-Zeytinburnu, 34010, Istanbul, Türkiye
| | - Ödemiş Akdeniz Demet
- Cancer Genetics Division, Oncology Institute, İstanbul University, Çapa-Fatih, 34093, Istanbul, Türkiye
- Health Institutes of Türkiye, Türkiye Cancer Institute, Kadıköy, 34734, Istanbul, Türkiye
| | - Tuncer Samuray
- Department of Eye Diseases, Faculty of Medicine, İstanbul University, Çapa-Fatih, 34093, Istanbul, Türkiye
| | - Yazıcı Hülya
- Cancer Genetics Division, Oncology Institute, İstanbul University, Çapa-Fatih, 34093, Istanbul, Türkiye.
- Department of Medical Biology and Genetics, Faculty of Medicine, İstanbul Arel University, Merkez Efendi Mah, Eski Londra Asfalti.Cd., No 1/3, Cevizlibag, Zeytinburnu, 34010, Istanbul, Türkiye.
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Wan Q, Ren X, Wei R, Yue S, Wang L, Yin H, Tang J, Zhang M, Ma K, Deng YP. Deep learning classification of uveal melanoma based on histopathological images and identification of a novel indicator for prognosis of patients. Biol Proced Online 2023; 25:15. [PMID: 37268878 DOI: 10.1186/s12575-023-00207-0] [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: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Deep learning has been extensively used in digital histopathology. The purpose of this study was to test deep learning (DL) algorithms for predicting the vital status of whole-slide image (WSI) of uveal melanoma (UM). METHODS We developed a deep learning model (Google-net) to predict the vital status of UM patients from histopathological images in TCGA-UVM cohort and validated it in an internal cohort. The histopathological DL features extracted from the model and then were applied to classify UM patients into two subtypes. The differences between two subtypes in clinical outcomes, tumor mutation, and microenvironment, and probability of drug therapeutic response were investigated further. RESULTS We observed that the developed DL model can achieve a high accuracy of > = 90% for patches and WSIs prediction. Using 14 histopathological DL features, we successfully classified UM patients into Cluster1 and Cluster2 subtypes. Compared to Cluster2, patients in the Cluster1 subtype have a poor survival outcome, increased expression levels of immune-checkpoint genes, higher immune-infiltration of CD8 + T cell and CD4 + T cells, and more sensitivity to anti-PD-1 therapy. Besides, we established and verified prognostic histopathological DL-signature and gene-signature which outperformed the traditional clinical features. Finally, a well-performed nomogram combining the DL-signature and gene-signature was constructed to predict the mortality of UM patients. CONCLUSIONS Our findings suggest that DL model can accurately predict vital status in UM patents just using histopathological images. We found out two subgroups based on histopathological DL features, which may in favor of immunotherapy and chemotherapy. Finally, a well-performing nomogram that combines DL-signature and gene-signature was constructed to give a more straightforward and reliable prognosis for UM patients in treatment and management.
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Affiliation(s)
- Qi Wan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Xiang Ren
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Ran Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Shali Yue
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Hongbo Yin
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Jing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Ke Ma
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.
| | - Ying-Ping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.
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Soliman N, Mamdouh D, Elkordi A. Choroidal Melanoma: A Mini Review. MEDICINES (BASEL, SWITZERLAND) 2023; 10:medicines10010011. [PMID: 36662495 PMCID: PMC9863301 DOI: 10.3390/medicines10010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/18/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Abstract
Choroidal melanoma is a rare malignant tumour, yet it is the most common primary intra-ocular neoplasm and second on the list of top ten most malignant melanoma sites in the body. Clinical presentation can be non-specific and includes photopsia, floaters, progressive visual field loss, and blurry vision. The tumour is quite often diagnosed clinically during fundus examination; however, the most valued diagnostic tests are A- and B-scan ultrasonography (US). Several factors affect prognosis, including the patient's age, tumour size, histological features, and presence of metastases. Still, with primary treatment and tight surveillance, around 50% of choroidal melanoma patients metastasise.
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Affiliation(s)
- Noha Soliman
- UCL Institute of Ophthalmology, London EC1V 9EL, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London EC1V 2PD, UK
- Royal College of Surgeons in Ireland, Medical University of Bahrain, Muharraq P.O. Box 15503, Bahrain
- Correspondence:
| | - Diaa Mamdouh
- Faculty of Medicine, Kuwait University, Kuwait City P.O. Box 24923, Kuwait
- Sheikh Jaber Al Ahmad Al Jaber Al Sabah Hospital, Kuwait City, Kuwait
| | - Aisha Elkordi
- Royal College of Surgeons in Ireland, Medical University of Bahrain, Muharraq P.O. Box 15503, Bahrain
- King Hamed University Hospital, Muharraq P.O Box 24343, Bahrain
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Stereotactic irradiation on linear accelerator - ultrasound versus MRI in choroidal melanoma volume calculation. BMC Ophthalmol 2022; 22:333. [PMID: 35931996 PMCID: PMC9356474 DOI: 10.1186/s12886-022-02558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Stereotactic irradiation is one of the treatment modalities for intraocular uveal melanoma. The study’s purpose was to describe the background of stereotactic one-day session radiosurgery, how the comparison in the difference between the tumor volume measured values from the magnetic resonance imaging (MRI) method and the ultrasound method was related to it, and which method was more precise to be used for tumor regression after irradiation. Methods The group of 147 patients with choroidal melanoma was treated by stereotactic irradiation on the linear accelerator with a single dose of 35.0 Gy. During the standard treatment process the uveal melanoma volumes, needed for dose calculation, were obtained using MRI from the individual stereotactic planning scheme and by ultrasound from the ultrasound device. All volumes were statistically compared using the paired t-test, and for the visualization purpose, the Bland-Altman plot was used. Results In the group of patients, it was 70 (47.6%) males and 77 (52.4%) females. The tumor volume median was from MRI equal to 0.44 cm3 and from ultrasound equal to 0.53 cm3. The difference between the ultrasound and the MRI volume measured values was statistically significant. However, the Bland-Altman plot clearly documents that the two methods are in agreement and can be used interchangeably. In most of the cases, the measured values of the ultrasound-calculated volume achieved slightly higher measured values. Conclusions The calculation of the intraocular uveal tumor volume is a crucial part of the stereotactic irradiation treatment. The ultrasound volume measured values were in most of the cases higher than the measured values from the MRI. Although the methods are comparable and can be used interchangeably, we are recommending using the more precise MRI method not only during the treatment but also on later regular medical checks of tumor regression or progression.
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Sabat‐Pośpiech D, Fabian‐Kolpanowicz K, Kalirai H, Kipling N, Coupland SE, Coulson JM, Fielding AB. Aggressive uveal melanoma displays a high degree of centrosome amplification, opening the door to therapeutic intervention. J Pathol Clin Res 2022; 8:383-394. [PMID: 35474453 PMCID: PMC9161346 DOI: 10.1002/cjp2.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
Uveal melanoma (UM) is the most common intraocular cancer in adults. Whilst treatment of primary UM (PUM) is often successful, around 50% of patients develop metastatic disease with poor outcomes, linked to chromosome 3 loss (monosomy 3, M3). Advances in understanding UM cell biology may indicate new therapeutic options. We report that UM exhibits centrosome abnormalities, which in other cancers are associated with increased invasiveness and worse prognosis, but also represent a potential Achilles' heel for cancer-specific therapeutics. Analysis of 75 PUM patient samples revealed both higher centrosome numbers and an increase in centrosomes with enlarged pericentriolar matrix (PCM) compared to surrounding normal tissue, both indicative of centrosome amplification. The PCM phenotype was significantly associated with M3 (t-test, p < 0.01). Centrosomes naturally enlarge as cells approach mitosis; however, whilst UM with higher mitotic scores had enlarged PCM regardless of genetic status, the PCM phenotype remained significantly associated with M3 in UM with low mitotic scores (ANOVA, p = 0.021) suggesting that this is independent of proliferation. Phenotypic analysis of patient-derived cultures and established UM lines revealed comparable levels of centrosome amplification in PUM cells to archetypal triple-negative breast cancer cell lines, whilst metastatic UM (MUM) cell lines had even higher levels. Importantly, many UM cells also exhibit centrosome clustering, a common strategy employed by other cancer cells with centrosome amplification to survive cell division. As UM samples with M3 display centrosome abnormalities indicative of amplification, this phenotype may contribute to the development of MUM, suggesting that centrosome de-clustering drugs may provide a novel therapeutic approach.
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Affiliation(s)
- Dorota Sabat‐Pośpiech
- Molecular Physiology and Cell Signalling, Institute of Systems Molecular & Integrative BiologyUniversity of LiverpoolLiverpoolUK
- Molecular and Clinical Cancer Medicine, Institute of Systems Molecular & Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Kim Fabian‐Kolpanowicz
- Biomedical and Life Sciences, Faculty of Health and MedicineLancaster UniversityLancasterUK
| | - Helen Kalirai
- Molecular and Clinical Cancer Medicine, Institute of Systems Molecular & Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Natalie Kipling
- Molecular and Clinical Cancer Medicine, Institute of Systems Molecular & Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Sarah E Coupland
- Molecular and Clinical Cancer Medicine, Institute of Systems Molecular & Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Judy M Coulson
- Molecular Physiology and Cell Signalling, Institute of Systems Molecular & Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Andrew B Fielding
- Molecular Physiology and Cell Signalling, Institute of Systems Molecular & Integrative BiologyUniversity of LiverpoolLiverpoolUK
- Biomedical and Life Sciences, Faculty of Health and MedicineLancaster UniversityLancasterUK
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Lv X, Ding M, Liu Y. Landscape of Infiltrated Immune Cell Characterization in Uveal Melanoma to Improve Immune Checkpoint Blockade Therapy. Front Immunol 2022; 13:848455. [PMID: 35309331 PMCID: PMC8924368 DOI: 10.3389/fimmu.2022.848455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background Numerous studies indicated that tumor-infiltrated immune cells (TIC) in the microenvironment are substantially linked to immunotherapy response and cancer prognosis. However, systematic studies of infiltrated immune cell characterization in uveal melanoma (UM) for prognosis and immune checkpoint blockade therapy are lacking. Methods UM datasets were extracted from open access resources (TCGA and GEO databases). The tumor-infiltrated immune cells in the microenvironment were decoded by using the CIBERSORT algorithm, which was further applied to classify UM patients into subgroups using an unsupervised clustering method. The Boruta algorithm and principal component analysis were used to calculate the TIC scores for UM patients. Kaplan–Meier curves were plotted to prove the prognostic value of TIC scores. Besides, the correlations of the TIC score with clinical features, mutated characteristics, and the immune therapeutic response were subsequently investigated. Results As a result, we defined three subtypes among 171 UM patients according to the TIC profiles and then calculated the TIC score to characterize the immune patterns for all patients. We discovered that high-TIC score patients with low BAP1 and high EIF1AX mutations have a better prognosis than low-TIC score patients. Activation of immune inflammatory response and increase in immune checkpoint-related genes in high-TIC score patients may account for good prognosis and immunotherapy response. Three melanoma cohorts received immunotherapy, proving that high-TIC score patients have substantial clinical and immune therapeutic improvements. Besides, several potential therapeutic agents were identified in the low-TIC score group. Conclusion Our study afforded a comprehensive view of infiltrated immune cell characterization to elucidate different immune patterns of UM. We also established a robust TIC-score signature, which may work as a prognostic biomarker and immune therapeutic predictor.
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Affiliation(s)
- Xiaohui Lv
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Min Ding
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yan Liu
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
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7
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Chen YN, Wang YN, Chen MX, Zhang K, Chen RT, Fang R, Wang H, Zhang HH, Huang YN, Feng Y, Luo JT, Lan YJ, Liu YM, Li Y, Wei WB. Machine learning models for outcome prediction of Chinese uveal melanoma patients: A 15-year follow-up study. Cancer Commun (Lond) 2022; 42:273-276. [PMID: 35001563 PMCID: PMC8923127 DOI: 10.1002/cac2.12253] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/26/2021] [Accepted: 12/30/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Yu-Ning Chen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Yi-Ning Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Meng-Xi Chen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Kai Zhang
- InferVision Healthcare Science and Technology Limited Company, Shanghai, 200030, P. R. China
| | - Rong-Tian Chen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Rui Fang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Heng Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Hai-Han Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Yi-Ning Huang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Yu Feng
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Jing-Ting Luo
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Yin-Jun Lan
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Yue-Ming Liu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology&Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China
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Sinusoidal Growth Pattern of Hepatic Melanoma Metastasis: Implications for Histopathologic Diagnosis. Am J Surg Pathol 2021; 46:832-839. [PMID: 34799482 DOI: 10.1097/pas.0000000000001835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Metastatic tumors interface with liver in multiple patterns, of which, the rare "sinusoidal" growth pattern can be subtle and easily overlooked on biopsy. We sought to characterize the metastasis-to-liver interface patterns of melanoma compared with other tumor types and assess the incidence of metastatic melanoma in histologically normal-appearing targeted liver lesion biopsies. Liver lesion samples from 54 melanoma patients were assessed. Nearly normal-appearing cases, defined as no obvious malignancy on routine hematoxylin and eosin stain (n=24), were stained with SOX10 and confirmed with MelanA. Tumor-to-liver interface patterns were determined in biopsies overtly positive for metastatic melanoma (n=30) versus other hepatic metastases as controls (colon, n=28; breast, n=20; pancreaticobiliary, n=20; and neuroendocrine, n=28). Of the 24 nearly normal-appearing liver biopsies from melanoma patients, 3 had subtle melanoma cells detected in sinusoids, confirmed with immunohistochemistry. Of 30 livers overtly positive for melanoma, 8 showed the sinusoidal pattern, compared with none in other metastases. In total, 11/33 (33%) cases of metastatic melanoma liver biopsies demonstrated the sinusoidal pattern. We describe 11 metastatic melanoma cases in liver with the rare sinusoidal pattern, 3 of which were subtle and easy to miss on routine hematoxylin and eosin stain. Given that sinusoidal metastasis does not elicit a tissue reaction, it is prudent for the pathologists to be aware of this pattern of metastases and have a low threshold to order immunostains for accurate diagnosis and optimal patient care.
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Tigari B, Saini M, Manchanda S, Vankdoth S. Large ciliary body melanoma. BMJ Case Rep 2021; 14:e246386. [PMID: 34764100 PMCID: PMC8587378 DOI: 10.1136/bcr-2021-246386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Basavaraj Tigari
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Saini
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubham Manchanda
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Vankdoth
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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10
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Ulltang E, Kiilgaard JF, Mola N, Scheie D, Heegaard S, Krohn J. Vitrectomy-Assisted Biopsy: An in vitro Study on the Impact of Cut Rate and Probe Size. Ocul Oncol Pathol 2021; 7:346-352. [PMID: 34722491 DOI: 10.1159/000516960] [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: 12/09/2020] [Accepted: 04/24/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to optimize the technique of performing vitrectomy-assisted biopsy of intraocular tumors by comparing the cytohistological findings in specimens obtained with different vitrectomy probes and cut rates. Methods Vitrectomy-assisted biopsies were taken from a fresh porcine liver. For each sampling, the vacuum level was 300 mm Hg. The following parameters were compared; cut rate (60, 600 and 6,000 cuts per minute [cpm]), probe type (standard and two-dimensional cutting [TDC]), and probe diameter (23-gauge and 25-gauge). The specimens were assessed by automated whole-slide imaging analysis and conventional light microscopy. Results Seventy-two biopsies were analyzed for the number of hepatocytes, total area of tissue fragments, and total stained area of each microscope slide. For all probe types, these parameters were significantly and positively correlated with the cut rate. TDC probes led to significantly higher scores than those of standard probes, independent of the cut rate. There were no significant differences in results when using 23-gauge or 25-gauge standard probes. Light microscopic examination demonstrated well-preserved cells sufficient for cytohistological analyses in all investigated cases. Conclusions The higher the cut rate, the larger is the amount of aspirated cellular material. There were no significant differences between 23-gauge and 25-gauge biopsies. Cut rates up to 6,000 cpm did not adversely affect the cytohistological features of the samples.
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Affiliation(s)
- Erlend Ulltang
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Jens Folke Kiilgaard
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nazanin Mola
- Department of Pathology, Haukeland University Hospital, Bergen, Norway.,Section for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - David Scheie
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen Krohn
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.,Section of Ophthalmology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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11
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Zhao H, Chen Y, Shen P, Gong L. Identification of Immune Cell Infiltration Landscape and Their Prognostic Significance in Uveal Melanoma. Front Cell Dev Biol 2021; 9:713569. [PMID: 34513843 PMCID: PMC8427429 DOI: 10.3389/fcell.2021.713569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/09/2021] [Indexed: 12/21/2022] Open
Abstract
Uveal melanoma (UVM) is the most common primary intraocular cancer in adults. Increasing evidence has demonstrated that immune cell infiltration (ICI) is crucial in predicting patient outcomes and therapeutic efficacy. Thus, describing the immune cell infiltrative landscape of UVM tumors may yield a novel prognostic marker and provide direction for immunotherapeutic selection. In this study, the gene expression data and clinical information of UVM patients were obtained from the cancer genome atlas (TCGA) and gene expression omnibus (GEO) databases. The ICI landscape of UVM was analyzed using the CIBERSORT and ESTIMATE algorithms. Two ICI phenotypes were defined, and the ICI scores were calculated by using principal component analysis algorithms. We found that a subtype with high ICI scores had poorer prognosis and increased expression levels of immune checkpoint-related genes. This study demonstrates that ICI scores are an independent prognostic biomarker and highlights their value in predicting immunotherapeutic outcomes.
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Affiliation(s)
- Han Zhao
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Laboratory of Myopia, NHC Key Laboratory of Myopia, Chinese of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Yun Chen
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Peijun Shen
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Non-resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Lan Gong
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Laboratory of Myopia, NHC Key Laboratory of Myopia, Chinese of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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12
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Liao CL, Hu N, Sun XY, Zhou Q, Tian M, Cao Y, Lyu HB. Identification and validation of tumor microenvironment-related lncRNA prognostic signature for uveal melanoma. Int J Ophthalmol 2021; 14:1151-1159. [PMID: 34414077 DOI: 10.18240/ijo.2021.08.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
AIM To investigate the role of tumor microenvironment (TME)-related long non-coding RNA (lncRNA) in uveal melanoma (UM), probable prognostic signature and potential small molecule drugs using bioinformatics analysis. METHODS UM expression profile data were downloaded from the Cancer Genome Atlas (TCGA) and bioinformatics methods were used to find prognostic lncRNAs related to UM immune cell infiltration. The gene expression profile data of 80 TCGA specimens were analyzed using the single sample Gene Set Enrichment Analysis (ssGSEA) method, and the immune cell infiltration of a single specimen was evaluated. Finally, the specimens were divided into high and low infiltration groups. The differential expression between the two groups was analyzed using the R package 'edgeR'. Univariate, multivariate and Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression analyses were performed to explore the prognostic value of TME-related lncRNAs. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional analyses were also performed. The Connectivity Map (CMap) data set was used to screen molecular drugs that may treat UM. RESULTS A total of 2393 differentially expressed genes were identified and met the criteria for the low and high immune cell infiltration groups. Univariate Cox analysis of lncRNA genes with differential expression identified 186 genes associated with prognosis. Eight prognostic markers of TME-included lncRNA genes were established as potentially independent prognostic elements. Among 269 differentially expressed lncRNAs, 69 were up-regulated and 200 were down-regulated. Univariate Cox regression analysis of the risk indicators and clinical characteristics of the 8 lncRNA gene constructs showed that age, TNM stage, tumor base diameter, and low and high risk indices had significant prognostic value. We screened the potential small-molecule drugs for UM, including W-13, AH-6809 and Imatinib. CONCLUSION The prognostic markers identified in this study are reliable biomarkers of UM. This study expands our current understanding of the role of TME-related lncRNAs in UM genesis, which may lay the foundations for future treatment of this disease.
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Affiliation(s)
- Chen-Lu Liao
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Nan Hu
- Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Xing-Yu Sun
- Department of Gynecology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Qi Zhou
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Min Tian
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Yang Cao
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Hong-Bin Lyu
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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13
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Teoh CS, Jeyabal P, Young SM, Lim VSY. Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:297-305. [PMID: 33990817 DOI: 10.47102/annals-acadmedsg.2020488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Limited data are available on the incidence of primary ophthalmic cancers worldwide. We describe the incidence and trends of primary ophthalmic cancers in Singapore. METHODS Data on ophthalmic cancers diagnosed in Singapore from 1996 to 2016 were retrieved from the Singapore Cancer Registry for analysis. All were histologically proven primary ophthalmic cancers. Calculations of incidence and age-specific frequency of ophthalmic malignancy were made. RESULTS A total of 297 cases were included, with males constituting 59.9%. The race distribution was 78.5% Chinese, 16.5% Malay, 3.7% Indians and 1.3% others. There was an overall increase in ophthalmic malignancies. The mean age of onset was 47.4 years. The most common cancers were retinoblastoma (93.3%) in patients younger than 15 years, and lymphoma (71.3%) in patients aged 15 years and older. There has been an increase in lymphomas from 16.7% in 1968-1995 to 71.3% in 1996-2016 in those aged 15 years and older. The most common types of ophthalmic cancer according to location are lymphoma of the orbit, conjunctiva, cornea and lacrimal gland; retinoblastoma of the retina; and malignant melanoma of the choroid and ciliary body. CONCLUSION Our study reported the incidence and trends of ophthalmic cancer in the Singapore population and showed an overall increase in ophthalmic malignancies in Singapore from 1996-2016. A substantial increase in lymphomas over the last 2 decades was noted. The data could aid clinicians, epidemiologists and policymakers in implementing strategies to address trends in ophthalmic cancers and spur aetiological research to improve quality of life in patients with such cancers.
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Affiliation(s)
- Chin Sheng Teoh
- Department of Ophthalmology, National University Hospital, Singapore
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14
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Santos-Buitrago B, Santos-García G, Hernández-Galilea E. Artificial intelligence for modeling uveal melanoma. Artif Intell Cancer 2020; 1:51-65. [DOI: 10.35713/aic.v1.i4.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
Understanding of the cellular signaling pathways involved in cancer disease is of great importance. These complex biological mechanisms can be thoroughly revealed by their structure, dynamics, and control methods. Artificial intelligence offers rule-based models that favor the research of human signaling processes. In this paper, we give an overview of the advantages of the formalism of symbolic models in medical biology and cell biology of the uveal melanoma. A language is described that allows us: (1) To define the system states and elements with their alterations; (2) To model the dynamics of the cellular system; and (3) To perform inference-based analysis with the logical tools of the language.
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Affiliation(s)
| | - Gustavo Santos-García
- IME, University of Salamanca, Salamanca 37007, Spain
- FADoSS Research Unit, Universidad Complutense de Madrid, Madrid 28040, Spain
| | - Emiliano Hernández-Galilea
- Department of Ophthalmology, Institute of Biomedicine Investigation of Salamanca (IBSAL), University Hospital of Salamanca, University of Salamanca, Salamanca 37007, Spain
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15
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Novel Methylation Patterns Predict Outcome in Uveal Melanoma. Life (Basel) 2020; 10:life10100248. [PMID: 33092094 PMCID: PMC7589184 DOI: 10.3390/life10100248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/25/2022] Open
Abstract
Uveal melanoma (UM) is the most common intraocular tumor in adults. Despite effective local treatments, 50% of patients develop metastasis. Better ways to determine prognosis are needed as well as new therapeutic targets. Epigenetic changes are important events driving cancer progression; however, few studies exist on methylation changes in UM. Our aim was to identify methylation events associated with UM prognosis. Matched clinical, genetic, and methylation data for 80 UM cases were obtained from The Cancer Genome Atlas (TCGA). Top differentially methylated loci were sorted through hierarchical clustering based on methylation patterns, and these patterns were compared to tumor characteristics, genomic aberrations, and patient outcome. Hierarchical clustering revealed two distinct groups. These classifications effectively separated high and low-risk cases, with significant differences between groups in patient survival (p < 0.0001) and correlation with known prognostic factors. Major differences in methylation of specific genes, notably NFIA, HDAC4, and IL12RB2, were also seen. The methylation patterns identified in this study indicate potential novel prognostic indicators of UM and highlight the power of methylation changes in predicting outcome. The methylation events enriched in the high-risk group suggest that epigenetic modulating drugs may be useful in reducing metastatic potential, and that specific differentially methylated loci could act as biomarkers of therapeutic response.
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16
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Steiner B, Wackernagel W, Vajda L, Georgi T, Langmann G. Gamma-Knife-Radiochirurgie in der Ophthalmoonkologie. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Singh MK, Singh L, Pushker N, Chosdol K, Bakhshi S, Meel R, Sen S, Kashyap S. Constitutive expression of c-REL in uveal melanoma patients: correlation with clinicopathological parameters and patient outcome. Clin Transl Oncol 2020; 22:1193-1204. [PMID: 31768922 DOI: 10.1007/s12094-019-02247-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Uveal melanoma (UM) is the most common intraocular cancer with a high mortality rate that requires new research in the field of prevention and treatment. c-REL is a member of the nuclear factor κB (NF-κB) transcription factor family and an emerging regulator of tumorigenesis. Therefore, the objective of the study is to evaluate the constitutive expression of c-REL in uveal melanoma patients and its prognostic significance. METHODS Detection of c-REL expression was carried out by immunohistochemistry in all 75 patients, and qRT-PCR performed on 58 fresh cases of uveal melanoma along with IL-6 status. Immunoblot was performed to validate immunohistochemistry results. Expression of c-REL protein correlated with clinicopathological parameters and overall survival of patients. RESULTS Immunohistochemistry results revealed nuclear expression of the c-REL protein (56%) in our cases. Out of 75 cases, 31 cases showed nuclear expression, and 11 cases had cytoplasmic expression. qRT-PCR showed upregulation of the REL gene in 56.89% cases at the transcriptional level. There was a statistically significant difference in the overall survival of patients with c-REL nuclear immunopositivity (p = 0.0048). On multivariate analysis, scleral invasion and c-REL nuclear expression found to be an independent prognostic factor (p < 0.05) CONCLUSIONS: To the best of our knowledge, this was the first study reporting the expression of the c-REL protein in uveal melanoma. Strong nuclear immunoexpression of c-Rel suggests NFκB pathway activation which might be involved in the progression of the disease. Differential expression of c-REL protein may be used as an attractive target for the development of anticancer strategies.
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Affiliation(s)
- M K Singh
- Department of Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - L Singh
- Departrment of Biosciences, JMI, New Delhi, India
| | - N Pushker
- Department of Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - K Chosdol
- Department of Biochemistry, AIIMS, New Delhi, India
| | - S Bakhshi
- Department of Medical Oncology, IRCH, AIIMS, New Delhi, India
| | - R Meel
- Department of Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S Sen
- Department of Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S Kashyap
- Department of Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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18
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Alkatan HM, Al Qahtani AA, Maktabi AM. Enucleated globes with choroidal melanoma: A retrospective histopathological study and correlation with cytogenetic profile in 2 eye centers. Ann Med Surg (Lond) 2020; 55:227-233. [PMID: 32518647 PMCID: PMC7272512 DOI: 10.1016/j.amsu.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Uveal melanoma is the commonest intraocular malignant tumor in adults and the choroid is the commonest involved location. It is more prevalent in Caucasians; however, the demographics are widely variable based on ethnicity. Histopathological features have been correlated to the cytogenetic profile, which we intend to report through the study of enucleated eyes with choroidal melanoma (CM). Materials and Methods A retrospective review of 28 enucleated globes with CM in 2 tertiary eye centers (January 2000-December 2017). The tumors were histopathologically classified based on the 8th edition of the American Joint Committee on Cancer (AJCC). The histopathological risk factors and the AJCC classifications were correlated with Fluorescence in situ hybridization (FISH) for chromosomes 3 and 8 available results in 18/28 eyes. Results We have included 28 patients with a mean age of 56 years, 13 males (46.4%) and 15 females (53.6%). None had lymph node involvement or metastatic disease. The tumor size was categorized as 3 and 4 in 68% of eyes. Half tumors were of spindle cell type and were associated with absent cytogenetic abnormality in chromosomes 3 and 8 (P=0.005). Closed vascular loops presence was significantly associated with abnormal chromosomes 3 and 8 (P=0.027). Conclusion Patients in our area presented late with larger tumor size. The spindle cell CM was the commonest and correlated with negative FISH results, while the presence of closed vascular loops was a risk factor for abnormal FISH results hence expected worse prognosis. AJCC classification did not correlate well with our FISH results.
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Affiliation(s)
- Hind M Alkatan
- Ophthalmology Department, King Saud University Riyadh, Saudi Arabia.,Pathology Department, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Aoun Al Qahtani
- Surgical Vitreo-retina, Ophthalmology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Azza My Maktabi
- Pathology & Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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19
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Bustamante P, Piquet L, Landreville S, Burnier JV. Uveal melanoma pathobiology: Metastasis to the liver. Semin Cancer Biol 2020; 71:65-85. [PMID: 32450140 DOI: 10.1016/j.semcancer.2020.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
Uveal melanoma (UM) is a type of intraocular tumor with a propensity to disseminate to the liver. Despite the identification of the early driver mutations during the development of the pathology, the process of UM metastasis is still not fully comprehended. A better understanding of the genetic, molecular, and environmental factors participating to its spread and metastatic outgrowth could provide additional approaches for UM treatment. In this review, we will discuss the advances made towards the understanding of the pathogenesis of metastatic UM, summarize the current and prospective treatments, and introduce some of the ongoing research in this field.
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Affiliation(s)
- Prisca Bustamante
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, Canada; Experimental Pathology Unit, Department of Pathology, McGill University, Montréal, Canada
| | - Léo Piquet
- Département d'ophtalmologie et d'ORL-CCF, Faculté de médecine, Université Laval, Quebec City, Canada; CUO-Recherche and Axe médecine régénératrice, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada; Centre de recherche sur le cancer de l'Université Laval, Quebec City, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Quebec City, Canada
| | - Solange Landreville
- Département d'ophtalmologie et d'ORL-CCF, Faculté de médecine, Université Laval, Quebec City, Canada; CUO-Recherche and Axe médecine régénératrice, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada; Centre de recherche sur le cancer de l'Université Laval, Quebec City, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Quebec City, Canada
| | - Julia V Burnier
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montréal, Canada; Experimental Pathology Unit, Department of Pathology, McGill University, Montréal, Canada; Gerald Bronfman Department Of Oncology, McGill University, Montréal, Canada.
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20
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Meijer TS, Geus-Oei LFD, Martini CH, Tijl FGJ, Sitsen ME, Erkel ARV, Meer RWVD, Kapiteijn E, Vahrmeijer AL, Burgmans MC. Embolization of variant hepatic arteries in patients undergoing percutaneous hepatic perfusion for unresectable liver metastases from ocular melanoma. ACTA ACUST UNITED AC 2020; 25:451-458. [PMID: 31650973 DOI: 10.5152/dir.2019.18138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE In patients undergoing percutaneous liver perfusion with melphalan (M-PHP), the presence of variant hepatic arteries (HAs) may require catheter repositioning and thus prolong procedure time. Coil-embolization of variant HAs may enable M-PHP with a single catheter position as occlusion of variant HAs results in redistribution of flow through preexisting intrahepatic arterial collaterals. We aimed to evaluate whether redistribution of flow has any negative effect on therapeutic response in ocular melanoma patients undergoing M-PHP. METHODS We retrospectively analyzed pretreatment angiograms in all 32 patients that underwent M-PHP between January 2014 and March 2017 for unresectable liver metastases from ocular melanoma. Patients that underwent embolization of a variant left HA (LHA) or middle HA (MHA) during pretreatment angiography followed by at least one technically successful M-PHP were included for further analysis. Redistribution of arterial flow was evaluated on angiography and cone-beam computed tomography (CBCT) images. In each patient, tumor response in liver segments with redistributed blood flow was evaluated using RECIST 1.1 and mRECIST, and then compared with tumor response in segments without flow redistribution. Follow-up scans were reviewed to evaluate progression of liver metastases. RESULTS A total of 12 patients were included. Replaced LHA embolization resulted in redistribution of flow to segment(s) 2 (n=3), 2 and 3 (n=5), and 2, 3 and 4 (n=2). MHA embolization resulted in redistribution of flow to segment 4 (n=2). Successful redistribution was confirmed by angiography and/or CBCT in all patients. Tumor response was similar for redistributed and non-redistributed liver segments in 8 out of 9 patients (89%) according to RECIST 1.1, and in 7 out of 8 patients (88%) according to mRECIST. In three patients, tumor response was not evaluable according to RECIST 1.1 or mRECIST as metastases were too small to be categorized as target lesions (n=1), or target lesions were confined to non-redistributed segments (n=2). In one patient, tumor response was not evaluable according to mRECIST as target lesions in the redistributed segments were hypovascular. After a median follow-up time of 17.1 months (range, 9.1-38.5 months), hepatic progression was seen in 9 out of 12 patients with a median time to progression of 9.9 months (range, 2.5-17.7 months). Progression of liver metastases was never seen only in the redistributed liver segments. CONCLUSION Flow redistribution in liver segments by coil-embolization of variant HAs is a feasible technique that does not seem to compromise tumor response in patients undergoing M-PHP.
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Affiliation(s)
- T Susanna Meijer
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian H Martini
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fred G J Tijl
- Department of Extra Corporal Circulation, Leiden University Medical Center, Leiden, The Netherlands
| | - M Elske Sitsen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arian R van Erkel
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger W van der Meer
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Mark C Burgmans
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
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21
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DNA damage response proteins and its role in tumor progression of uveal melanoma with patient outcome. Clin Transl Oncol 2020; 22:1472-1480. [PMID: 32124242 DOI: 10.1007/s12094-019-02281-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/26/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of DNA damage response (DDR) proteins is poorly understood in uveal melanoma. ATR belongs to one of those proteins that induce DDR by arresting the cell cycle which leads to DNA repair. ATR is localized at position 23 on the same chromosome 3 where BAP1 is located at position 21.1 which is a known poor prognostic marker of UM. The aim of our study is to detect the expression of ATR at the protein and RNA levels and determine its prognostic significance. METHODS Expression of nuclear ATR was investigated on sixty-nine UM patients. Formalin-fixed paraffin-embedded choroidal melanoma samples were taken to evaluate the expression of ATR. Fifty samples were also validated by real-time PCR. Results of both protein and mRNA were then correlated with clinicopathological parameters. To determine the prognostic significance, Kaplan-Meier and multivariate analyses were performed. RESULTS Loss of ATR protein was seen in 72% cases which was statistically significant with epithelioid cell type (p = 0.005), tumor thickness (p = 0.016), mitotic figures (p = 0.001) and BAP1 loss (p < 0.001). At the transcriptional level loss of ATR was seen in 76% cases which were statistically significant with metastasis (p = 0.046), staging (0.044) and loss of BAP1 (p = 0.022). On multivariate analysis loss of ATR and tumor staging came out to be independent prognostic parameters. CONCLUSION Our data suggest that ATR might serve as a potential prognostic marker in UM patients and could serve as a potential therapeutic target.
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22
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Wierenga APA, Cao J, Mouthaan H, van Weeghel C, Verdijk RM, van Duinen SG, Kroes WGM, Dogrusöz M, Marinkovic M, van der Burg SSH, Luyten GPM, Jager MJ. Aqueous Humor Biomarkers Identify Three Prognostic Groups in Uveal Melanoma. Invest Ophthalmol Vis Sci 2020; 60:4740-4747. [PMID: 31731294 DOI: 10.1167/iovs.19-28309] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate whether we can identify different patterns of inflammation in the aqueous humor of a uveal melanoma (UM)-containing eye, and whether these are related to prognosis. Methods Ninety samples of aqueous humor from UM-containing eyes were analyzed using a high-throughput multiplex immunoassay that enables simultaneous analysis of 92 predefined protein biomarkers. Cytokine expression was compared to clinical and histopathological characteristics. Cluster analysis was performed, after which the clusters were compared with clinical and histopathological tumor characteristics. Results Cluster analysis revealed three distinct clusters, with one cluster showing hardly any inflammatory cytokines, one showing intermediate levels, and one showing a high expression of inflammation-related biomarkers. Significant differences between the clusters were seen with regard to patient age (P = 0.008), tumor prominence (P = 0.001), ciliary body involvement (P < 0.001), American Joint Committee on Cancer (AJCC) stage (P < 0.001), monosomy of chromosome 3 (P = 0.03), and gain of chromosome 8q (P = 0.04), with the cluster with a highest cytokine expression having the worst prognostic markers. Especially apoptosis-related cytokines were differentially expressed. Conclusions Analysis of cytokines in the aqueous humor shows distinct differences between aqueous humor samples and allocates these samples into three different prognostic tumor clusters. Especially large tumors with ciliary body involvement and monosomy 3 were associated with many cytokines, especially apoptosis-related cytokines. The presence of these cytokines in the aqueous humor may play a role in the lack of effective antitumor immune responses.
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Affiliation(s)
- Annemijn P A Wierenga
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jinfeng Cao
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | | | | | - Robert M Verdijk
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma G M Kroes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mehmet Dogrusöz
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
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23
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Fatehi N, McCannel TA, Giaconi J, Caprioli J, Law SK, Nouri-Mahdavi K. Outcomes of Glaucoma Drainage Device Surgery in Eyes with Treated Uveal Melanoma. Ocul Oncol Pathol 2019; 5:20-27. [PMID: 30675473 DOI: 10.1159/000488056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/28/2018] [Indexed: 11/19/2022] Open
Abstract
Aim We report patient safety and intraocular pressure (IOP) control after placement of a glaucoma drainage device (GDD) in eyes with a history of treated malignant uveal melanoma. Methods A retrospective review of the records of patients with uveal melanoma was performed. Outcomes were local tumor recurrence, rate of metastases, and to-nometric success, based on survival curves, defined as IOP < 21 mm Hg. Results Eleven eyes with choroidal melanoma, 4 with iris melanoma, and 1 with ciliary body melanoma were followed for a median (interquartile range) of 2.1 (1.1-3.2) years. Two subjects developed liver metastases; one had monosomy 3 and tumor gene expression profile class 2. The other case with ciliary body melanoma was negative for monosomy 3. There were no cases of local treatment failure. Mean preoperative IOP decreased from 30.5 ± 7.7 to 15.9 ± 8.1 mm Hg at 1 year after surgery (1-year success rate 80%). Conclusions Our case series with a median follow-up of 2 years shows that placing a GDD in patients with treated uveal melanoma does not expose patients to greater risk of local or extraocular recurrence. A larger series and longer follow-up time are required to fully evaluate the safety of GDDs in this clinical scenario.
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Affiliation(s)
- Nima Fatehi
- Stein Eye and Doheny Eye Institutes, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Tara A McCannel
- Stein Eye and Doheny Eye Institutes, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - JoAnn Giaconi
- Stein Eye and Doheny Eye Institutes, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- Stein Eye and Doheny Eye Institutes, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Simon K Law
- Stein Eye and Doheny Eye Institutes, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- Stein Eye and Doheny Eye Institutes, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Abstract
Melanomas affecting different components of the uvea occur with differing frequencies and clinical presentations. Uveal melanoma is diagnosed via funduscopic exam and ancillary tests. These lesions may present with visual findings or incidental findings on physical exam. Metastasis occurs in approximately half of all patients with primary uveal melanoma. The liver is the most common site of metastasis. Enucleation was at one time considered the definitive local treatment for primary uveal melanoma, but has been largely replaced by other therapeutic procedures that aim to prevent metastasis while preserving vision. Unfortunately, metastasis of uveal melanoma almost always proves to be fatal. The current treatment of metastatic uveal melanoma is limited by the intrinsic resistance of uveal melanoma to conventional systemic therapies. Advancements in molecular biology have resulted in the identification of a number of promising prognostic and therapeutic targets. Early detection and therapy are important factors in disease survival. It is imperative that the treating physician be familiar with the clinical features of uveal melanoma and distinguish it from mimickers in order to ensure effective and timely treatment.
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Affiliation(s)
| | - Priya Durairaj
- Department of Ocular Oncology, The Princess Margaret Hospital, Toronto, ON, Canada
| | - Jensen Yeung
- Department of Medicine (Dermatology), University of Toronto, Toronto, ON, Canada
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Park JJ, Diefenbach RJ, Joshua AM, Kefford RF, Carlino MS, Rizos H. Oncogenic signaling in uveal melanoma. Pigment Cell Melanoma Res 2018; 31:661-672. [DOI: 10.1111/pcmr.12708] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022]
Affiliation(s)
- John J. Park
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
| | - Russell J. Diefenbach
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
| | - Anthony M. Joshua
- Melanoma Institute Australia; Sydney New South Wales Australia
- Kinghorn Cancer Centre; St Vincent’s Hospital; Sydney New South Wales Australia
| | - Richard F. Kefford
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
- Department of Medical Oncology; Crown Princess Mary Cancer Centre; Westmead and Blacktown Hospitals; Sydney New South Wales Australia
| | - Matteo S. Carlino
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
- Department of Medical Oncology; Crown Princess Mary Cancer Centre; Westmead and Blacktown Hospitals; Sydney New South Wales Australia
| | - Helen Rizos
- Department of Biomedical Sciences; Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
- Melanoma Institute Australia; Sydney New South Wales Australia
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Clinical experience of stereotactic radiosurgery at a linear accelerator for intraocular melanoma. Melanoma Res 2018; 27:463-468. [PMID: 28520637 DOI: 10.1097/cmr.0000000000000364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Long-term results with linear accelerator LINAC-based stereotactic radiosurgery for intraocular uveal malignant melanoma were assessed. A retrospective study was carried out of patients with uveal melanoma after a 1-day session stereotactic radiosurgery at LINAC in Slovakia. In the period 2001-2015, a group of 150 patients with uveal melanoma (139 choroidal melanoma, 11 ciliary body melanoma) was treated. The median tumor volume at baseline was 0.5 cm (with range from 0.2 to 1.6 cm). Tumors ranged in size from 2.4 to 20.8 mm in basal diameter and from 2.0 to 18.3 mm in thickness. The therapeutic dose was 35.0 Gy by 99% of dose volume histogram. Older age at treatment was correlated with the largest basal tumor diameter, tumor thickness, and TNM stage. The survival after stereotactic irradiation was 96% in 1 year, 93% in 2 years, 84% in 5 years, 80% in 7 years, and 53% in 11 years. In 20 (13.3%) patients, secondary enucleation was necessary because of complications (secondary glaucoma). Enucleation-free interval ranged from 1 to 6 years. The median age at death was lower (65.7 years) for patients who died from metastatic disease than for those who died from any other cause (75.0 years). Survival rates at 5-year intervals and the need for secondary enucleation because of complications after linear accelerator irradiation are comparable to other techniques.
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Staibano S, Mascolo M, Tranfa F, Salvatore G, Mignogna C, Bufo P, Nugnes L, Bonavolontà G, De Rosa G. Tumor Infiltrating Lymphocytes in Uveal Melanoma: A Link with Clinical Behavior? Int J Immunopathol Pharmacol 2018. [DOI: 10.1177/205873920601900117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Experimental and clinical evidence indicate that immunological mechanisms might be important in the clinical course of uveal malignant melanoma (UMM). We analyzed the amount and phenotype of tumor infiltrating lymphocytes (TIL) and the expression of the apoptosis-inducing molecule Fas and its ligand, FasL, on tumor cells and TIL in a selected series of UMM with the aim to establish if a correlation between their expression and the clinical behavior of UMM exists. TIL phenotype and Fas/FasL expression were evaluated by immunohistochemistry in 61 cases of formalin-fixed, paraffin-embedded UMM. Results were compared with the follow-up data of patients. Most of the UMM showed a prevalence of CD8+ CD3+ T lymphocytes, or CD4+ and CD8+ cells in equal amounts. UMM showed a variable expression of FasL, ranging from 0 to > 40% of neoplastic cells. Fas was always expressed in TIL, although with a variable extent. A subgroup of UMM showed in TIL a strongly reduced or even absent expression of TCR ζ-chain, involved in activation of T-lymphocytes. This subgroup was characterized by a worse outcome. We hypothesized that an impaired cytotoxic immune response due to the loss of the ζ-chain expression plays a primary role in the biological course of UMM. Our results indicate that the overcoming of the impairment of TCR function may represent a prerequisite for the development of new therapeutic strategies for managing UMM, suggesting that elimination of tumor cells may be possible by activation of cytotoxic cells present within ocular melanomas.
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Affiliation(s)
- S. Staibano
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - M. Mascolo
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - F. Tranfa
- Department of Ophthalmology, University of Naples “Federico II”, Naples
| | - G. Salvatore
- Department of Medicine, University of Naples “Federico II”, Naples
| | - C. Mignogna
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - P. Bufo
- Department of Surgical Sciences, University of Foggia, Foggia, Italy
| | - L. Nugnes
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - G. Bonavolontà
- Department of Ophthalmology, University of Naples “Federico II”, Naples
| | - G. De Rosa
- Department of Biomorphological and Functional Sciences, Pathology Section,
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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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Lorenzo D, Ochoa M, Piulats JM, Gutiérrez C, Arias L, Català J, Grau M, Peñafiel J, Cobos E, Garcia-Bru P, Rubio MJ, Padrón-Pérez N, Dias B, Pera J, Caminal JM. Prognostic Factors and Decision Tree for Long-Term Survival in Metastatic Uveal Melanoma. Cancer Res Treat 2017; 50:1130-1139. [PMID: 29198096 PMCID: PMC6192913 DOI: 10.4143/crt.2017.171] [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: 04/09/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to demonstrate the existence of a bimodal survival pattern in metastatic uveal melanoma. Secondary aims were to identify the characteristics and prognostic factors associated with long-term survival and to develop a clinical decision tree. Materials and Methods The medical records of 99 metastatic uveal melanoma patients were retrospectively reviewed. Patients were classified as either short (≤ 12 months) or long-term survivors (> 12 months) based on a graphical interpretation of the survival curve after diagnosis of the first metastatic lesion. Ophthalmic and oncological characteristicswere assessed in both groups. RESULTS Of the 99 patients, 62 (62.6%) were classified as short-term survivors, and 37 (37.4%) as long-term survivors. The multivariate analysis identified the following predictors of long-term survival: age ≤ 65 years (p=0.012) and unaltered serum lactate dehydrogenase levels (p=0.018); additionally, the size (smaller vs. larger) of the largest liver metastasis showed a trend towards significance (p=0.063). Based on the variables significantly associated with long-term survival, we developed a decision tree to facilitate clinical decision-making. CONCLUSION The findings of this study demonstrate the existence of a bimodal survival pattern in patients with metastatic uveal melanoma. The presence of certain clinical characteristics at diagnosis of distant disease is associated with long-term survival. A decision tree was developed to facilitate clinical decision-making and to counsel patients about the expected course of disease.
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Affiliation(s)
- Daniel Lorenzo
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - María Ochoa
- Department of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Cristina Gutiérrez
- Department of Brachytherapy, Catalan Institute of Oncology, Barcelona, Spain
| | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Jaume Català
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - María Grau
- Medical Research Division, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Judith Peñafiel
- Medical Research Division, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Estefanía Cobos
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Pere Garcia-Bru
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Marcos Javier Rubio
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Noel Padrón-Pérez
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Bruno Dias
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Joan Pera
- Department of Brachytherapy, Catalan Institute of Oncology, Barcelona, Spain
| | - Josep Maria Caminal
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
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30
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Jang BS, Chang JH, Oh S, Lim YJ, Kim IH. Surgery vs. radiotherapy in patients with uveal melanoma. Strahlenther Onkol 2017; 193:931-942. [DOI: 10.1007/s00066-017-1203-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/16/2017] [Indexed: 12/18/2022]
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31
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Mahendraraj K, Shrestha S, Lau CS, Chamberlain RS. Ocular melanoma-when you have seen one, you have not seen them all: a clinical outcome study from the Surveillance, Epidemiology and End Results (SEER) database (1973-2012). Clin Ophthalmol 2017; 11:153-160. [PMID: 28115829 PMCID: PMC5221652 DOI: 10.2147/opth.s120530] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ocular melanoma (OM) comprises <5% of all melanomas. Uveal melanoma (UM) is the most common subtype of OM, while conjunctival melanoma (CM) is rare and differs significantly from UM. The purpose of this study is to evaluate a large cohort of OM patients to differentiate demographic, pathologic, and clinical factors between these two neoplasms, which may affect treatment and outcomes. METHODS The Surveillance, Epidemiology, and End Results database (1973-2012) was used to extract demographic and clinical data on 8,165 OM patients (92.1% UM and 7.9% CM). RESULTS Both CM and UM were most prevalent among Caucasian males in the seventh decade of life. UM patients presented more often with localized disease (90.9% vs 81.2, P<0.01). Surgery (42.8%), radiation (43.0%), or combined surgery and radiation (7.0%) were used in the treatment of UM, while CM was treated almost exclusively with surgery (88.7%). Mean overall survival was longer (15.4 vs 14.6 years; P<0.01) and mortality rates were lower in patients (38.8% vs 46.1%; P<0.01) with CM. CONCLUSION Despite presenting with more advanced disease than UM, CM is associated with an increased overall survival. Surgery is the primary therapy for CM, whereas radiotherapy is the primary therapy for UM and is associated with prolonged survival.
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Affiliation(s)
| | - Sneha Shrestha
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Christine Sm Lau
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies
| | - Ronald S Chamberlain
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies; Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA; Department of Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
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32
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Vasalaki M, Fabian ID, Reddy MA, Cohen VML, Sagoo MS. Ocular oncology: advances in retinoblastoma, uveal melanoma and conjunctival melanoma. Br Med Bull 2017; 121:107-119. [PMID: 28069617 DOI: 10.1093/bmb/ldw053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Retinoblastoma, uveal and conjunctival melanomas are important malignancies within the remit of ocular oncology. Outlined are the diagnostic features and management principles, as well as advancements in the field and current challenges. SOURCES OF DATA Original papers, reviews and guidelines. AREAS OF AGREEMENT Most eyes with retinoblastoma (International Intraocular Retinoblastoma Classification (IIRC) Group A-D) are salvaged, whereas advanced cases (Group E) remain a challenge. Despite a high rate of local tumour control in uveal melanoma, metastatic spread commonly occurs. Conjunctival melanoma is treated by complete resection, but high rates of local recurrence occur, with the possibility of systemic relapse and death. AREAS OF CONTROVERSY Use of the IIRC in retinoblastoma, and systemic screening in melanomas. GROWING POINTS Utilization of novel treatment modalities in retinoblastoma and an increasing understanding of the genetic basis of melanomas. AREAS TIMELY FOR DEVELOPING RESEARCH Improvements in chemotherapy delivery in retinoblastoma and prognostic tests in melanomas.
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Affiliation(s)
- Marina Vasalaki
- UCL Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK.,Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK
| | - Ido D Fabian
- Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Ocular Oncology Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.,Ocular Oncology Service, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - M Ashwin Reddy
- Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Paediatric Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK
| | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.,Ocular Oncology Service, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Mandeep S Sagoo
- Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Ocular Oncology Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.,Ocular Oncology Service, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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33
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Liver Metastases From Noncolorectal Malignancies (Neuroendocrine Tumor, Sarcoma, Melanoma, Breast). Cancer J 2016; 22:381-386. [DOI: 10.1097/ppo.0000000000000232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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34
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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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Grossniklaus HE, Zhang Q, You S, McCarthy C, Heegaard S, Coupland SE. Metastatic ocular melanoma to the liver exhibits infiltrative and nodular growth patterns. Hum Pathol 2016; 57:165-175. [PMID: 27476775 DOI: 10.1016/j.humpath.2016.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/07/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
We examined liver specimens from 15 patients with uveal melanoma (UM) who had died of their disseminated disease. We found 2 distinct growth patterns of UM metastasis: infiltrative (n = 12) and nodular (n = 3). In the infiltrative pattern, individual UM cells with a CD133+ cancer stem cell-like phenotype were present and formed aggregates of stage I <50-μm-diameter micrometastases in the sinusoidal spaces. These micrometastases appeared to expand, destroy adjacent hepatocytes, and form stage II 51- to 500-μm-diameter and then stage III >500μm-diameter metastases, which were encapsulated by collagenized fibrous septae. In the nodular growth pattern, CD133+ melanoma cells aggregated adjacent to portal venules and subsequently appeared to grow and efface the adjacent hepatocytes to form stage II 51- to 500-μm-diameter nodules that surrounded the portal venule. These avascular nodules appeared to further expand to form stage III >500-μm-diameter nodules that exhibited vascularization with minimal fibrosis. The tumor stem cell-like phenotype seen in individual UM cells was lost as the tumors progressed. There were CD56+ natural killer cells in sinusoidal spaces and CD3+ lymphocytes in periportal areas. The nodular growth pattern showed UM cells expressing MMP9 and VEGF. UM cells in both above-described growth patterns exhibited variable BAP1 expression. We propose that changes in the liver microenvironment are related to metastatic UM growth. We hypothesize that these changes include immune regulation within the sinusoidal space for the infiltrative pattern and changes in the VEGF/PEDF ratio for the nodular pattern.
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Affiliation(s)
- Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA 30322; Winship Cancer Institute, Emory University, Atlanta, GA, USA 30322.
| | - Qing Zhang
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA 30322
| | - Shuo You
- Winship Cancer Institute, Emory University, Atlanta, GA, USA 30322
| | - Conni McCarthy
- Molecular and Clinical Cancer Medicine, Royal Liverpool and Broadgreen University Hospital NHS Trust, University of Liverpool, Liverpool, L69 3GA UK
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Sarah E Coupland
- Molecular and Clinical Cancer Medicine, Royal Liverpool and Broadgreen University Hospital NHS Trust, University of Liverpool, Liverpool, L69 3GA UK
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36
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Tarlan B, Kıratlı H. Uveal Melanoma: Current Trends in Diagnosis and Management. Turk J Ophthalmol 2016; 46:123-137. [PMID: 27800275 PMCID: PMC5076295 DOI: 10.4274/tjo.37431] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 12/25/2022] Open
Abstract
Uveal melanoma, which is the most common primary intraocular malignancy in adults, arises from melanocytes within the iris, ciliary body and choroid. The diagnosis is based principally on clinical examination of the tumor with biomicroscopy and indirect ophthalmoscopy and confirmed by diagnostic techniques such as ultrasonography, fundus fluorescein angiography and optical coherence tomography. The clinical diagnosis of posterior uveal melanomas can be made when the classical appearance of a pigmented dome-shaped mass is detected on dilated fundus exam. Uveal melanomas classically show low to medium reflectivity on A-scan ultrasonography and on B-scan ultrasonography the tumor appears as a hyperechoic, acoustically hollow intraocular mass. Management of a suspicious pigmented lesion is determined by its risk factors of transforming into a choroidal melanoma, such as documentation of growth, thickness greater than 2 mm, presence of subretinal fluid, symptoms and orange pigment, margin within 3 mm of the optic disc, and absence of halo and drusen. Advances in the diagnosis and local and systemic treatment of uveal melanoma have caused a shift from enucleation to eye-conserving treatment modalities including transpupillary thermotherapy and radiotherapy over the past few decades. Prognosis can be most accurately predicted by genetic profiling of fine needle aspiration biopsy of the tumor before the treatment, and high-risk patients can now be identified for clinical trials that may lead to target-based therapies for metastatic disease and adjuvant therapy which aims to prevent metastatic disease.
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Affiliation(s)
| | - Hayyam Kıratlı
- Hacettepe University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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37
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Tumor Volumes in Choroidal Melanoma: Agreement Between Three-Dimensional Ultrasound and Two Mathematical Models. Am J Ophthalmol 2016; 166:181-188. [PMID: 27066723 DOI: 10.1016/j.ajo.2016.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the degree of agreement between 2 mathematical models and 3-dimensional ultrasonography (3DUS) in estimating choroidal melanoma tumor volumes. DESIGN Reliability analysis. METHODS Tumor measurements estimated by 2 mathematical models (designated Formula 1 and Formula 2) were compared to those obtained by 3DUS in 45 consecutive patients with primary choroidal melanoma to determine the percentage agreement between the models and 3DUS. RESULTS Both formulas tended to overestimate the tumor volume. Overall, the mean volume differences between 3DUS and Formula 1 and between 3DUS and Formula 2, respectively, were 51.7 mm(3) (95% confidence interval [CI], 187.6 to 84.3) and 23.8 mm(3) (95% CI, 122.5 to 74.8). Excluding mushroom-shaped tumors, the mean volume differences were 52.0 mm(3) (95% CI, 194.9 to 91.0) and 23.0 mm(3) (95% CI, 127.0 to 81.0), respectively. In mushroom-shaped tumors, mean volume differences were 49.9 mm(3) (95% CI, 135.7 to 35.9) and 29.3 mm(3) (95% CI, 87.6 to 29.0), respectively. CONCLUSIONS The agreement between these mathematical models and the measured 3DUS volume was high. The data obtained in this study show that both formulas provide a simple, fast, and accurate method of estimating tumor volumes in the clinical setting, suggesting that these models could be used as a reliable and inexpensive alternative to time-consuming procedures such as 3DUS or magnetic resonance imaging. The accurate tumor volume values provided by these formulas may help to provide more reliable estimates of tumor regression or regrowth following globe-preserving treatment of choroidal melanomas, and may be a valuable prognostic indicator.
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38
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Nichols EE, Richmond A, Daniels AB. Tumor Characteristics, Genetics, Management, and the Risk of Metastasis in Uveal Melanoma. Semin Ophthalmol 2016; 31:304-9. [PMID: 27128983 PMCID: PMC5526754 DOI: 10.3109/08820538.2016.1154175] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Uveal melanoma is the most common intraocular malignancy in adults. Although rates of local control for uveal melanoma exceed 95% with radiotherapy or enucleation, as many as 50% of patients develop hematogenous metastases, which manifest in the decades following initial diagnosis and are uniformly and rapidly fatal. Recent compelling evidence suggests that not all uveal melanomas are themselves equivalent with respect to metastatic potential and patient survival. This review focuses on the mounting evidence of survival disparities based on intrinsic tumor clinical and histopathologic characteristics and based on tumor genetics and gene expression profiles.
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Affiliation(s)
- Erin E. Nichols
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Richmond
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, USA
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony B. Daniels
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
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Halenda KM, Kudchadkar RR, Lawson DH, Kies DD, Zhelnin KE, Krasinskas AM, Grossniklaus HE. Reduction of Nodular Growth Pattern of Metastatic Uveal Melanoma after Radioembolization of Hepatic Metastases. Ocul Oncol Pathol 2015; 2:160-5. [PMID: 27239458 DOI: 10.1159/000442950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/22/2015] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of this study was to report a case of metastatic uveal melanoma in which radioembolized nodular liver metastases decreased in size while infiltrative sinusoidal metastases progressed, leading to jaundice without obstruction of the biliary ducts. METHODS The relevant clinical features, imaging, and histopathologic findings of this case are reviewed. RESULTS A 61-year-old Caucasian male with a history of uveal melanoma of the left eye status post plaque brachytherapy developed numerous liver metastases. After progression on systemic therapies, he underwent palliative radioembolization. Despite some radiographic improvement in the liver metastases, he developed hyperbilirubinemia without biliary tract obstruction or signs of liver failure. A biopsy of radiographically normal liver demonstrated extensive sinusoidal infiltration with melanoma. CONCLUSIONS Distinct angiographic and histopathologic growth patterns of metastatic uveal melanoma differ in their amenability to radioembolization. Sinusoidal infiltration may lead to hyperbilirubinemia in the absence of overt obstruction or liver failure.
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Affiliation(s)
| | - Ragini R Kudchadkar
- Departments of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Ga., USA
| | - David H Lawson
- Departments of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Ga., USA
| | - Darren D Kies
- Departments of Radiology and Imaging Sciences, Winship Cancer Institute of Emory University, Atlanta, Ga., USA
| | - Kristen E Zhelnin
- Department of Pathology, Winship Cancer Institute of Emory University, Atlanta, Ga., USA
| | - Alyssa M Krasinskas
- Department of Pathology, Winship Cancer Institute of Emory University, Atlanta, Ga., USA
| | - Hans E Grossniklaus
- Department of Pathology, Winship Cancer Institute of Emory University, Atlanta, Ga., USA; Department of Ophthalmology, Winship Cancer Institute of Emory University, Atlanta, Ga., USA
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Abstract
Dynamic contrast-enhanced MRI is used for the assessment of microvasculature in several tumours. We aimed to assess the contrast signal enhancement characteristics of ocular melanoma. Forty patients with ocular melanoma were prospectively investigated with ocular MRI including dynamic contrast-enhanced sequences over a 13-month period. A region-of-interest analysis of the images was carried out to calculate signal enhancement characteristics after a contrast injection. Clinical follow-up data such as extraocular spread and development of liver metastasis were compared with the signal enhancement characteristics of the ocular melanoma. In 39 patients (98%), the ocular melanomas showed an early strong signal enhancement after contrast injection, resulting in a mean time of maximum enhancement of 49 s. Clinical follow-up was available in 28 patients (70%) and indicated that the peak signal intensity was significantly increased (P=0.039) in patients who developed extraocular spread or liver metastasis at a later stage. Ocular melanoma shows signal enhancement characteristics of hypervascular neoplasms. This study provides baseline curve pattern data that may be useful for assessing changes in vascularity, for example during therapy response. Furthermore, the study showed that a strong signal enhancement of the ocular melanoma might be linked to a less favourable prognosis.
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41
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Arterial Blood, Rather Than Venous Blood, is a Better Source for Circulating Melanoma Cells. EBioMedicine 2015; 2:1821-6. [PMID: 26870807 PMCID: PMC4740300 DOI: 10.1016/j.ebiom.2015.09.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 12/21/2022] Open
Abstract
Background CTCs provide prognostic information and their application is under investigation in multiple tumor types. Of the multiple variables inherent in any such process, none is more important to outcome than the appropriateness of the sample source. To address this question, we investigated CTCs in paired peripheral venous and arterial blood specimens obtained from stage IV uveal melanoma patients. Methods Blood specimens were obtained from both common femoral arteries and antecubital veins in 17 uveal melanoma patients with multiple hepatic metastases for CTC measurements. Finding CTCs were detectable with greater frequency (100%) and in larger numbers (median 5, range 1 to 168) in all arterial blood specimens than in venous samples (52.9%; median 1, range 0 to 8). Patients with hepatic as well as extra-hepatic metastasis showed higher number of arterial CTCs, compared to patients with liver-only metastasis (p = 0.003). There was no significant association between the number of arterial CTCs and the tumor burden within the liver in patients who had liver-only metastases. Interpretation Our data indicate that arterial blood specimens might be a better source of circulating uveal melanoma cells. Although less conveniently processed, perhaps arterial blood should be evaluated as sample source for measurement of CTCs. CTCs were detectable in 100% of arterial blood obtained from metastatic uveal melanoma patients, while only 53% of venous blood was positive for CTCs.
CTCs have been investigated to provide prognostic information in multiple tumor types. Of the multiple variables, none is more important than the appropriateness of the sample source. Blood specimens were obtained from both femoral arteries and antecubital veins in 17 uveal melanoma patients with multiple hepatic metastases. CTCs were detectable with greater frequency (100%) and in larger numbers in all arterial blood specimens than in venous samples (52.9%). Our data indicate that arterial blood specimens might be a better source of circulating uveal melanoma cells. Although less convenient, arterial blood should be evaluated as sample source for measurement of CTCs.
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Key Words
- AKTi, AKT inhibitor
- Ab, antibody
- Arterial venous
- BCNU, bischlorethylnitrosourea
- CTC count
- Circulating tumor cells
- DEBDOX, drug-eluting beads with doxorubicin
- EDTA, ethylenediaminetetraacetic acid
- HMW-MAA, high molecular weight melanoma associated antigen
- Hepatic metastasis
- Ipi, ipilimumab
- LN, lymph node
- MEKi, MEK inhibitor
- METi, MET inhibitor;
- Peripheral venous
- TACE, transarterial chemoembolization
- Uveal melanoma
- VPA, valproic acid
- XRT, radiation therapy
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van den Bosch T, Vaarwater J, Verdijk R, Muller K, Kiliç E, Paridaens D, de Klein A, Naus N. Risk factors associated with secondary enucleation after fractionated stereotactic radiotherapy in uveal melanoma. Acta Ophthalmol 2015; 93:555-60. [PMID: 25879399 DOI: 10.1111/aos.12731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/01/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate risk factors for secondary enucleation after fractionated stereotactic radiotherapy (fSRT) in uveal melanoma. METHODS In this retrospective study, clinical data of 118 consecutive patients who had initially been treated with fSRT between 1999 and 2009 were collected and analysed. The patients who had undergone secondary enucleation were identified and examined for clinical, histopathological and cytogenetical (fluorescence in situ hybridization determined) data. Also, the reasons for secondary enucleation, such as treatment failure (progressive tumour growth or tumour recurrence) or complications following fSRT (painful blind eye), were recorded and examined. RESULTS The secondary enucleation rate was 16% after a median follow-up of 4.7 years, with 5% due to treatment failure and 11% due to complications. In the univariate analysis, large tumour diameter (p = 0.019) and large tumour height (p = 0.001) were associated with secondary enucleation, tumour involvement of the optic disc showed borderline significance (p = 0.068). Cox regression multivariate analysis displayed large tumour height as independent prognostic factor (HR 1.42, 95% CI 1.12-1.81, p = 0.004). Following secondary enucleation, mitotic figures were present in five of 18 tumours, and gain of chromosome 8q was also present in five tumours. Within the subgroup of patients who required secondary enucleation due to failed tumour control by fSRT (N = 6), mitotic figures were present in four of six tumours while gain of 8q was present in three of six tumours. CONCLUSION Secondary enucleation after previous fSRT was associated with large tumour height. High mitotic counts and gain of chromosome 8q were frequently found in secondary enucleations and possibly indicate a more aggressive or radiation-resistant tumour.
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Affiliation(s)
| | - Jolanda Vaarwater
- Department of Clinical Genetics, Ophthalmology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Rob Verdijk
- Department of Pathology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Karin Muller
- Department of Radiotherapy; Deventer Hospital; Deventer The Netherlands
| | - Emine Kiliç
- Department of Ophthalmology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Dion Paridaens
- Ocular Oncology; Rotterdam Eye Hospital; Rotterdam The Netherlands
- Department of Ophthalmology; Geneva University Hospitals; Geneva Switzerland
| | - Annelies de Klein
- Department of Clinical Genetics; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Nicole Naus
- Department of Ophthalmology; Erasmus University Medical Center; Rotterdam The Netherlands
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43
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Kilian MM, Loeffler KU, Pfarrer C, Holz FG, Kurts C, Herwig MC. Intravitreally Injected HCmel12 Melanoma Cells Serve as a Mouse Model of Tumor Biology of Intraocular Melanoma. Curr Eye Res 2015; 41:121-8. [PMID: 25658144 DOI: 10.3109/02713683.2015.1004721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To establish a mouse model with histologic characteristics of uveal melanoma for investigation of intraocular tumor biology of melanoma. METHODS After injection of 1 × 10(5) of HCmel12 melanoma cells, a cutaneous melanoma cell line, into the vitreous of CX3CR1(+/GFP) or C57Bl/6 mice (n = 12), tumor growth patterns, clinicopathological features, angiogenesis and metastatic behavior were analyzed by histology (hematoxylin and eosin, periodic acid-Schiff without hematoxylin) and immunohistochemistry (HMB45/MART-1-Ab, F4/80-Ab, green fluorescent protein (GFP)-Ab and VE-cadherin-Ab). RESULTS HCmel12 cells formed intraocularly growing tumor masses, which showed histologic features of intraocular melanoma such as angiotropism, intratumoral endothelial-lined vasculature, vasculogenic mimicry including prognostic significant extravascular matrix patterns, and invasion by inflammatory cells, in particular macrophages. There was no difference in tumor growth characteristics between CX3CR1(+/GFP) and C57Bl/6 mice. Five of 10 mice proceeded to extrascleral tumor growth and three of these developed metastases. CONCLUSIONS Intraocularly injected HCmel12 cells developed tumor masses with histologic characteristics of aggressive melanoma similar to human uveal melanoma. Since hematogenous dissemination to the liver was not observed, intravitreally injected HCmel12 cells do not qualify as a model for metastasizing intraocular melanoma. However, since the eye represents a semi-closed compartment with access to constant blood supply, these intraocular tumors represent a model for studies of isolated parameters in general tumor biology of intraocular melanoma.
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Affiliation(s)
- Marta M Kilian
- a Department of Ophthalmology , University of Bonn , Bonn , Germany
| | - Karin U Loeffler
- a Department of Ophthalmology , University of Bonn , Bonn , Germany
| | - Christiane Pfarrer
- b Department of Anatomy , University of Veterinary Medicine Hannover , Hannover , Germany , and
| | - Frank G Holz
- a Department of Ophthalmology , University of Bonn , Bonn , Germany
| | - Christian Kurts
- c Institute of Experimental Immunology, University of Bonn , Bonn , Germany
| | - Martina C Herwig
- a Department of Ophthalmology , University of Bonn , Bonn , Germany
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Abstract
Uveal melanoma is a malignant intraocular tumor associated with poor vital prognosis, process generalization, and death from metastatic disease. A number of factors are considered undesirable in the presence of a tumor. This paper provides a review of the literature on major prognostic factors for uveal melanoma development and their contribution to vital prognosis.
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Affiliation(s)
- A G Amiryan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - S V Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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45
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Triozzi PL, Schoenfield L, Plesec T, Saunthararajah Y, Tubbs RR, Singh AD. Molecular profiling of primary uveal melanomas with tumor-infiltrating lymphocytes. Oncoimmunology 2014; 8:e947169. [PMID: 31646061 DOI: 10.4161/21624011.2014.947169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/18/2014] [Accepted: 06/05/2014] [Indexed: 11/19/2022] Open
Abstract
In contrast to other cancers, the presence of tumor-infiltrating lymphocytes (TILs) in uveal melanoma is associated with a poor prognosis. However, how TILs may promote disease progression and what regulates their infiltration has not yet been established. To address these clinically relevant outstanding questions, T cell, immune regulatory, and chemokine gene expression profiles of 57 enucleated uveal melanoma tumors were compared, encompassing 27 with TILs and 30 without,. Tumors with infiltrating lymphocytes expressed more CD8A mRNA, as well as IFNG, TGFB1, and FOXP3 transcripts. Other T helper associated cytokines and T helper transcription factors were not differentially expressed, nor were mediators of lymphocyte cytotoxicity. The immune inhibitors INDO, PDCA1, CTLA4, and LAG3, and the non-classical MHC Class I target of CD8+ T regulatory cells, HLA‑E, were significantly higher in tumors with TILs. FAS was also significantly higher. The C-C chemokine ligands CCL4, CCL5, and CCL20 were higher in tumors with TILs. Levels of CCL5 were most strongly correlated with levels of CD8A. Chemokine receptors were not differentially expressed. Molecular profiling of uveal melanoma tumors with TILs supports the existence of an immunosuppressive tumor microenvironment and suggests roles for CD8+ regulatory T cells, as well as specific chemokines, in fostering uveal melanoma disease progression.
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Affiliation(s)
- Pierre L Triozzi
- Taussig Cancer Institute; Cleveland Clinic Foundation; Cleveland, OH USA
| | - Lynn Schoenfield
- Department of Anatomic Pathology; Cleveland Clinic Foundation; Cleveland, OH USA
| | - Thomas Plesec
- Department of Anatomic Pathology; Cleveland Clinic Foundation; Cleveland, OH USA
| | | | - Raymond R Tubbs
- Department of Molecular Pathology; Cleveland Clinic Foundation; Cleveland, OH USA
| | - Arun D Singh
- Cole Eye Institute; Cleveland Clinic Foundation; Cleveland, OH USA
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Abstract
Recent efforts in genomic research have enabled the characterization of molecular mechanisms underlying many types of cancers, ushering novel approaches for diagnosis and therapeutics. Melanoma is a molecularly heterogeneous disease, as many genetic alterations have been identified and the clinical features can vary. Although discoveries of frequent mutations including BRAF have already made clinically significant impact on patient care, there is a growing body of literature suggesting a role for additional mutations, driver and passenger types, in disease pathophysiology. Although some mutations have been strongly associated with clinical phenotypes of melanomas (such as physical distribution or morphologic subtype), the function or implications of many of the recently identified mutations remains less clear. The phenotypic and clinical impact of genomic mutations in melanoma remains a promising opportunity for progress in the care of melanoma patients.
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Affiliation(s)
- Elena B Hawryluk
- Dermatology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115 Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
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47
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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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Mutation frequencies of GNAQ, GNA11, BAP1, SF3B1, EIF1AX and TERT in uveal melanoma: detection of an activating mutation in the TERT gene promoter in a single case of uveal melanoma. Br J Cancer 2014; 110:1058-65. [PMID: 24423917 PMCID: PMC3929883 DOI: 10.1038/bjc.2013.804] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/30/2013] [Accepted: 12/04/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Uveal melanoma is the most frequent primary tumour of the eye. It is molecularly clearly distinct from cutaneous melanoma and shows a different pattern of driver mutations. The influence of sunlight ultraviolet (UV) exposure on the aetiology of uveal melanoma is a matter of debate. The recent identification of driver mutations in the promoter of the telomerase reverse transcriptase (TERT) gene with UV-induced cytidine-to-thymidine transitions in cutaneous melanoma prompted us to investigate whether these mutations also occur in uveal melanoma. METHODS We analysed 50 cases of uveal melanoma obtained from enucleation surgery for mutations in the genes GNAQ, GNA11, BAP1, SF3B1, EIFAX1 and TERT, measured gene expression using microarrays and analysed gene copy numbers by SNP arrays. RESULTS We detected a TERT mutation in only one case of a 57-year-old white male patient with clinical and histopathological features typical for uveal melanoma. The tumour showed mutations in GNA11 and EIF1AX that are typical for uveal melanoma and absent from cutaneous melanoma. No mutations were detected in GNAQ, BAP1 and SF3B1 that are frequently mutated in uveal melanoma. Both copies of chromosome 3 were retained. Several tumours among which the one carrying the TERT promoter mutation showed elevated TERT expression. Consistent with previous reports, GNAQ is inversely associated with chromosome 3 monosomy and metastasis. BAP1 mutations are significantly associated with chromosome 3 monosomy but not with relapse. CONCLUSION These data indicate that TERT mutations are rare in uveal melanoma. No conclusion can be drawn on their potential influence on tumour progression.
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Wackernagel W, Tarmann L, Mayer CF, Holl E, Avian A, Schneider MR, Sommer M, Kapp KS, Langmann G. Visusprognose nach Gamma Knife Radiochirurgie von Aderhautmelanomen. SPEKTRUM DER AUGENHEILKUNDE 2013. [DOI: 10.1007/s00717-013-0196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Tsianakas A, Böhm M, Getova V, Metze D, Eter N, Spieker T, Bräuninger A, Luger T, Schiller M, Sunderkötter C. Skin metastases in metastatic uveal melanoma:GNAQ/GNA11mutational analysis as a valuable tool. Br J Dermatol 2013; 169:160-3. [DOI: 10.1111/bjd.12291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Tsianakas
- Department of Dermatology; University Hospital of Muenster; Muenster Germany
| | - M.R.R. Böhm
- Department of Ophthalmology; University Hospital of Muenster; Muenster Germany
| | - V. Getova
- Department of Dermatology; University Hospital of Muenster; Muenster Germany
| | - D. Metze
- Department of Dermatology; University Hospital of Muenster; Muenster Germany
| | - N. Eter
- Department of Ophthalmology; University Hospital of Muenster; Muenster Germany
| | - T. Spieker
- Gerhard-Domagk-Institute for Pathology; University Hospital of Muenster; Muenster Germany
| | - A. Bräuninger
- Gerhard-Domagk-Institute for Pathology; University Hospital of Muenster; Muenster Germany
| | - T. Luger
- Department of Dermatology; University Hospital of Muenster; Muenster Germany
| | - M. Schiller
- Department of Dermatology; University Hospital of Muenster; Muenster Germany
| | - C. Sunderkötter
- Department of Dermatology; University Hospital of Muenster; Muenster Germany
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