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Kivelä TT. The first description of the complete natural history of uveal melanoma by two Scottish surgeons, Allan Burns and James Wardrop. Acta Ophthalmol 2018; 96:203-214. [PMID: 28834323 DOI: 10.1111/aos.13535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Abstract
James Wardrop (1782-1869), a young Scottish surgeon and an early ophthalmologist in Edinburgh, is credited for describing in 1809 retinoblastoma as an entity in his treatise 'Observations on Fungus Haematodes or Soft Cancer'. His treatise also reveals that Allan Burns (1781-1813), another young Scottish surgeon and anatomist, had invited Wardrop to assist in enucleating an eye from a 41-year-old Glasgow woman who, in retrospect, had a uveal melanoma. Her eye had become blind 4 months after symptoms of exudative retinal detachment had appeared, and it had become painful after a further 2-4 months. The tumour eventually perforated the sclera, and she died within a year thereafter of hepatic metastases. Burns and Wardrop went on to publish detailed parallel accounts of the symptoms, signs, ophthalmic pathology and post-mortem findings regarding the primary, recurrent and metastatic tumour. Burns may have performed the post-mortem after exhuming the body, a common occurrence in early 19th Century Scotland, a thriving hub for teaching morbid anatomy to young surgeons at the time.
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Affiliation(s)
- Tero T. Kivelä
- Ocular Oncology Service and Ophthalmic Pathology Laboratory; Department of Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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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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Szalai E, Wells JR, Grossniklaus HE. Mechanisms of Optic Nerve Invasion in Primary Choroidal Melanoma. Ocul Oncol Pathol 2017; 3:267-275. [PMID: 29344479 DOI: 10.1159/000456718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/08/2017] [Indexed: 11/19/2022] Open
Abstract
Aim The aim of this study was to assess morphological risk factors associated with optic nerve invasion of choroidal melanoma and to identify possible mechanisms of optic nerve invasion. Methods Medical charts and histology slides of patients with primary choroidal melanoma who were treated by enucleation/exenteration and whose pathology showed optic nerve invasion were reviewed. Results Twenty-one patients (mean age: 65.67 ± 14.72 years) with primary uveal melanoma arising from the choroid were included in this analysis. A peripapillary location was present in 86% of the cases. Four types of optic nerve invasion were identified: transvitreal invasion (10%); retinal invasion (23%); direct peripapillary invasion (57%); and a combined mechanism (10%). Optic nerve invasion was prelaminar in 67%, laminar in 10%, and retrolaminar in 23% of the cases. Significantly higher largest basal diameter (p = 0.021) and tumor thickness values (p = 0.017) and higher rates of vortex vein (p = 0.022) and retinal invasion (p = 0.007) were observed in the transvitreal/retinal invasion groups when compared to the direct peripapillary invasion group. Conclusions A peripapillary tumor location was the most common mechanism of optic nerve invasion of choroidal melanoma. In 43% of the cases, other mechanisms including transvitreal and retinal invasion resulted in optic nerve invasion.
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Affiliation(s)
- Eszter Szalai
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jill R Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
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Lemaître S, Zmuda M, Jacomet PV, Lévy-Gabriel C, Dendale R, Berges O, Fréneaux P, Mariani P, Desjardins L, Galatoire O, Cassoux N. Small Choroidal Melanoma Revealed by a Large Extrascleral Extension. Ocul Oncol Pathol 2017; 3:240-246. [PMID: 29071276 DOI: 10.1159/000455870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
AIMS Orbital extraocular extension of choroidal melanoma is very rare with small melanomas. We report the case of a patient whose small choroidal melanoma was initially overlooked and was revealed by a large extrascleral extension. METHODS A 48-year-old Caucasian woman presented with sudden total visual loss in the right eye. Multicolor imaging of the fundus showed right optic disc edema and an orange and green lesion near the optic disc. The diagnosis of unilateral optic neuritis was made. Magnetic resonance imaging showed an extraocular mass adjacent to the optic nerve; on ultrasound, this mass was acoustically hollow and a small intraocular component was visible. RESULTS Choroidal melanoma with a large extrascleral extension was diagnosed (T4eN0M0, stage IIIC according to the AJCC 7th TNM classification, 2010). The size of the extraocular nodule was 13 × 5 mm. Treatment consisted of enucleation followed by adjuvant external beam orbital radiotherapy. Tumor analysis showed a mixed cell type melanoma with monosomy 3. The patient developed liver metastasis 10 months after local treatment. CONCLUSION Extraocular extension of choroidal melanoma can occur with small lesions. Prognosis is generally poor according to AJCC TNM. This case is a reminder that fundus examination may reveal the nature of the mass in some patients with orbital tumors.
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Affiliation(s)
- Stéphanie Lemaître
- Institut Curie, Paris, France.,Université Paris Descartes, Paris, France
| | - Mathieu Zmuda
- Fondation ophtalmologique Adolphe de Rothschild, Paris, France
| | | | | | - Rémi Dendale
- Institut Curie, ICPO (Protontherapy Center), Orsay, France
| | - Olivier Berges
- Fondation ophtalmologique Adolphe de Rothschild, Paris, France
| | | | | | | | | | - Nathalie Cassoux
- Institut Curie, Paris, France.,Université Paris Descartes, Paris, France
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Singh AD, Platt SM, Lystad L, Lowe M, Oh S, Jones SE, Alzahrani Y, Plesec T. Optic Nerve Assessment Using 7-Tesla Magnetic Resonance Imaging. Ocul Oncol Pathol 2016; 2:178-80. [PMID: 27239461 DOI: 10.1159/000443650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/08/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this study was to correlate high-resolution magnetic resonance imaging (MRI) and histologic findings in a case of juxtapapillary choroidal melanoma with clinical evidence of optic nerve invasion. METHODS With institutional review board approval, an enucleated globe with choroidal melanoma and optic nerve invasion was imaged using a 7-tesla MRI followed by histopathologic evaluation. RESULTS Optical coherence tomography, B-scan ultrasonography, and 1.5-tesla MRI of the orbit (1-mm sections) could not detect optic disc invasion. Ex vivo, 7-tesla MRI detected optic nerve invasion, which correlated with histopathologic features. CONCLUSIONS Our case demonstrates the potential to document the existence of optic nerve invasion in the presence of an intraocular tumor, a feature that has a major bearing on decision making, particularly for consideration of enucleation.
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Affiliation(s)
- Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sean M Platt
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lisa Lystad
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Lowe
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sehong Oh
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Yahya Alzahrani
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Plesec
- Pathology Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Abstract
Retinoinvasive uveal melanoma demonstrates prominent diffuse retinal and optic nerve invasion, with little or no involvement of the adjacent choroid. Prior studies have advanced hypotheses on the potential role of molecular and cellular interactions in the pathogenesis of retinoinvasiveness and neuroinvasiveness, but the precise molecular events are not known. Here, we investigate the role of neutrotrophic factors in the pathogenesis of retinoinvasive uveal melanoma. The records of three ophthalmic pathology departments (The New York Eye and Ear Infirmary, Wills Eye Institute, and University of California San Francisco) were searched to identify all cases of retinoinvasive uveal melanoma, yielding four eyes (all previously irradiated). Eight eyes with nonretinoinvasive melanomas (four irradiated and four nonirradiated) were randomly selected as controls. All enucleated eyes were examined histopathologically and immunohistochemically for the expression of neurotrophic factor receptors [Pan-Trk, p75 neurotrophin receptor (p75(NTR) and ciliary neurotrophic factor receptor-α]. Histopathologic features were similar in both retinoinvasive and control melanomas with regard to choroidal tumor location and size, neovascular glaucoma, and cell type. The eyes with retinoinvasive melanoma showed diffuse retinal invasion beyond the choroidal tumor (n=4) and prelaminar (n=1) and retrolaminar (n=2) optic nerve invasion. The control melanomas showed focal retinal invasion over the tumor apices (n=6) and prelaminar optic nerve invasion (n=1). Nonirradiated melanomas demonstrated no trace immunoreactivity for neurotrophic factor receptors, whereas irradiated melanomas showed more prominent (trace to moderate) immunoreactivity. When controlled for irradiation, no difference in immunoreactivity for neurotrophin receptors nor tumor duration was observed between retinoinvasive and nonretinoinvasive melanomas. This study failed to demonstrate a direct causation between the expression of neurotrophin receptors and a retinoinvasive uveal melanoma growth pattern.
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Dhupper M, Biswas J, Gopal L, Kumar SK, Khetan V. Clinicopathological correlation of choroidal melanoma in Indian population: A study of 113 cases. Oman J Ophthalmol 2012; 5:42-5. [PMID: 22557876 PMCID: PMC3339674 DOI: 10.4103/0974-620x.94766] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: To correlate the clinical presentation, tumor characteristics, and histopathological findings of choroidal melanoma in the Indian population Materials and Methods: A retrospective analysis of 113 patients of choroidal melanoma over a period of 10 years was done. Patient demography, clinical presentation, tumor characteristics, and histopathological findings were correlated. Results: Among 113 patients histopathologically diagnosed with choroidal melanoma over 10 years, most were males. The mean age was 45.9 ± 14.84 years among which 6 (5.3%) patients were less than 20 years. Thirty-six (31.8%) patients were misdiagnosed. The mean basal diameter was 12.41 ± 1.4 mm. Mixed cell type was seen in 71 (63%) patients, while 28 (25%) patients had spindle cell type. Epithelioid cell type was present in 11 (10%) patients and necrotic cell type was seen in 3 (2%) patients. Enucleation was the primary treatment modality in 107 (94.6%) patients, while exenteration was done in 6 (5.3%) patients. Three patients with epithelioid cell type with orbital extension underwent exenteration. The mean follow-up period was 14 months. No mortality was reported at the end of 5 years in patients with longer follow-up. Conclusions: Malignant melanoma of the choroid is a rare occurrence. They can occur in younger age group and can be misdiagnosed. Mixed cell type is commonest. Diffuse tumors with epithelioid cell type are likely to have orbital extension.
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Affiliation(s)
- Maneesh Dhupper
- Bhagwan Mahavir Vitreo Retina Services, Sankara Nethralaya, Nungambakkam, Chennai, Tamil Nadu, India
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Schefler AC, Mutapcic L, Murray TG, Dubovy SR. Optic nerve invasion from an amelanotic peripapillary choroidal melanoma. Retin Cases Brief Rep 2009; 3:329-32. [PMID: 25389839 DOI: 10.1097/icb.0b013e3181985935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report an unusual case of an amelanotic optic nerve head melanoma. PATIENTS/METHODS/RESULTS This is a retrospective case report of an 81-year-old woman with a slowly enlarging amelanotic optic nerve head lesion. Histopathologic evaluation of the lesion after enucleation revealed a peripapillary choroidal melanoma. The lesion was highly atypical in that the patient's visual acuity was excellent despite the lesion's growth and the intraocular pressure did not differ from the fellow eye. The patient did have a history of primary open angle glaucoma, which may have rendered the optic nerve more susceptible to tumor invasion. CONCLUSION Optic nerve invasion by choroidal melanoma is a rare event, which is typically associated with poor visual acuity, elevated intraocular pressure, and large necrotic lesions; however, invasive melanoma with optic nerve invasion may occur in the absence of these classic findings.
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Affiliation(s)
- Amy C Schefler
- From the Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Lindegaard J. Primary and secondary tumours of the optic nerve, with emphasis on invasion of uveal malignant melanoma. ACTA ACUST UNITED AC 2007; 85:347-8. [PMID: 17488471 DOI: 10.1111/j.1600-0420.2006.00868.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jens Lindegaard
- Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark.
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