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Yesiltas YS, Singh N, Oakey Z, Wrenn J, Singh AD. Choroidal Nevi in Children: Size, Growth, and Topographic Distribution. Am J Ophthalmol 2024; 266:102-109. [PMID: 38762092 DOI: 10.1016/j.ajo.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To explore size, growth, and topographic distribution of choroidal nevi in children to gain insights into choroidal nevogenesis. DESIGN Retrospective consecutive case series using pediatric clinic - and population-study data, comparing to adult data. METHODS Clinical data from Cole Eye Institute (CEI) database (December 2005-January 2023) was derived from a retrospective consecutive case series of 20 children (< 20 years) with choroidal nevi. For population data, 48 children from previously reported pooled data of the participants of the Sydney Pediatric Eye Disease Study, Sydney Myopia Study, Sydney Childhood Eye Study, and Sydney Adolescent Vascular and Eye Disease Study were included. Fundus photographs were reviewed and the locations of 18 choroidal nevi seen at CEI with widefield imaging were mapped on a radial scatter plot. For comparison, 100 consecutive adults with choroidal nevi were identified from CEI database. Main outcomes were size, growth, and topographic distribution of choroidal nevi. RESULTS The median largest basal diameter was 1.6 mm (range 0.4-4.2) in children. Most choroidal nevi (75%) remained stable, and 16% demonstrated growth at follow-up. The mean growth rate was calculated as 0.12 mm/year (range 0.10-0.15). Malignant transformation was not noted during childhood. All secondary changes (drusen, orange pigment, and subretinal fluid) associated with choroidal nevi in children were less common than those in adults (p < .05). Choroidal nevi in children were located significantly more posterior than in adults. The median distance to fovea was 2.1 mm (range 0.5-8.5) in children and 5.1 mm (range 0.4-16) in adults (p < .0001). CONCLUSIONS The onset and growth of choroidal nevi in children suggest active choroidal nevogenesis in childhood. A posterior topographic distribution may support the developmental framework for migration and maturation of choroidal melanoblasts.
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Affiliation(s)
- Yağmur Seda Yesiltas
- From the Department of Ophthalmic Oncology (Y.S.Y., Z.O., J.W., A.D.S.), Cole Eye Institute, Cleveland, Ohio, USA
| | - Nakul Singh
- Wilmer Eye Institute (N.S.), Johns Hopkins University, Baltimore, Maryland, USA
| | - Zackery Oakey
- From the Department of Ophthalmic Oncology (Y.S.Y., Z.O., J.W., A.D.S.), Cole Eye Institute, Cleveland, Ohio, USA
| | - Jacquelyn Wrenn
- From the Department of Ophthalmic Oncology (Y.S.Y., Z.O., J.W., A.D.S.), Cole Eye Institute, Cleveland, Ohio, USA
| | - Arun D Singh
- From the Department of Ophthalmic Oncology (Y.S.Y., Z.O., J.W., A.D.S.), Cole Eye Institute, Cleveland, Ohio, USA.
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Hu Z, Wang T. Beyond skin white spots: Vitiligo and associated comorbidities. Front Med (Lausanne) 2023; 10:1072837. [PMID: 36910477 PMCID: PMC9995999 DOI: 10.3389/fmed.2023.1072837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Vitiligo is a common depigmentation disorder of an unknown origin characterized by the selective loss of melanocytes, resulting in typical white macules and patches. However, vitiligo is now recognized as more than just a skin disease, what a dermatologist observes as a white spot of skin is just the "tip of the iceberg" of the condition. We attempt to clarify the classification of comorbidities associated with vitiligo from various reviews and reports, and describe their possible pathogenesis. In conclusion, the literature provides evidence of an association between vitiligo and ocular and auditory abnormalities, autoimmune disorders, other dermatological diseases, metabolic syndrome and related disorders, and psychological diseases. These associations highlight the importance of a multidisciplinary approach in managing vitiligo patients.
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Affiliation(s)
- Zhonghui Hu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Tao Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Happle R. Can Waardenburg syndrome type 2 be explained by epigenetic mosaicism? Am J Med Genet A 2021; 185:1304-1306. [PMID: 33438357 DOI: 10.1002/ajmg.a.62075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Rudolf Happle
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
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Pelles Z, Gáspárdy A, Zöldág L, Lénárt X, Ninausz N, Varga L, Zenke P. Merle allele variations in the Mudi dog breed and their effects on phenotypes. Acta Vet Hung 2019; 67:159-173. [PMID: 31238727 DOI: 10.1556/004.2019.018] [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] [Indexed: 11/19/2022]
Abstract
A retrotransposon insertion in the SILV gene is associated with a peculiar phenotype of dog, known as a merle. It is characterised by various areas of their coat colour becoming diluted due to a malfunction in the eumelanin-producing pigment cells. Recent studies have shown that the exact size of the short interspersed element (SINE) insertion is in correlation with specific phenotypic attributes, but was not able to absolutely confine dogs to a certain colour pattern. Our study focused on the merle variations occurring in the Mudi breed. Altogether, 123 dog samples from 11 countries were tested and genotyped. The exact length of the merle alleles were determined by automated fluorescent capillary fragment analysis. The most frequent merle genotype in this Mudi sample collection was the 'classic' merle (m/M: 61.8%), whereas other variants, such as atypical (m/Ma and m/Ma+: 5.7%), harlequin (m/Mh: 13.8%), double merle (M/M: 0.8%) and mosaic profiles (17.9%) were also observed. The practical significance of testing this mutation is that, phenotypically, not only merle dogs are carriers of this insertion, but also the so-called hidden merle individuals (where the merle phenotype is fully covered by the pheomelanin-dominated colouration) are potentially capable of producing unintentionally homozygous 'double merle' progeny with ophthalmologic, viability and auditory impairments.
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Affiliation(s)
- Zsófia Pelles
- 1Department of Animal Breeding and Genetics, University of Veterinary Medicine Budapest, István utca 2, H-1078 Budapest, Hungary
| | - András Gáspárdy
- 1Department of Animal Breeding and Genetics, University of Veterinary Medicine Budapest, István utca 2, H-1078 Budapest, Hungary
| | - László Zöldág
- 1Department of Animal Breeding and Genetics, University of Veterinary Medicine Budapest, István utca 2, H-1078 Budapest, Hungary
| | - Xénia Lénárt
- 2Institute of Genetics, Microbiology and Biotechnology, Szent István University, Gödöllő, Hungary
| | - Nóra Ninausz
- 3 Research Centre for Farm Animal Gene Conservation, Gödöllő, Hungary
| | - László Varga
- 2Institute of Genetics, Microbiology and Biotechnology, Szent István University, Gödöllő, Hungary
- 3 Research Centre for Farm Animal Gene Conservation, Gödöllő, Hungary
| | - Petra Zenke
- 1Department of Animal Breeding and Genetics, University of Veterinary Medicine Budapest, István utca 2, H-1078 Budapest, Hungary
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Dawson-Baglien EM, Noland EL, Sledge DG, Kiupel M, Petersen-Jones SM. Physiological characterization of ocular melanosis-affected canine melanocytes. Vet Ophthalmol 2018; 22:132-146. [PMID: 29701286 DOI: 10.1111/vop.12572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cairn terriers with ocular melanosis (OM) accumulate large, heavily pigmented melanocytes in the anterior uvea. Darkly pigmented plaques develop within the sclera, leading us to hypothesize that OM uveal melanocytes may have an abnormal migratory capacity. ANIMALS STUDIED Globes from OM-affected Cairn terriers and unaffected control eyes enucleated for reasons unrelated to this study were used for immunohistochemistry and to culture melanocytes for in vitro cell behavior assays. PROCEDURES The scleral plaques of six dogs were immunolabeled for HMB-45, MelanA, PNL2, CD18, CD204, and Iba-1 and compared with the pigment cells accumulated within the irides. Cultured uveal melanocytes from OM-affected and control dogs were compared using conventional assays measuring cell proliferation, invasion capability, and melanin production. RESULTS Melanocytes isolated from OM eyes had significantly elevated levels of per-cell melanin content and production compared to controls. The majority of pigmented cells in the scleral plaques were HMB45 positive indicating a melanocytic origin. Many were also CD18 positive. No differences were observed between cultured melanocytes from OM-affected and control uvea for standard in vitro proliferation or invasion assays. CONCLUSION Pigmented cells which accumulate in the sclera of OM-affected Cairn terriers are predominantly melanocytes; however, in vitro assays of uveal melanocytes did not reveal differences in migratory behavior between OM and control cells. Migratory behavior of OM-melanocytes may be environment-dependent. We suggest that RNA sequencing and differential expression analysis would be a useful next step in understanding this disease.
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Affiliation(s)
- Ethan M Dawson-Baglien
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.,Genetics Program, College of Natural Science, Michigan State University, Lansing, MI, USA
| | - Erica L Noland
- Diagnostic Center for Population and Animal Health, Michigan State University, Lansing, MI, USA
| | - Dodd G Sledge
- Diagnostic Center for Population and Animal Health, Michigan State University, Lansing, MI, USA
| | - Matti Kiupel
- Diagnostic Center for Population and Animal Health, Michigan State University, Lansing, MI, USA
| | - Simon M Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.,Genetics Program, College of Natural Science, Michigan State University, Lansing, MI, USA
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Die Geschichte der Ophthalmoonkologie an der Univ.-Augenklinik Graz. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Einleitung
Der Beginn der organerhaltenden Therapie an der Univ.-Augenklinik datiert auf das Jahr 1985 mit der Einführung der Ruthenium 106 Applikatoren (Lommatzsch, Vormun) zurück.
Der Autor skizziert in zeitlicher Abfolge die Einführung und gemeinsame Entwicklung verschiedener Arten von organerhaltender Therapien und endet mit neuen Therapieansätzen des Retinoblastoms und des metastasierenden Aderhautmelanoms.
Methodik
Die Vorstände der Univ.-Augenklinik beginnend mit Hofmann (1964–1987) unterstützten den Paradigmenwechsel von einem radikalchirurgischen Konzept (Enukleation) bei intraokularen Tumoren zu einem organerhaltenden Konzept trotz Fehlens von großen Studien mit hoher Evidenz. Zuweisende FachärztInnen waren zu Recht im Zweifel über die Sinnhaftigkeit dieser neuen Therapiekonzepte, unterstützen jedoch mit ihren PatientInnen Zuweisungen den neuen Arbeitsschwerpunkt bzw. den organerhaltenden Therapieansatz bis zum heutigen Tag.
Ergebnisse
Aderhautmelanom: 1985 wurde die organerhaltende Therapie mittels Ruthenium 106 Applikatoren in Graz für kleine und mittelgroße Aderhautmelanome mit aequatorialler und anteriorer Lokalisation eingeführt, ab 1992 war die Gamma Knife Radiochirurgie alternativ zur Protonen- und Photonentherapie an der Univ. Klinik für Neurochirurgie in Graz verfügbar und wurde mit Beiträgen anderer Tumorzentren für die Behandlung von großen Aderhautmelanomen oder solchen mit posteriorer Lokalisation entwickelt.
Die transpupillare Thermotherapie (TTT) wurde 1995 in Leiden von Osterhuis und Journée-de Korver für die Behandlung von flachen posterior lokalisierten Melanomen im Tiermodell entwickelt. Die Therapie geriet auf Grund einer erhöhten Rate von Rezidiven in einzelnen Tumorzentren in Mißkredit und Vergessenheit, sollte jedoch auf Grund guter eigener Erfahrungen und der Einführung der TTT bei der Behandlung von Retinoblastomen in Hinblick auf Technik und Indikationen neuerlich evaluiert werden.
Endoresektion: Aderhautmelanome werden nach Vorbestrahlung wegen des großen Tumorvolumens bzw. einer persistierenden Amotio mittels Vitrektomie Techniken reserziert, als Bestrahlungstechnik wurde in Graz und in Essen das Gamma Knife verwendet.
Biopsien werden seit einigen Jahren für genetische und mikrobiologische Untersuchungen durchgeführt, neue mikrobiologische Erkenntnisse werden zur Entwicklung neuer systemischer Therapiekonzepte führen.
Retinoblastom: Im Gegensatz zum Aderhautmelanom erwies sich die adjuvante Chemotherapie beim Retinoblastom als hoch wirksam v. a. in der Volumsreduktion der Tumoren.
Die Brachytherapie mit Ruthenium 106 Schalen, die 3‑fach Kryotherapie bzw. die Lasertherapie werden bereits seit Jahrzehnten an der Univ.-Augenklinik als organerhaltende Lokaltherapien durchgeführt, seit kurzem komplettiert die TTT (mit oder ohne simultane Chemotherapie) das Spektrum der fokalen Therapien. Neue Therapiekonzepte wie die intrabulbäre Chemotherapie (bereits in Anwendung) sowie die intraarterielle Chemotherapie (steht kurz vor der Implementierung) sind bereits in Routine.
Seit 2003 werden erstmals Retinoblastome in einer Therapie Optimierungsstudie RBA2003 (die das Department für Hämato‑/Onkologie der Univ. Kinderklinik Graz zusammen mit der Univ.-Augenklinik entwickelt hat) in Graz behandelt. Das Univ. Klinikum Graz etabliert sich als Referenzzentrum für Retinoblastome und Pseudoretinoblastome in Österreich und dem umgebenden Ausland und erhielt Anfragen und PatientInnen Zuweisungen aus den Alpe Adria Ländern sowie Schweiz, Bulgarien, Tschechien, Rumänien, Ukraine und Rußland. Wedrich, derzeitiger Vorstand der Univ.-Augenklinik Graz, förderte die Entwicklung des Retinoblastom Kompetenz Zentrums in personeller, instrumenteller und logistischer Hinsicht.
2015 entwickelte das Klinikum Essen ein auf das Protokoll RBA2003 aufbauendes, erweitertes internationales Protokoll, nach dem nun PatientInnen aus Essen und Graz gemeinsam behandelt, evaluiert und nachkontrolliert werden. Dieses wiederum wird in einem EU-Antrag, initiert von Chandada (Buenos Aires, Barcelona) für eine einheitliche Behandlung des Retinoblastoms in Europa berücksichtigt.
2005 engagierte sich die Arbeitsgruppe erstmals in Mosambique, Afrika folgend einer Bitte der NGO, Licht für die Welt, die Rahmenbedingungen für die Etablierung eines Retinoblastomzentrums zu prüfen.
2008 wurde am LKH Univ. Klinikum Graz ein Forschungsfeld Onkologie etabliert, in weiterer Folge das Comprehensive Cancer Center (CCC) der MUG gegründet, in das die Ophthalmoonkologie thematisch eingegliedert ist.
Schlussfolgerung
Das vor 32 Jahren am LKH Univ.-Klinikum Graz etablierte Konzept der organerhaltenden Therapie erfuhr 13 Jahre später die Bestätigung durch die bislang größte multizentrische Studie (COMS Studie) in den USA, wonach kein Unterschied in Hinblick auf Überleben zwischen Enukleation und bulbuserhaltender Therapie mit Jod 125 Schalen bei kleinen und mittelgroßen Aderhautmelanomen gefunden wurde. Die seit über 30 Jahren unveränderte (z. T. sehr schlechte) Prognose kann möglicherweise in absehbarer Zeit durch neue Medika verbessert werden. Basis für diese erfreulichen Entwicklungen sind neue bahnbrechende Erkenntnisse aus der zytogenetischen und molekularbiologischen Forschung.
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