Sunglasses to hide behind may also prevent melanoma of the eyes

In 1967, Sandy Posey pronounced that sunglasses are essential beachwear ( https://www.youtube.com/watch?v=4HVBEb-GA1Y ). Now, whole-genome sequencing reveals that ultraviolet radiation (UVR) can contribute to melanomas in the iris and conjunctiva, data that provide a molecular explanation for why it is important to protect our eyes from exposure to UVR.

CYFRA21-1/TG ratio as an accurate risk factor to predict eye metastasis in nasopharyngeal carcinoma: A STROBE-compliant article

Nasopharyngeal carcinoma (NPC) has a distinctive geographical distribution in China, especially southern China. There are several risk factors for NPC, such as Epstein-Barr virus, genetics, and environmental exposures. Although the incidence of eye metastasis (EM) is lower than metastasis in other body parts, it often indicates poor prognosis.We assessed several serum biomarkers for their ability to predict EM in NPC. Patients with NPC were selected (n = 963), and were separated into two groups, EM and no eye metastasis. Ten factors were analyzed in both groups including triglyceride (TG), high-density lipoprotein, low-density lipoprotein, alkaline phosphatase, alpha fetoprotein, carbohydrate antigen-199, cancer antigen-153, apolipoproteins AI, apolipoprotein B, and cytokeratin fragment 19 (CYFRA21-1). Independent t tests, binary logistic regression, and receiver operating characteristic curves were used to assess the data.The EM group had significantly higher CYFRA21-1 and lower TG compared with the no eye metastasis group. Areas under the curve for CYFRA21-1, TG and CYFRA21-1/TG were 0.966, 0.771, and 0.976, respectively. The corresponding cut-off values were 12.12 ng/ml, 0.41 mmol/L, and 13.5. The sensitivity and specificity of CYFRA21-1/TG were 100% and 92.2%, respectively.The increased ratio of CYFRA21-1 to TG can be an accurate method to detect EM in patients with NPC.

Environmental effects of ozone depletion and its interactions with climate change: progress report, 2015

The Environmental Effects Assessment Panel (EEAP) is one of three Panels that regularly informs the Parties (countries) to the Montreal Protocol on the effects of ozone depletion and the consequences of climate change interactions with respect to human health, animals, plants, biogeochemistry, air quality, and materials. The Panels provide a detailed assessment report every four years. The most recent 2014 Quadrennial Assessment by the EEAP was published as a special issue of seven papers in 2015 (Photochem. Photobiol. Sci., 2015, 14, 1-184). The next Quadrennial Assessment will be published in 2018/2019. In the interim, the EEAP generally produces an annual update or progress report of the relevant scientific findings. The present progress report for 2015 assesses some of the highlights and new insights with regard to the interactive nature of the effects of UV radiation, atmospheric processes, and climate change.

Isolated Ocular Relapse in Childhood Acute Lymphoblastic Leukemia during Second Interim Maintenance Phase of Chemotherapy: Case Report

More than 80% of acute lymphoblastic leukemia (ALL) in pediatric population is curable by using combinations of chemotherapy. However, 20% of the cases still suffer from disease relapse. The most common site of relapse is bone marrow. Relapse of childhood ALL involving the eyeball is rare. However, it occurs in 2.2% of relapsing children. The authors described a 10-year-old Thai boy with underlying ALL on therapy, presented with a one-month history of progressive visual loss of his right eye. The clinical and imaging studies strongly suggested the diagnosis of isolated ocular relapse. In this report, the authors presented the findings from successfully specific treatment consisting of systemic chemotherapy and radiation therapy on the affected eye. From other studies, the outcome was more favorable in cases of ocular relapse off therapy. In our study, one case of isolated ocular relapse ALL was reported.

[Top ten research progresses of ocular pathology in China in the past five years]

Ten researches that may represent the progresses of clinical and basic ocular pathological studies in China in the past 5 years, were voted by specialists from Chinese Ocular Pathology Group. These researches were concentrated in following 5 fields: Stem cell therapy for retinal disease, Molecular imaging approach for detection of ocular fundus disease, Pathogenesis and comprehensive therapy of ocular tumors, Study of thyroid-associated opthalmopathy and Study of diabetic retinopathy. These studies, in a certain extent, represented the current level of research and the influence of our national ocular pathology specialists in the international ocular pathology field.

[Ocular changes in ophthalmo-heliosis]

Ophthalmoheliosis are a class of diseases in which acute or chronic exposure to UV radiation is crucial. Pathology is different, depending on the duration, wave-lenghth, size and intensity of exposure. The aim of this paper is to highlight the mechanisms by which UVR absorption occurs in the eye and patho-physiological changes with many types of pathology. There are also presented categories risk factors and preventive measures of the disease.

Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure

BACKGROUND

According to a fundamental law of radiobiology ("Law of Bergonié and Tribondeau", 1906), the brain is a paradigm of a highly differentiated organ with low mitotic activity, and is thus radio-resistant. This assumption has been challenged by recent evidence discussed in the present review.

RESULTS

Ionizing radiation is an established environmental cause of brain cancer. Although direct evidence is lacking in contemporary fluoroscopy due to obvious sample size limitation, limited follow-up time and lack of focused research, anecdotal reports of clusters have appeared in the literature, raising the suspicion that brain cancer may be a professional disease of interventional cardiologists. In addition, although terminally differentiated neurons have reduced or mild proliferative capacity, and are therefore not regarded as critical radiation targets, adult neurogenesis occurs in the dentate gyrus of the hippocampus and the olfactory bulb, and is important for mood, learning/memory and normal olfactory function, whose impairment is a recognized early biomarker of neurodegenerative diseases. The head doses involved in radiotherapy are high, usually above 2 Sv, whereas the low-dose range of professional exposure typically involves lifetime cumulative whole-body exposure in the low-dose range of < 200 mSv, but with head exposure which may (in absence of protection) arrive at a head equivalent dose of 1 to 3 Sv after a professional lifetime (corresponding to a brain equivalent dose around 500 mSv).

CONCLUSIONS

At this point, a systematic assessment of brain (cancer and non-cancer) effects of chronic low-dose radiation exposure in interventional cardiologists and staff is needed.

Progress in the studies of etiology, epidemiology and pathogenesis of ocular melanomas

Our population-based epidemiological studies demonstrated that the epidemiological aspects of ocular melanomas are different from those in cutaneous melanoma. The incidences of conjunctival melanoma increased in the past decades and was higher in the South (greater sun exposure), which is consistent with the occurrence of cutaneous melanoma. On the contrary, incidences of uveal melanoma are in the opposite direction of cutaneous melanomas. This indicates that solar radiation does not cause an increase of incidences of melanoma in ocular tissues (uveal melanoma) that are not exposed to solar radiation. Solar radiation increases the incidence of melanoma only in tissues exposed to said radiation, such as in conjunctival and eyelid melanomas. Uveal melanoma incidences in light-pigmented individuals are much greater than in dark-pigmented individuals. This result cannot be attributed to a melanin photo-screening effect, and is possibly related to melanin's biophysical and biochemical effects. The difference in incidences between light- and dark-pigmented individuals in conjunctival melanomas, as well as in vulvar and vaginal melanomas, are much lower than that in the uveal and cutaneous melanomas. This difference may be related to the different histological structures in these melanomas; conjunctival and vaginal melanomas occur in the mucous membrane, whereas cutaneous melanomas occur in the skin. Recent molecular biological studies indicate that each type of melanoma has its own molecular changes which are different from the others. Therefore, independent studies are required for each type of melanoma to discover their own etiology and pathogenesis, and to develop relevant novel prevention and treatment procedures.

[Lack of biological exchange in assisted reproductive techniques]

There is a clear dividing line in the group of actions aimed at solving sterility, and the techniques aimed at generating embryos to be transferred to a womb. The dividing line is now clearly established by science. The growing alarm among paediatricians raised by the higher risk of malformations and diseases in children when generated in vitro, with respect to those normally engendered, is leading to the need to clearly establish the consequences of in vitro technologies and informing society in an honest way. Two types of lack of exchange of information, cellular and molecular, cause the detected defects. In the fi rst place it is clear that both gametes should recognize each other when adequately mature and in the appropriate natural environment. In vitro technologies force these conditions and either one or both gametes might be impaired and consequently negative effects for the child might be caused. In the second place both embryo and maternal womb are deprived of that early mother-child communication facilitating implantation.

Ocular manifestations of Burkitt's lymphoma: experience in Ile-Ife south western Nigeria

BACKGROUND

Burkitt's lymphoma is the most common childhood tumour in subSaharan Africa that typically affects the jaws and abdomen. Ocular involvement with blindness has been documented in some studies.

OBJECTIVE

This was to evaluate the role of Burkitt's lymphoma (BL) as a cause of blindness in Nigerian children.

METHODS

Cases of BL seen in the hospital between 1986 and 2003 were studied retrospectively. Some of the patients with orbital disease at presentation underwent ultrasonographic examination of the eyes.

RESULTS

Forty-three (16.5%) of the 260 patients seen presented with orbital tumours; 29 (67.4 %) of the 43 patients had full ophthalmic examination. The patients studied comprised 22 males and 7 females with a M: F ratio of 3:1, and median(age range) of 7(3-15) years. Orbital tumours occurred concurrently with jaw masses on the same side in 19(65.5 %) of 29 patients; the eye diseases were unilateral in 23 (79.3%) and bilateral in six (20.7%) of the cases. Proptosis was the ocular presentation in 27(93%) of patients and it was associated with conjunctival injection in nine, chemosis in 11 and exposure keratopathy in five. Fourteen (48.3%) patients had associated blindness; 12 (85.7%) remained blind in the affected eye(s) and one regained vision to 6/36 after chemotherapy. The patients underwent Cyclophosphamide-Oncovin-Methotrexate (COM) regimen with intrathecal therapy. Eight (27.6%) patients had concomitant CNS disease; these included cases of 6th and 7th nerve palsies, one case of intra-cerebral extension of tumour and another case of total ophthalmoplegia.

CONCLUSION

Burkitt's lymphoma is an important cause of childhood blindness in Nigeria and the orbital disease ismainly extra ocular.

Meta-analyses of the association between Chlamydia psittaci and ocular adnexal lymphoma and the response of ocular adnexal lymphoma to antibiotics

BACKGROUND

There are conflicting reports regarding the association between Chlamydia psittaci (Cps) and ocular adnexal lymphoma (OAL) and the efficacy of antibiotics for OAL. In the current study, the authors attempted to clarify the association between Cps and OAL and the efficacy of antibiotics for OAL.

METHODS

Two meta-analyses were conducted. One focused on the association between Cps and OAL across geographic regions and among different studies. The other was a meta-analysis of the response of OAL to antibiotic treatment.

RESULTS

The authors identified 11 studies of Cps prevalence that included 458 cases of OAL from 10 different countries. Four studies regarding the efficacy of oral antibiotics to treat OAL were found. One hundred four of the 458 OAL specimens (23%) and 87 of the 346 mucosa-associated lymphoid tissue (MALT) lymphoma specimens (25%) were found to be positive for Cps. Ninety-four of the 104 Cps-positive OAL specimens (90%) came from 3 of the 11 studies. There was wide variation noted between geographic regions and even between studies from the same geographic region with regard to the rate of Cps positivity. The 4 studies concerning the efficacy of antibiotics for OAL were from Italy, Austria, Taiwan, and the U.S. and included 42 patients. Twenty patients (48%) achieved some response (complete response in 8 patients, partial response in 8 patients, and minimal response in 4 patients). Twenty patients also had stable disease, and 2 patients progressed during antibiotic therapy. Objective documentation of response (radiographs or clinical slit-lamp photographs) was available for only 3 of the 42 patients. Seven additional patients developed disease recurrence after their initial response or stable disease after antibiotic therapy; 6 of these cases of disease recurrence occurred during the first 12 months of follow-up.

CONCLUSIONS

The findings of the current study suggest a striking variability in the association between Cps and OAL across geographic regions and even between studies from the same geographic regions. The overall rate of Cps positivity in our meta-analysis (23%) was much lower than that reported in the original report. The current study findings also suggest that antibiotics have variable efficacy against OAL. Future prospective trials with standard objective response criteria and a longer follow-up period would be necessary to evaluate the role of antibiotics in the treatment of OAL further.

The risk for cutaneous malignant melanoma, melanoma in situ and intraocular malignant melanoma in relation to tobacco use and body mass index

BACKGROUND

The incidence of cutaneous malignant melanoma (CMM) and melanoma in situ (MIS) has been increasing during the last 50 years. Malignant melanoma (MM) is also the most common intraocular malignancy (IMM). Besides ultraviolet radiation, the cause of these tumours is largely unknown.

OBJECTIVES

We designed a study to examine the effect of body mass index (BMI) and tobacco use on the risk for MM and MIS.

METHODS

Analyses were performed on a nationwide cohort of 339 802 Swedish construction workers. Exposure information was collected prospectively by questionnaires combined with personal interviews.

RESULTS

Follow up yielded a total of 7 663 400 person-years during which 1639 workers developed MM/MIS. The risk for MM/MIS was reduced in current or previous smokers compared with those who had never smoked, both when analysing all smoking tobacco products combined and when analysing cigarette and pipe smokers separately. The risk was further diminished with longer duration of smoking and greater quantity of tobacco smoked. The effect was more evident in CMM/MIS than in IMM. Snuff taking conferred a decreased risk for CMM/MIS, and a BMI over normal weight range conferred an increased risk for CMM.

CONCLUSIONS

Tobacco smoking was found to be inversely associated with the risk for CMM and MIS. The mechanism of action is unknown but it has been suggested to be due to the immune suppressive effect that tobacco exerts which would be protective against deleterious immune reactions caused by, for example, the sun. Neither is the mechanism behind the higher risk for CMM due to being overweight known. One hypothesis is that it is an effect of a hormonal imbalance. Further studies are required to elucidate these mechanisms.

Occult donor malignancy in pancreas transplantation

Tumor of the pancreas allograft is extremely rare. We report a case of an occult donor malignant undifferentiated tumor arising in a pancreas allograft. A 42-year-old female with Type 1 diabetes received a macroscopically normal pancreas allograft. The donor was a 22-year-old male who died of spontaneous intracerebral hemorrhage. She underwent transplant pancreatectomy, the histology of the pancreas allograft demonstrated a tumor measuring 5 mm in diameter, and a diagnosis of malignant undifferentiated tumor was made. In a different transplant center, the recipient of the left kidney transplant from the same donor had a nephrectomy, and the recipient of the liver transplant died of metastatic disease. Microscopic examination of the liver and kidney allografts subsequently revealed histological features identical to the pancreas tumor. Tumor transmission in transplantation may occur from an organ that contains metastatic cells or, less commonly, from the transmission of an unrecognized or occult primary tumor. A report from the United Network for Organs Sharing transplant data 1997-2002 is illustrated and discussed. This case illustrates the difficulties associated with identifying donors with occult primary tumor or metastases.

Influence of immune surveillance and immune privilege on formation of intraocular tumors

The immune surveillance theory proposed almost half a century ago stated that the immune system was responsible for preventing the formation of spontaneous tumors by identifying and eliminating neoplastic cells early in their development. Recent studies demonstrating that innate and adaptive immune effector cells participate in preventing tumor growth and are effective in reducing the frequency of tumors have revived interest in immune surveillance. Paradoxically, other recent studies demonstrate that the immune system can also promote tumor progression by altering the immunogenic phenotype of developing tumors in a process called immunoediting. These data raise new questions regarding whether immune surveillance and immunoediting occur within the immune-privileged ocular environment where the innate and adaptive immune effector cells are inhibited and/or participate in the development of regulatory T cells.

Condições oftalmológicas de pacientes com síndrome da imunodeficiência adquirida com longo tempo de seguimento

PURPOSE

To evaluate the ophthalmologic conditions of patients with AIDS, with long-term follow-up, previously evaluated by an ophthalmologist, considering general conditions related with AIDS.

METHODS

Observational study of 42 patients with AIDS divided into two groups: Group I: 8 patients with previous AIDS-related cytomegalovirus retinitis, Group II: 34 patients with AIDS without cytomegalovirus retinitis. Each patient had been submitted to one ophthalmologic examination. General data of the patients were obtained from the medical records.

RESULTS

The majority of the patients presented visual acuity in the best eye between logMAR 0.0 (68.3%) and 0.1 (26.9%). Optic prescription for refractive errors benefited 39.4% of the patients in Group II but none of the patients in Group I. Presbyopia was corrected in 27.3% of Group II and in 12.5% of Group I patients. No current ocular AIDS-related manifestations were detected in any group. Ocular posterior segment alterations, all of them consisting of retinitis / retinochoroiditis scars, were found in 10 patients, 7 (16.7%) belonging to Group I and 3 (7.1%) to Group II.

CONCLUSION

Ten (24.4%) patients presented visual alteration due to age. Except for the patients presenting previous retinitis and retinochoroiditis, all the other patients were in good ophthalmic conditions and most of them were in immunologic recovery due to the use of highly active antiretroviral therapy.

Ocular surface squamous neoplasia (OSSN) and human immunodeficiency virus at Sekuru Kaguvi Eye Unit in Zimbabwe: the role of operational research studies in a resource poor environment?

OBJECTIVE

To determine the extent of association and relative risk of developing ocular surface squamous neoplasia (OSSN) among HIV positive patients seen in July 2004 at Sekuru Kaguvi Eye Unit, in Harare, Zimbabwe.

DESIGN

Prospective study.

SETTING

Sekuru Kaguvi Eye Unit.

SUBJECTS

All patients who presented with conjunctival growths in July 2004.

MAIN OUTCOME MEASURE

Relative risk.

RESULTS

The relative risk of being HIV positive among patients with ocular surface squamous neoplasia was 3.6 with 95% CI 1.5 to 8.6. The mean CD4 cell count level was significantly lower among OSSN patients when compared to patients with non-ocular surface squamous neoplasia.

RECOMMENDATIONS

1. HIV related malignancies can be used as an indicator of when to commence patients on anti-retroviral (ARVs) when CD4 counts are not accessible; 2. Medical practitioners in resource-poor settings should conduct meaningful operational research as part and parcel of their routine clinical work using available resources, since funding is not readily available.

Oxidants and ocular tumors

Serum superoxide dismutase and catalase assays were performed using spectrophotometry in 60 adults and children with benign or malignant tumors and in controls. There was a statistically significant difference in the antioxidative status of children with intraocular tumors (primary retinoblastoma) compared with children without tumors. The difference was not significant in adults. These enzymes may be of value in the early diagnosis of malignant intraocular tumor, especially retinoblastoma.

Non-cell-autonomous induction of tissue overgrowth by JNK/Ras cooperation in a Drosophila tumor model

The role of c-Jun N-terminal kinase (JNK) signaling in cancer is enigmatic, and both tumor-promoting and tumor-suppressing functions have been ascribed to JNK pathway components. We have used the Drosophila eye to investigate the function of the JNK pathway in three different tumor models of increasing malignancy. Benign lesions caused by loss of the neoplastic tumor suppressor gene scribble can efficiently be eliminated by JNK-induced apoptosis. In such a scenario, the eye reverts to a wild-type phenotype, indicating that the JNK pathway prevents tumor formation. The situation changes in the case of aggressive tissue overgrowth, which can be induced by oncogenic activation of the Ras/Raf pathway in the eye, or in malignant invasive tumors resulting when Raf activation is combined with loss of scribble. The growth of these more aggressive tumor types is significantly, yet incompletely, suppressed by JNK-mediated apoptosis. Remarkably, oncogenic Raf and JNK cooperate in these tumors, to induce massive hyperplasia in adjacent wild-type tissue. Thus, depending on the genetic context, JNK signaling can eradicate tumors by removing premalignant cells, or promote aberrant overgrowth in tissues surrounding primary lesions.

[Diseases of the lacrimal gland]

Experience with the differential diagnosis of lacrimal gland illnesses is limited in daily practice due to their rarity. It is therefore of particular importance to have guidelines for the practitioner by which he can decide on the application of conservative or surgical therapy, and whether it is necessary to take a biopsy to clarify the diagnosis. There is a wide spectrum of possible illnesses which include systemic diseases, inflammatory disorders, neoplastic, benign and malignant tumors. When a pleomorphic adenoma cannot be excluded, biopsy is contraindicated and complete tumor excision with its capsule is necessary to prevent the possibility of malignant transformation and a negative effect on long-term prognosis. In this overview, special interest is placed on the typical clinical aspects and imaging features of lesions of the lacrimal gland fossa, their differential diagnosis and management.

Neurally selected embryonic stem cells induce tumor formation after long-term survival following engraftment into the subretinal space

PURPOSE

To determine whether transplantation of embryonic stem (ES) cells into the subretinal space of rhodopsin-knockout mice has a tumorigenic effect.

METHODS

Mouse ES-cell-derived neural precursor cells carrying the sequence for the green fluorescent protein (GFP) gene were grafted subretinally into the eyes of rhodopsin(-/-) mice, whereas control animals underwent sham surgery. Eyes were retrieved after 2, 4, and 8 weeks after cell injection or sham surgery for histologic analysis.

RESULTS

Gross morphologic, histologic, and immunohistochemical analysis of eyes at 2 and 4 weeks after engraftment exhibited no morphologic alterations, whereas neoplasia formation was detected in 50% of the eyes evaluated at 8 weeks after engraftment. Because the neoplasias expressed differentiation characteristics of the different germ layers, they were considered to be teratomas. The resultant tumor formation affected almost all layers of the eye, including the retina, the vitreous, and the choroid.

CONCLUSIONS

Although ES cells may provide treatment for degenerative disease in the future, their unlimited self-renewal and high differentiation potential poses the risk of tumor induction after engraftment. Thus, more care must be taken before using ES cell transplantation as a therapeutic option for patients with degenerative disease.

Spontaneous Ocular Squamous Cell Carcinoma in Twin Goats: Pathological and Biomolecular Studies

Ocular squamous cell carcinoma (OSCC) is a well-characterized tumour occurring spontaneously in cattle and other mammalian species but not previously reported in the goat. This report describes the histological features of well-differentiated OSCCs in twin goats. Biomolecular investigations led to the identification of Papillomavirus-related DNA sequences within the neoplastic ocular parenchyma of both animals, but immunohistochemical and ultrastructural studies failed to demonstrate viral particles. A putative role of Papillomavirus in the aetiology of OSCC is discussed, together with other possible causative factors.

Cancer-related diseases of the eye: the role of calcium and calcium-binding proteins

The eye provides unique opportunities to study complex biochemical pathways and to describe how components of these pathways contribute to the molecular basis of disease. In this article, the role of calcium-binding proteins in cancer-related diseases of the eye is reviewed. First, paraneoplastic syndromes, or so-called remote effects of cancer, arise from damage to tissues distant from any tumor or its metastases. Many of these syndromes are believed to be immune-mediated. Cancer-associated retinopathy (CAR), a blinding disease due to the degeneration of retinal photoreceptor cells, is one of the best characterized of the paraneoplastic syndromes. The CAR autoantigen has been identified as recoverin, a calcium-binding protein of the EF-hand superfamily. Its features as a calcium-binding protein, along with its function in photoreceptor cells and its role as the CAR autoantigen, are discussed. Next, unlike visual symptoms instigated by a distant tumor, ocular melanoma is the primary malignancy originating in the eye. ALG-2 encodes a pro-apoptotic calcium-binding protein that is down-regulated in ocular melanoma, thus providing these tumor cells with a selective advantage. In addition to background discussion of ALG-2, data describing the expression, cellular localization, and dimerization characteristics of ALG-2 in melanoma cells are presented. Biochemical studies of ALG-2 and its interactions with its target Alix/AIP1 also are presented. Finally, the function of ALG-2 in calcium-induced cell death is discussed. Additional calcium-binding proteins in retina and in ocular tumors are described in relation to different disease entities. Such proteins and their expression in the eye provide valuable examples bridging studies of protein chemistry, cellular function, and human disease.

Ultraviolet radiation from welding and possible risk of skin and ocular malignancy

Arc welding produces the full spectrum of ultraviolet radiation (UVR). It is possible that welders are at greater risk of developing skin cancer than the general population, but there is a dearth of well designed studies in this area. The only major study of the relationship between arc welding and skin cancer risk did not reveal an increased incidence of skin cancer in welders. As the welders examined were all well protected and the length-of-exposure period was limited, the findings cannot be generalised to all welders. Studies have demonstrated that welding increases the risk of ocular melanoma. Just as we urge the public to protect themselves from UVR, we need to consider similar advice for arc welders.

Benign Mixed Tumor of the Lacrimal Gland

The accurate clinical diagnosis of benign mixed tumors of the lacrimal gland is important for the proper therapeutic management. We present an adult case with a benign mixed tumor of the orbital lobe of the lacrimal gland, 8 years after periorbital blunt injury. The tumor lesion was diagnosed later in the persisting traumatic tumefaction region. Clinical examination, ultrasonography and MRI revealed a soft-tissue mass with high density and peripheral enhancement over the superior lateral portion of the right eye with expansion to and invasion of the orbital roof and lateral wall. Lateral orbitotomy was performed to resect the tumor. Histopathology disclosed a pleomorphic adenoma of the orbital lobe of the lacrimal gland. Pleomorphic adenomas of the lacrimal gland are seen rarely. The awareness of the clinical and diagnostic features of benign mixed tumors of the orbital lobe should help to avoid complications arising from an incisional biopsy or incomplete tumor resection.

Ocular melanoma in a Long Evans rat

During a long-term study, a rat exposed to half-amplitude band pass fluorescent blue light (434 to 475 nm) and receiving a calcium channel blocker developed an ocular mass. By visual examination, a presumptive diagnosis of ocular melanoma was made. Subsequent surgical removal of the eye, followed by histopathology, confirmed the lesion as a highly pigmented epitheliod melanoma.

Incidence of ocular melanoma in Australia from 1990 to 1998

Routinely collected incidence data have often lacked specific identification of ocular melanoma in the past and with increasing diagnosis and management of this disease by noninvasive techniques may now underestimate the true incidence. We attempted to accurately measure the incidence of ocular melanoma in Australia from 1990 to 1998 using 2 population-based sources, cancer registries and ophthalmologists. We examined the distribution across the continent, by latitude and in subpopulations, and evaluated the extent of nonnotification to cancer registries. One-half (51%) of the incident cases from 1996 to 1998 were diagnosed clinically and had no tissue diagnosis. An estimated 20% of melanomas, mainly those lacking a tissue diagnosis, were not notified to Australian cancer registries, but only 1.3% were not notified by ophthalmologists. Expert reviewers agreed that a high proportion (95%) of clinically diagnosed lesions were probable or possible melanomas. Incidence was significantly higher in men than in women, especially at older ages, relatively uniform across the Australian states with only weak evidence of a latitude gradient, and higher in rural than in urban areas. The incidence of ocular melanoma in people born in Southern Europe was half and in those born in Asia only 20% of the rate in people born in Australia and New Zealand. We concluded that it was possible to identify a high proportion of cases by surveying relevant sources additional to cancer registries and to be reasonably confident of the accuracy of the clinical diagnoses. The higher incidence in older men, who probably have higher sun exposure, than in older women and in residents of rural areas, where outdoor work is more prevalent, than in urban areas; the low incidence in dark-eyed populations, who may have a lower sensitivity to or less transmission of solar radiation to the choroid; and the preferential location of ocular melanomas in ocular sites known to receive the highest exposure to solar radiation all support a role for solar radiation in the aetiology of ocular melanoma. The absence of a strong latitude gradient in incidence does not argue against such a role because exposure of the eye to solar UV is probably determined most by the horizon sky, where ambient solar UV is less affected by latitude.

Sun exposure predicts risk of ocular melanoma in Australia

Previous studies examining sun exposure and ocular melanoma have produced inconsistent results. We investigated this association in a population-based case-control study in Australia. Cases (n = 290) aged 18-79 years were diagnosed between January 1996 and July 1998. Controls (n = 893) were randomly selected from the electoral rolls and frequency-matched to cases by age, sex and state. A self-administered questionnaire and a telephone interview measured sun exposure on weekdays and weekends at 10, 20, 30 and 40 years of age and over the whole of life for specific jobs and recreations. Multivariate logistic regression models of ocular melanoma and sun exposure contained age, sex, region of birth, eye color and measures of ocular and cutaneous sun sensitivity as covariates. Choroid and ciliary body melanoma (n = 246) was positively associated with time outdoors on weekdays and, less persuasively, total time outdoors but not ambient solar irradiance. Odds ratios increased with increasing exposure to OR 1.8 (95% confidence interval 1.1-2.8) for the highest quarter of sun exposure on weekdays up to 40 years of age for men and women together. The strongest positive associations were for total exposure up to 40 years of age, lifetime occupational exposure and total exposure at about 20 years of age in men; all had odds ratios between 2 and 3 in the highest exposure categories. There was inconclusive evidence for an association between sun exposure and iris (n = 25) or conjunctival (n = 19) melanomas. Sun exposure is an independent risk factor for choroidal and ciliary body melanoma in Australia.

Vision-threatening complications of nasal T/NK lymphoma

PURPOSE

Nasal T/NK lineage lymphoma, previously known as lethal midline granuloma, is common among Oriental, Native-American, and Hispanic patients and is invariably associated with Epstein-Barr virus. Nasal localization, local necrosis, angioinvasion, and aggressive behavior are hallmarks of the disease. Ophthalmologic symptoms and signs may precede lymphoma diagnosis or complicate its disease course. We aim to define the incidence and disease pattern of ophthalmic involvement.

DESIGN

Retrospective single-institution consecutive interventional case series.

METHODS

Records of all lymphoma patients from 1996 to 2000 were retrieved from a computer database, and the primary sites and lineage were reviewed. Nasal T/NK lymphoma was defined by a combination of morphology, positive CD3 epsilon and CD56 expression, in situ hybridization staining for Epstein-Barr virus expressed RNA (EBER), and negative staining for B cell markers (CD20 and CD79a).

RESULTS

Thirty-five consecutive patients with T/NK lymphoma were identified. Primary nasal or nasopharyngeal disease was found in 24 patients. Six (25%) of the 24 patients suffered from vision-threatening complications of two distinct categories, namely uveitis/vitritis and orbital infiltration. The former preceded the diagnosis of lymphoma in two patients and also led to novel ocular complications like rhegmatogenous retinal detachment and macular hole that were successfully managed by ocular surgery. In four patients, orbital extension of lymphomatous disease accompanied biopsy-proven in-field disease relapse. Generally, the prognosis is grave, but remission can still be achieved with aggressive combined chemotherapy and radiotherapy.

CONCLUSION

Both oncologists and ophthalmologists should be aware of ocular complications when dealing with known or suspected cases of T/NK lymphoma at diagnosis and relapse. Regular ophthalmic assessment of these patients is warranted.

Causes of uveitis in dogs: 102 cases (1989-2000)

Uveitis is one of the most common ocular diseases and one of the most common causes of blindness in dogs. The purpose of this retrospective study was to correlate the signalment, history, clinical signs and ophthalmic findings of dogs with uveitis with the underlying etiology. We conducted a retrospective study of 102 dogs presented to the NCSU-VTH from 1989 to 2000 with clinical signs of uveitis. Medical records of dogs presented for uveitis were reviewed. Dogs were included in the study only if a complete diagnostic work-up database was collected, if sufficient follow-up was documented, and if the uveitis was not secondary to trauma or a hypermature cataract. The mean age +/- SD of all dogs in this study was 6.2 +/- 3.6 years. There were 33 intact and 16 castrated males, and 14 intact and 27 neutered females. Fourteen breeds were represented, with the Golden Retriever (n = 14) most common. Fifty-nine dogs (58%) were diagnosed with idiopathic/immune-mediated uveitis, neoplasia was diagnosed in 25 dogs (24.5%) and 18 dogs (17.6%) were diagnosed with infectious causes of uveitis. Aqueous flare was the most common clinical sign, occurring in 88 dogs (86%). The most common infectious organisms associated with uveitis in the dogs of this study were Ehrlichia canis (n = 7). Lymphosarcoma (n = 17) was the most common neoplasm. In approximately 60% of dogs presenting for uveitis an underlying cause was not found, and a diagnosis of immune-mediated or idiopathic uveitis was made. However, approximately 25% of dogs had ocular and/or systemic neoplasia (with 17% of cases having lymphosarcoma) and 18% with an underlying infectious cause for uveitis. Because of the high percentage of systemic disease associated with uveitis in dogs, extensive diagnostic testing is recommended before instituting symptomatic anti-inflammatory therapy.

Cancer transmission through corneal transplantation

PURPOSE

A retrospective study to demonstrate the safety of corneas from donors affected by systemic malignancies in a view of keratoplasty.

METHODS

Using the data of the cancer registry department in a district of 500,000 residents, we analyzed retrospectively 143 patients followed up in the same region and transplanted between 1987 and 1995. We compared the incidence of cancer in recipients of cornea coming from donors with malignancies with recipients of cornea from donors without malignancies. The rate of cancer in this population was also compared with the incidence of cancer in the general population at the same age.

RESULTS

Eleven patients (7%) were excluded from the study, eight of them for the presence of cancer in their medical history before surgery and the three others because of lack of information about their follow-up after surgery. Forty patients received corneas from cancerous donors and 103 from donors without cancer. Six patients developed malignancies between 1 and 4 years after transplantation, and only one of them received a cornea from a donor with a systemic malignancy. This recipient developed a different type of cancer from that of the donor. The five other patients received corneas from donors without systemic malignancies. By comparing theses results, there was no relationship between the occurrence of malignancies and transplantation of corneas from cancerous donors (relative risk = 0.49, 95% confidence interval = 0.01-13.62).

CONCLUSION

There was no increased incidence of cancer in our patient population compared with reference population. Based on this study, there is no statistical or clinical evidence to suggest the transmission of cancer from donors with malignancies via corneal transplantation, according to the accepted criteria of donor selection.

Molecular analysis of mucosa-associated lymphoid tissue (MALT) lymphoma of ocular adnexa

Lymphomas of mucosa-associated lymphoid tissue (MALT) are a distinct subgroup of extranodal B-cell non-Hodgkin's lymphomas. Most studies have failed to demonstrate the clonal rearrangement of BCL-1, BCL-2 or c-MYC genes for MALT lymphomas. Further, alteration of the p53 gene is rarely demonstrated in low-grade MALT lymphomas, but can be detected in high-grade disease. Lymphomas of the ocular adnexa represent approximately eight percent of all extranodal lymphomas, most of which are MALT lymphomas, but few studies had explored the alterations of BCL-1, BCL-2, c-MYC and p53 genes specifically for ocular MALT lymphomas. We investigated the changes to BCL-1, BCL-2, c-MYC and p53 genes in these lymphomas for Taiwanese patients. Clonal rearrangement for immunoglobulin heavy-chain (IgH), BCL-1, BCL-2, c-MYC and p53 genes was examined for 16 cases of ocular MALT lymphoma. Restriction-length polymorphism and polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) of the DNA, corresponding to exons 5 through 9, followed by DNA sequencing, were utilized to analyze the possible mutations of the p53 gene for these tumors. Thirteen of the cases revealed rearranged IgH genes using Southern blotting or PCR. No rearrangement of BCL-1, BCL-2, c-MYC or p53 genes was discovered, with point mutation of the p53 gene in one case. As for other types of MALT lymphomas, BCL-1, BCL-2 and c-MYC genes are not implicated in the pathogenesis of the ocular sub-group. Although alteration of the p53 gene is rare for low-grade ocular MALT lymphoma, its role in disease progression merits further research.

Posttraumatic benign pleomorphic adenoma of the lacrimal gland

A 55-year-old man presented with a painless and slowly developing mass in the right superior lateral eyelid region. He had sustained periorbital blunt injury about 4 years previously. The mass was observed several months later in the persisting traumatic tumefaction region. Computed tomography showed a cystic soft-tissue mass with central low density and peripheral enhancement over the upper anterior quadrant of the right orbit. Lateral orbitotomy was performed to remove the lesion. Histopathologic examination showed proliferation of epithelial and myoepithelial cells arranged in ductules and nests in the myxoid stroma. Benign pleomorphic adenoma of the lacrimal gland associated with traumatic tumefaction, as demonstrated in our patient, may be rare.

Amelanotic corneal melanoma after a blast injury

PURPOSE

To report a case of a corneal melanoma after trauma.

METHODS

Case report.

RESULTS

A 68-year-old man sustained an ocular injury from a blast furnace explosion in 1958. In 1998, he underwent a penetrating keratoplasty for a corneal scar. Histologic examination and cell markers of the host button revealed intrastromal and subepithelial melanoma. No clinical or microscopic evidence of adjacent conjunctival or uveal melanoma was found.

CONCLUSION

Melanoma of the cornea can present as a stromal opacity after trauma.

Eye color and cutaneous nevi predict risk of ocular melanoma in Australia

Ethnicity, cutaneous nevi and eye color are generally accepted risk factors for melanoma of the eye, although case-control studies have produced conflicting results. We sought to determine the constitutional risk factors for melanomas of the choroid, ciliary body, iris and conjunctiva in Australia. A population-based case-control study was conducted, with case ascertainment from a prospective national incidence survey and randomly selected community controls. Two hundred and ninety cases aged 18-79 years and diagnosed between 1st January 1996 and 31st July 1998 were enrolled with 916 controls frequency matched by age, sex and State or Territory of residence. Risk of choroidal and ciliary body melanoma (n = 246) was increased in people with grey (OR 2.9, 95% CI 1.5-5.5), hazel (OR 2.2, 95% CI 1.4-3.7) and blue eyes (OR 1.7, 95% CI 1.0-2.7) compared with brown eyes. Risk was also increased in those with 4 or more nevi on their back, those unable to tan, and those who squinted when outdoors as a child. Risk was reduced in people born other than in Australia and New Zealand (OR 0.7, 95% CI 0.5-1.0). Non-brown eye color was a risk factor for iris melanoma (n = 25). No risk factors were identified for conjunctival melanoma (n = 19). Eye color is the strongest constitutional predictor of choroidal and ciliary body melanoma, and may indicate a protective effect of melanin density at these sites. An independent association with cutaneous nevi suggests a role for other genetic factors.

[A case of malignant melanoma occurring 63 years after evisceration]

BACKGROUND

We report a rare case of a 69-year-old woman with malignant melanoma of her right socket, who had undergone evisceration of her right globe for unknown reasons at the age of 6.

CASE

A 69-year-old woman presented with the complaint of inability to keep the prosthesis in her socket. A large blackish brown mass was seen behind the eyelids, and biopsy of this tissue revealed a mixed type malignant melanoma. A right exenteration was performed and histopathologic examination demonstrated a large tumor mass anterior and adjacent to the remains of the eviscerated globe.

CONCLUSION

During evisceration, uveal pigment may be incompletely removed from the globe, or may be inadvertently scattered in the orbit. This case may demonstrate the development of a malignant melanoma from the uvea of an eviscerated globe. We recommend that careful long-term follow-up be performed on patients who have undergone evisceration.

[Eye involvement in AIDS-related Kaposi sarcoma]

BACKGROUND

The study evaluates the incidence of ocular compromise in the Kaposi's sarcoma associated with AIDS.

METHODS

We revised the clinical histories of HIV seropositives patients seen in the ophthalmology department from January, 1994 to December, 1998. All patients were examined by direct visually and dilated fundus examination with the use of either a direct or an indirect ophthalmoscope.

RESULTS

In 6,552 patients, ocular Kaposi's sarcoma was diagnosed in 17 (0.25%), predominantly in male sex (88.23%). The lesions predominated in eyelids, and the inferior has been the most affected. In only one female, the ocular compromise was the first neoplastic manifestation.

CONCLUSIONS

The ocular compromise in the Kaposi's sarcoma is an alternative to be considered in AIDS patients with previous or simultaneous cutaneous or visceral involvement. Due to the few clinical signs of these lesions, a thorough ocular study is recommended in these patients.

Cellular origins of ultraviolet radiation-induced corneal tumours in the grey, short-tailed South American opossum (Monodelphis domestica)

Corneal tumours were induced in almost 100% of grey, short-tailed South American opossums (Monodelphis domestica) exposed three times weekly to ultraviolet radiation (UVR) for periods of a year or more. Five tumours, representing the morphological spectrum of UVR-induced corneal tumours (two fibrosarcomas, one malignant fibrous histiocytoma, one putative haemangiosarcoma, and one squamous cell carcinoma overlying a sarcoma), were assayed immunohistochemically for reactivity with antibodies against the intermediate filaments vimentin, smooth muscle actin (alpha isoform), muscle-specific actins (alpha and gamma isoforms), desmin and cytokeratin, and with antibodies against the vascular endothelial marker von Willebrand factor. The squamous cell carcinoma was cytokeratin-positive. Other tumours were cytokeratin-negative and vimentin-positive. Three tumours had scattered individual cells and groups of cells immunoreactive with antibodies against smooth muscle actin and muscle-specific actins; two tumours (a fibrosarcoma and the malignant fibrous histiocytoma) had small numbers of desmin-positive cells. The putative haemangiosarcoma contained two populations of neoplastic cells, von Willebrand factor-positive vascular endothelial cells and smooth muscle actin-positive spindle cells. It was concluded (1) that UVR-induced corneal tumours may be composed of cells derived from resident epithelial cells, immigrant vascular endothelial cells, or fibroblast-like cells of unknown origin, and (2) that such tumours may contain more than one neoplastic cell type.

Radium-induced eye melanomas in dogs

The intraocular radiotoxicity of intravenously injected 226Ra and 228Ra was studied in beagle dogs. Approximately 0.071% of injected radium was retained in each eye of beagles following intravenous administration. The retention was principally in the tapetum and the intraocular pigmented structures where significant pigmentary lesions were produced. These included melanotic plaques on the iris, melanosis of the ciliary body, varying degrees of tapetal degeneration, and intraocular melanomas. The tumors occurred principally in the ciliary body and to a much lesser extent in the iris. They appeared to arise from the pigment epithelium layer of the ciliary body. Thus, unlike melanomas arising in other sites, they are apparently not of neural crest origin. In addition to bone cancer, they represent another radium-induced neoplasm in beagles. Radium-induced intraocular melanomas have not been reported in people.

Photobiology of Monodelphis domestica

The gray, short-tailed opossum, Monodelphis domestica, has been used for photobiologic studies since 1984. The presence of a light-activated DNA repair pathway in the tissues of Monodelphis has been used to identify pyrimidine dimers in DNA as initiating events for a number of ultraviolet radiation (UVR)-induced pathologies of the skin and cornea. Furthermore, Monodelphis, unlike common laboratory rodents, is susceptible to the induction of melanoma by UVR alone.

Molecular genetic alterations and viral presence in ophthalmic pterygium

Pterygium is a lesion of the corneoscleral limbus which tends to grow in size, often recurs after surgical excision and is associated with exposure to solar light. Additionally, a family history is frequently reported. Loss of heterozygosity (LOH), increased P53 expression and the presence of oncogenic viruses, such as human papilloma virus (HPV) and herpes simplex virus (HSV), have been detected in pterygia, supporting the possible neoplastic nature of the lesion. Co-infection by HSV and HPV as well as LOH at some loci have also been correlated with clinical features, such as postoperative recurrence and history of conjunctivitis. A possible model of pterygium formation is proposed, in which genetic predisposition, environmental factors and viral infection(s) participate in a multi-step process. Future research may lead to new ways of pterygium treatment such as anti-viral or gene therapy.

T-cell lymphoproliferative disorder of vitreous associated with mycosis fungoides

59-year-old man with a history of mycosis fungoides developed loss of visual acuity and visual field in the left eye. Epiretinal lesions were present in the right eye and multifocal choroidal lesions, optic disc edema, and vitritis were present in the left eye. A diagnostic vitrectomy was performed and cytologic examination of the vitreous confirmed the diagnosis of T-cell lymphoproliferative disorder. Systemic and intrathecal chemotherapy resulted in marked improvement in ocular signs and symptoms. At last follow-up, the patient was found to have improved visual acuity in the left eye; however, significant worsening of his systemic condition developed and he died shortly thereafter.