Table of Contents
1
UI - 11801498
AU - Zamir E; Mechoulam H; Micera A; Levi-Schaffer F; Pe'er J
TI -
Inflamed juvenile conjunctival naevus: clinicopathological
characterisation.
SO - Br J Ophthalmol 2002 Jan;86(1):28-30
AIM: Inflamed juvenile conjunctival naevi (IJCN) are often erroneously
suspected to be malignant because of rapid growth. Their clinical and
histopathological features have not been characterised in series of
patients. The aim of the study is to characterise IJCN clinically and
histopathologically. METHODS: This is a retrospective non-randomised
clinicopathological study. All patients younger than 20 years with
conjunctival naevi which were excised between 1990 and 2000 were
included. The clinical signs of the affected patients and the
histopathological findings of the excised lesions were characterised.
RESULTS: A total of 63 conjunctival naevi were resected. 25% of the
patients had simple compound conjunctival naevi and 75% had compound
naevi with prominent inflammatory histological features (discrete
lymphocyte aggregates, plasma cells, and eosinophils). Epithelial cysts
and solid epithelial islands were common in the IJCN. The IJCN were all
located at or near the limbus, and characterised by recurrent periods of
congestion and growth. 75% of the IJCN patients with complete medical
records had a history of allergic disease. Marked conjunctival papillary
reaction was present in all of the patients, indicating a possible
conjunctival allergy. CONCLUSIONS: IJCN is a unique entity, different
from simple compound conjunctival naevus. Its association with allergic
conjunctivitis is suggestive, and despite periods of alarmingly rapid
growth, is histologically benign.
2
UI - 11801499
AU - Kemp EG; Harnett AN; Chatterjee S
TI -
Preoperative topical and intraoperative local mitomycin C adjuvant
therapy in the management of ocular surface neoplasias.
SO - Br J Ophthalmol 2002 Jan;86(1):31-4
AIMS: To demonstrate the efficacy of mitomycin C as adjuvant therapy
preoperatively and intraoperatively in the management of recurrent or
diffuse ocular surface neoplasias. METHODS: The case notes of 11
patients receiving mitomycin C adjuvant therapy as 0.04% eye drops four
times a day in two weekly courses preoperatively and/or a single
intraoperative application of 0.4 mg/ml of mitomycin C were reviewed.
The histopathology included conjunctival primary acquired melanosis,
conjunctival melanomas, sebaceous cell carcinomas with conjunctival
intraepithelial spread, and conjunctival intraepithelial squamous
neoplasias. Seven patients had additional limited local excision of the
residual tumour mass and one had cryotherapy. RESULTS: All cases showed
a favourable response to mitomycin C adjuvant therapy with regression in
size or retardation of a rapid growth pattern and no serious sequelae.
Postoperative follow up of 6-36 months following excision of the lesion
with or without intraoperative mitomycin C showed no clinical recurrence
in any of the cases. CONCLUSION: In this series, mitomycin C adjuvant
therapy of recurrent or diffuse ocular surface neoplasias was well
tolerated and showed favourable clinical results.
3
UI - 11827005
AU - van Ruyven RL; Mooy CM; Dinjens WN; van den Bosch WA; Paridaens AD
TI -
Ptois as presenting sign of metastatic skin melanoma.
SO - Eye 2001 Dec;15(Pt 6):790-1
4
UI - 11827017
AU - Gupta M; Puri P; Rennie IG
TI -
Iris seeding following iridocyclectomy for localised iris melanoma.
SO - Eye 2001 Dec;15(Pt 6):808-9
5
UI - 11825800
AU - Shields CL; Shields JA; Perez N; Singh AD; Cater J
TI -
Primary transpupillary thermotherapy for small choroidal melanoma in 256
consecutive cases: outcomes and limitations.
SO - Ophthalmology 2002 Feb;109(2):225-34
AD - Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson
University, Philadelphia, Pennsylvania 19107, USA.
OBJECTIVE: The objective of this report was to evaluate ocular and
systemic outcomes after primary transpupillary thermotherapy for
choroidal melanoma and to identify the limitations of this treatment
method. DESIGN: Noncomparative interventional case series. PARTICIPANTS:
The participants included 256 patients with newly diagnosed choroidal
melanoma. MAIN OUTCOME MEASURES: The outcome measures included local
tumor recurrence and visual acuity. RESULTS: Before treatment, the mean
tumor base was 7.1 mm, and mean tumor thickness was 2.7 mm. Overlying
subretinal fluid was present in 215 cases (84%) and orange pigment on
the tumor surface in 200 cases (78%). All tumors showed either
photographic documentation of growth (114 cases; 45%) or substantial
risk factors for growth (142 cases; 55%). After a mean of three
treatment sessions, complete tumor control without recurrence was found
in 232 cases (91%) and recurrence in 24 cases (9%). The mean time to
recurrence was 22 months, and the mean recurrent tumor size was 3.8 mm
base and 2.4 mm thick. Of the recurrent tumors, additional thermotherapy
was successful in controlling 13 (5%), plaque radiotherapy in 8 (3%),
and enucleation in 3 (1%). Using multivariable analysis, the risk
factors for tumor recurrence included increasing number of thermotherapy
sessions (reflecting less responsive tumor) (P = 0.0001) and optic disc
overhung by tumor (P = 0.03). Kaplan Meier estimates revealed that 4%
showed recurrence at 1 year, 12% at 2 years, and 22% at 3 years
follow-up. When analyzing those 214 patients without multivariable risk
factors for recurrence, Kaplan Meier estimates for recurrence were 2% at
1 year, 8% at 2 years, and 10% at 3 years. The visual acuity after
treatment was 20/20 to 20/40 in 128 cases (50%), 20/50 to 20/100 in 47
(18%), and 20/200 or worse in 81 (32%). Using multivariable analysis,
the most statistically significant factors at initial visit that were
predictive of poor visual acuity (20/200 or worse) after treatment
included documented tumor growth before treatment (P = 0.0001), mushroom
tumor configuration (P = 0.002), initial symptom of blurred vision (P =
0.008), poor initial visual acuity (P = 0.005), superior quadrant tumor
location (P = 0.03), underlying diabetes mellitus (P = 0.04), and optic
disc overhung by tumor (P = 0.04). Tumor-related mortality occurred in
two patients (1%), one of whom showed complete tumor regression to
thermotherapy and the other with diffuse choroidal melanoma and local
tumor margin recurrence. CONCLUSIONS: Transpupillary thermotherapy is an
effective treatment for certain small choroidal melanomas. Appropriate
tumor selection is critical to successful treatment. Patients with
tumors abutting or overhanging the optic disc or those requiring more
than three sessions for tumor control are more likely to develop
ultimate tumor recurrence. Transpupillary thermotherapy can cause
damaging effects to the retina, leading to visual loss shortly after
treatment.
6
UI - 11825801
AU - Bechrakis NE; Foerster MH; Bornfeld N
TI -
Biopsy in indeterminate intraocular tumors.
SO - Ophthalmology 2002 Feb;109(2):235-42
AD - Department of Ophthalmology, Universitatsklinikum Benjamin Franklin,
Freie Universitat Berlin, Berlin, Germany.
bechrakis@medizin.fu-berlin.de
OBJECTIVE: To describe an intraocular biopsy technique that allows
accurate histopathologic diagnosis in cases of clinically unclassifiable
uveal tumors. DESIGN: Retrospective noncomparative consecutive
interventional case series. PARTICIPANTS/METHODS: Intraocular biopsies
were performed by a vitreous cutter either by a two-port clear cornea
approach in 11 patients with unclassifiable iris tumors or by a
three-port pars plana vitrectomy in 23 patients with unclassifiable
choroidal tumors. Specimens were formalin fixed and paraffin processed.
Hematoxylin-eosin and periodic acid-Schiff stains were performed in all
cases, with additional immunohistochemical stains using the alkaline
phosphatase, antialkaline phosphatase method in cases that could not be
conventionally classified. MAIN OUTCOME MEASURES: Clinical observation
and histopathologic examination of intraocular biopsies. RESULTS: In 97%
of cases (n = 33) a definite diagnosis could be established by the
biopsy specimen. A melanoma could be diagnosed in 73% of cases (n = 8)
of iris tumors and in 57% of cases (n = 13) of posterior intraocular
tumors. Other diagnoses included nevus, metastasis, vasoproliferative
tumor, hemorrhage, gliosis, and scleritis. Complications were
encountered in four cases: a vitreous hemorrhage occurred twice, an
inconclusive biopsy result, and an intraocular tumor spread occurred
once, respectively. No increased tumor-related mortality was observed
after a mean follow-up of 44 months. CONCLUSIONS: Intraocular biopsy by
a vitreous cutter allows the histopathologic examination of
formalin-fixed paraffin-embedded tumor tissue. This increases the
diagnostic accuracy, avoiding the risk of extraocular tumor spread seen
with transscleral biopsy techniques.
7
UI - 11812429
AU - Brantley MA Jr; Worley L; Harbour JW
TI -
Altered expression of Rb and p53 in uveal melanomas following plaque
radiotherapy.
SO - Am J Ophthalmol 2002 Feb;133(2):242-8
AD - Center for Ocular Oncology, Department of Ophthalmology and Visual
Sciences and Division of Molecular Oncology, Washington University
School of Medicine, St. Louis, Missouri 63110, USA.
PURPOSE: To examine the expression of proteins in the Rb and p53 tumor
suppressor pathways in uveal melanomas following plaque radiotherapy.
METHODS: Immunohistochemistry and cell culture studies.
Immunohistochemistry for Rb, p16, cyclin D1, p53, HDM2, and Bcl-2 was
performed on twelve eyes containing posterior uveal melanomas that were
enucleated following plaque radiotherapy. Cell culture studies were
performed in three cases. RESULTS: The irradiated eyes were enucleated
for radiation complications (five cases), local tumor recurrence (three
cases), and other reasons (four cases). On histopathologic examination,
all cases showed evidence of tumor cell loss. However, residual tumor
cells were present in all cases, including those that were clinically
regressed. Residual cells from three of the clinically regressed cases
were cultured and demonstrated minimal cell division, marked cell death,
and extensive chromosomal damage. Strong p53 staining was observed in
six cases (50%) and was significantly associated with recent
radiotherapy (P = .04). Abnormal cytoplasmic staining for Rb was
observed in four cases (33%). CONCLUSIONS: Plaque radiotherapy of uveal
melanomas induces DNA damage, inhibits cell division, and promotes cell
death. These changes may be due, at least in part, to induction of p53,
which activates genes involved in both cell cycle arrest and apoptosis.
Plaque radiotherapy can also cause alterations in the expression of Rb,
but the significance of this finding will require further study.
8
UI - 11812446
AU - Shields JA; Eagle RC Jr; Shields CL; Nelson LB
TI -
Progressive growth of an iris melanocytoma in a child.
SO - Am J Ophthalmol 2002 Feb;133(2):287-9
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, Pennsylvania 19107, USA. jerry.shields@shieldsoncology.com
PURPOSE: To document progressive growth of a benign iris melanocytoma.
METHODS: Interventional case report. A 9-year-old male underwent removal
of a pigmented iris tumor that had been documented photographically to
double in size. RESULTS: Histopathologic sections revealed a deeply
pigmented mass with cytologic features typical of a melanocytoma.
CONCLUSION: Although iris melanocytoma is generally a stationary lesion,
it can show progressive growth. Such enlargement does not necessarily
imply malignant transformation of the lesion.
9
UI - 11642368
AU - Robertson DM
TI -
Melanoma endoresection: a perspective.
SO - Retina 2001;21(5):403-7
10
UI - 11642372
AU - Garcia-Arumi J; Sararols L; Martinez V; Corcostegui B
TI -
Vitreoretinal surgery and endoresection in high posterior choroidal
melanomas.
SO - Retina 2001;21(5):445-52
AD - Hospital Vall d'Hebron, Universidad Autonoma de Barcelona, Spain.
17215jga@comb.es
PURPOSE: Eyes with posterior choroidal melanomas more than 9 mm in
thickness frequently are enucleated because of the potential
complications of radiotherapy. The aim of this study was to evaluate the
safety and efficacy of internal resection of these tumors. METHODS:
Twenty-five consecutive patients with high posterior choroidal melanomas
with a diameter less than 15 mm and a thickness greater than 9 mm were
treated. If the retina was not invaded by the tumor, a vitrectomy was
performed, followed by posterior hyaloid dissection, 120 degrees
anterior retinotomy, endophotocoagulation 2 mm past the tumor margin,
melanoma removal with the vitrectomy probe, retinal reattachment with
liquid perfluorocarbon and air, and silicone oil exchange. If the tumor
invaded the retina, the laser was applied through the retina, and the
retina and tumor were removed together. RESULTS: The mean patient age
was 46.6 years. The tumor thicknesses ranged from 9.1 to 12.8 mm, and
the tumor diameter ranged from 8.9 to 14.8 mm. The mean preoperative
visual acuity was 20/60. In 11 patients, the tumor had invaded the
retina. We removed the entire tumor from all 25 eyes. The main
postoperative complications were cataract (40%), retinal detachment
(16%), macular traction (16%), and epiretinal macular proliferation
(8%). The mean postoperative visual acuity was 20/100. No tumors
recurred, and there was no evidence of metastasis. The follow-up ranged
from 12 to 72 months. CONCLUSIONS: These data suggest that internal
resection of high posterior melanomas may conserve ocular and functional
vision and does not seem to increase the risk of metastatic disease.
Longer follow-up is necessary to establish the safety of the procedure.
11
UI - 11642395
AU - Shields JA; Eagle RC Jr; Shields CL; Singh AD; Sarin LK
TI -
Diffuse uveal melanoma presenting as an amelanotic cystic epibulbar
lesion.
SO - Retina 2001;21(5):550-3
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, Pennsylvania 19107, USA.
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