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A case of melanocytomalytic glaucoma. J Fr Ophtalmol 2022; 45:e252-e253. [DOI: 10.1016/j.jfo.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
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2
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Sia DIT, Agi J, Grewal P, Russell L, Weis E. Two Cases of Giant Melanocytoma (Hyperpigmented Magnocellular Nevus). Ocul Oncol Pathol 2020; 6:344-352. [PMID: 33123528 DOI: 10.1159/000507399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022] Open
Abstract
Melanocytoma or hyperpigmented magnocellular nevus is a variant of melanocytic nevus that is most commonly seen in the optic nerve, but has also been reported to occur in the iris, ciliary body, choroid, sclera, and conjunctiva. We present two cases of giant uveal melanocytoma with histopathology. The first case occurred in a 10-year-old girl who presented with decreased vision in the right eye and a mushroom-shaped pigmented choroidal lesion measuring 15.5 mm in apical height. The lesion was abutting the lens but not causing a cataract. This was diagnosed as a choroidal melanocytoma on open scleral window biopsy. The second case was in a 68-year-old lady, referred for a left nasal pigmented choroidal lesion measuring 8 mm in apical height and having a mushroom configuration. The lesion grew to 8.6 mm in height and was complicated by a vitreous hemorrhage and rhegmatogenous retinal detachment and was treated with iodine-125 plaque brachytherapy. Subsequently, the treated eye became a painful phthisical eye and was enucleated. Histopathology confirmed melanocytoma with extrascleral extension but without malignant transformation. Features of melanocytoma and other very large cases reported in the literature are discussed.
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Affiliation(s)
- David I T Sia
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jorge Agi
- Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Alberta, Canada
| | - Parampal Grewal
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Laurie Russell
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ezekiel Weis
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Calgary, Calgary, Alberta, Canada
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Shanmugam PM, Sofi IA, Sagar P, Konana VK, Ramanjulu R. Vitrectomy as a treatment modality in vitreous seeding secondary to ciliary body melanocytoma. Indian J Ophthalmol 2019; 67:2083-2085. [PMID: 31755468 PMCID: PMC6896563 DOI: 10.4103/ijo.ijo_439_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Melanocytoma is a locally invasive intraocular tumor usually located in the optic nerve head, iris, ciliary body and choroid. Melanocytoma can undergo necrosis and lead to pigment dispersion. We report a case of melanocytoma of the ciliary body with vitreous seeds filling the vitreous cavity. A sub conjunctival pigmented lesion was seen due to extra scleral extension of the tumor. The diagnosis of melanocytoma was confirmed by biopsy of the sub conjunctival lesion. Pars plana vitrectomy was performed to clear the vitreous cavity with good visual recovery.
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Affiliation(s)
- P Mahesh Shanmugam
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Ishfaq A Sofi
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Pradeep Sagar
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Vinaya K Konana
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - Rajesh Ramanjulu
- Department of Vitreo-Retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
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Abstract
PURPOSE OF REVIEW Glaucoma secondary to intraocular tumors is important to consider in eyes with a known tumor and those with unilateral or refractory glaucoma. The purpose of this review is to discuss the mechanisms and management of intraocular tumors with related secondary glaucoma. RECENT FINDINGS Several intraocular tumors can lead to glaucoma, including iris melanoma, iris metastasis, iris lymphoma, trabecular meshwork melanoma, choroidal melanoma, choroidal metastasis, retinoblastoma, and medulloepithelioma. The mechanisms for glaucoma include solid tumor invasion into the angle, tumor seeding into the angle, angle closure, and iris neovascularization. Management of the tumor can lead to resolution of glaucoma. Management of the secondary glaucoma may involve medical therapy, transscleral cyclophotocoagulation, laser trabeculoplasty, and potentially antivascular endothelial growth factor therapy. Minimally invasive glaucoma surgery (MIGS) can be considered for eyes with treated, regressed posterior segment malignancies if there is no iris or ciliary body involvement. Importantly, avoidance of MIGS, filtering, or shunting surgery in eyes with active malignancies is emphasized. SUMMARY Intraocular tumors can produce secondary glaucoma. Treatment of the primary tumor can sometimes resolve the glaucoma. Topical, oral, or laser therapies can be considered. Avoidance of MIGS, filtering, or shunting surgery is advised until the malignancy is completely regressed.
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Rapidly growing iris melanocytoma with secondary glaucoma in a 6-year-old child. Eur J Ophthalmol 2016; 26:e71-3. [PMID: 26692065 DOI: 10.5301/ejo.5000726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe an unusual case of pediatric iris melanocytoma with pigment dispersion glaucoma that resolved after resection of the primary tumor. METHODS Retrospective case review of the clinical record, ultrasonographic images, and histopathology. RESULTS A 6-year-old Asian girl, with a dark iris tumor, pigment dispersion, and secondary glaucoma, was initially treated with topical antiglaucoma medication and observation. Rapid growth prompted biopsy, revealing melanocytoma. As the tumor continued to grow, excision of the primary tumor was performed. Surgery proved curative in that the pigment dispersion slowly reabsorbed and her glaucoma resolved. CONCLUSIONS In this case, rapid growth did not indicate malignant transformation. Initial observation for growth and judiciously timed surgical intervention prevented progression, loss of vision, and potentially the loss of the eye.
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6
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Nishiya AT, Massoco CO, Felizzola CR, Perlmann E, Batschinski K, Tedardi MV, Garcia JS, Mendonça PP, Teixeira TF, Zaidan Dagli ML. Comparative Aspects of Canine Melanoma. Vet Sci 2016; 3:vetsci3010007. [PMID: 29056717 PMCID: PMC5644618 DOI: 10.3390/vetsci3010007] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
Melanomas are malignant neoplasms originating from melanocytes. They occur in most animal species, but the dog is considered the best animal model for the disease. Melanomas in dogs are most frequently found in the buccal cavity, but the skin, eyes, and digits are other common locations for these neoplasms. The aim of this review is to report etiological, epidemiological, pathological, and molecular aspects of melanomas in dogs. Furthermore, the particular biological behaviors of these tumors in the different body locations are shown. Insights into the therapeutic approaches are described. Surgery, chemotherapy, radiotherapy, immunotherapy, and the outcomes after these treatments are presented. New therapeutic perspectives are also depicted. All efforts are geared toward better characterization and control of malignant melanomas in dogs, for the benefit of these companion animals, and also in an attempt to benefit the treatment of human melanomas.
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Affiliation(s)
- Adriana Tomoko Nishiya
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Cristina Oliveira Massoco
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Claudia Ronca Felizzola
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
- Surgical Oncology Rua Antônio Alves Magan, 124, CEP 01251-150, São Paulo, Brazil.
| | - Eduardo Perlmann
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, CEP 05508-270, São Paulo, Brazil.
| | - Karen Batschinski
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Marcello Vannucci Tedardi
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Jéssica Soares Garcia
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Priscila Pedra Mendonça
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, CEP 05508-270, São Paulo, Brazil.
| | - Tarso Felipe Teixeira
- Pathology Veterinary Medicine, FEPI Itajubá University Center, Dr. Antonio Braga Filho Street, 687, Itajubá, 37.501-002 Minas Gerais, Brazil.
| | - Maria Lucia Zaidan Dagli
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
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Lad EM, Cousins SW, Proia AD. Identity of pigmented subretinal cells in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2016; 254:1239-41. [PMID: 26728757 DOI: 10.1007/s00417-015-3249-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, DUMC 3802, Durham, NC, 27710, USA.
| | - Scott W Cousins
- Department of Ophthalmology, Duke University Medical Center, DUMC 3802, Durham, NC, 27710, USA
| | - Alan D Proia
- Department of Ophthalmology, Duke University Medical Center, DUMC 3802, Durham, NC, 27710, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA
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Awaji S, Alkatan H, Al-Kharashi S, Al-Rajhi A. Iris melanocytoma in child diagnosed by fine needle aspiration biopsy. Saudi J Ophthalmol 2013; 27:277-80. [PMID: 24371424 DOI: 10.1016/j.sjopt.2013.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/19/2013] [Accepted: 07/29/2013] [Indexed: 02/01/2023] Open
Abstract
We report a case of large iris melanocytoma in a child diagnosed by fine needle aspiration biopsy. In this interventional case report, cytologic features typical of melanocytoma were obtained by fine needle aspiration biopsy (FNAB). FNAB can be used in difficult diagnostic cases if a good sample is obtained, this technique has an accuracy of more than 99% in tumors larger than 3 mm; however, false-negative and false-positive results may be obtained. Its risk of local spread is very small, an advantage over incisional biopsy. The most common complication is intralesional hemorrhage and hyphema.
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Affiliation(s)
- Samira Awaji
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind Alkatan
- Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Soliman Al-Kharashi
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ali Al-Rajhi
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Rennie IG. Don't it make my blue eyes brown: heterochromia and other abnormalities of the iris. Eye (Lond) 2012; 26:29-50. [PMID: 21979861 PMCID: PMC3259577 DOI: 10.1038/eye.2011.228] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 12/26/2022] Open
Abstract
Eye colour is one of the most important characteristics in determining facial appearance. In this paper I shall discuss the anatomy and genetics of normal eye colour, together with a wide and diverse range of conditions that may produce an alteration in normal iris pigmentation or form.
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Affiliation(s)
- I G Rennie
- Academic Unit of Ophthalmology & Orthoptics, University of Sheffield, Sheffield, UK.
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10
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Mazzuca DE, Shields CL, Sinha N, Bianciotto CG, Fox G, Shields JA. Progressive retinal invasion and vitreous seeding from optic disc melanocytoma. Clin Exp Ophthalmol 2011; 40:e123-5. [PMID: 22004250 DOI: 10.1111/j.1442-9071.2011.02720.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Kathil P, Milman T, Finger PT. Characteristics of Anterior Uveal Melanocytomas in 17 Cases. Ophthalmology 2011; 118:1874-80. [DOI: 10.1016/j.ophtha.2011.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022] Open
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Abstract
Surgical resection of uveal melanomas is an alternative eye-salvaging approach to the more commonly used irradiation techniques. There are two surgical resection techniques: Transscleral resection or “Exoresection” via a partial lamellar sclerouvectomy and “Endoresection” via a pars plana vitrectomy. While exoresection is more applicable to anteriorly located tumors with ciliary body and/or iris involvement, endoresection is more suitable for posteriorly located tumor without ciliary body involvement. Both approaches are suitable for large tumors with >8 mm in thickness. In general, eyes containing these large tumors have a very dismal prognosis regarding long-term visual function, eye retention, and irradiation-induced side effects. By removing the tumor burden from the eye, histopathologic and cytogenetic information of the tumor is available and complications associated with the so-called toxic tumor syndrome are avoided. However, both types of surgical resection are challenging surgical procedures, bearing the risk of early and late postoperative complications.
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Affiliation(s)
- Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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13
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Kurt RA, Gündüz K. Exoresection via partial lamellar sclerouvectomy approach for uveal tumors: A successful performance by a novice surgeon. Clin Ophthalmol 2010; 4:59-65. [PMID: 20169050 PMCID: PMC2819770 DOI: 10.2147/opth.s8660] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the results and complications of exoresection via a partial lamellar sclerouvectomy (PLSU) procedure for uveal tumors performed by a novice surgeon without help from an experienced surgeon. METHODS Medical records of 22 patients who underwent exoresection for uveal tumors between February 1999 and January 2009 were evaluated retrospectively. Exoresection was considered for tumors with their epicenter in the iris or in the ciliary body. RESULTS Twenty-two patients with a mean age of 45.9 years (range: 19-72 years) were included in this study. The histopathologic diagnosis was uveal malignant melanoma in 16 patients, iridociliary nevus in 2 patients, iris nevus in 2 patients, and iridociliary melanocytoma in 2 patients. Postoperative complications included cataract in 11 patients (50%), scleral thinning in 4 patients (18%), vitreous hemorrhage in 2 patients (9%), hyphema in 2 patients (9%), secondary glaucoma in 2 patients (9%), iridodialysis in 1 patient (4.5%), bullous keratopathy in 1 patient (4.5%), and posterior synechiae in 1 patient (4.5%). At a mean follow-up of 40.1 months (range: 1-98 months), there were no recurrences or metastatic events. CONCLUSIONS Exoresection seems to be an effective treatment option in selected cases of iridociliary and ciliary body tumors. Novice surgeons with limited training in PLSU should not discourage themselves from doing this type of surgery. Several postoperative complications inevitably occur and require frequent patient monitoring.
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Affiliation(s)
- Rengin Aslihan Kurt
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Malandrini A, Mittica V, Tosi GM, Paradiso A, Balestrazzi A. Clinical and ultrasound biomicroscopic features in iris melanocytoma. Ophthalmic Surg Lasers Imaging Retina 2009; 40:46-9. [PMID: 19205496 DOI: 10.3928/15428877-20090101-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The clinical and ultrasound biomicroscopic features of two cases of iris melanocytoma are evaluated. On ultrasound biomicroscopy examination, iris melanocytoma appears as a highly reflective nodular mass with a smooth or irregular surface and sharp and well-defined edges. Ultrasound biomicroscopy also allows clear visualization and measurement of the tumors. These findings were compared with clinical and histopathologic findings.
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Affiliation(s)
- Alex Malandrini
- Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy
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16
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17
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Choi SW, Seo SG, Her J. A Case of Melanocytoma of the Ciliary Body. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.6.946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Wook Choi
- Department of Ophthalmology, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Sung Gwan Seo
- Department of Ophthalmology, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Jun Her
- Department of Ophthalmology, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
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Chen MJ, Liu JL, Li WY, Lee FL, Chou CK, Hsu WM. Diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma with iris melanocytoma. J Chin Med Assoc 2008; 71:546-8. [PMID: 18955192 DOI: 10.1016/s1726-4901(08)70166-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Iris melanocytoma is a rare melanocytic nevus with distinctive clinical and pathologic features. Secondary glaucoma may develop rapidly and respond poorly to glaucoma medication in some cases. However, few data are available in the literature with respect to the appropriate treatment for refractory glaucoma associated with iris melanocytoma. Herein, we present a 28-year-old man with blurred vision and an elevated intraocular pressure (IOP) of 40 mmHg in his right eye while on multiple glaucoma medications. A dark brown lobulated iris mass with surrounding small pigmented lesions was noted between the 4 and 5:30 o'clock positions. Sector iridectomy was performed and pathologic examination revealed an iris melanocytoma. After surgery, antiglaucomatous medications still failed to control IOP. The patient then underwent diode laser transscleral cyclophotocoagulation (TSCP). At the last follow-up of 15 months, IOP had returned to normal without the need for medication.
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Affiliation(s)
- Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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19
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Vásquez LM, Pavlin CJ, McGowan H, Simpson ER. Ring melanoma of the ciliary body: clinical and ultrasound biomicroscopic characteristics. Can J Ophthalmol 2008. [DOI: 10.3129/i08-025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Shields JA, Shields CL, Eagle RC. Melanocytoma (hyperpigmented magnocellular nevus) of the uveal tract: the 34th G. Victor Simpson lecture. Retina 2007; 27:730-9. [PMID: 17621182 DOI: 10.1097/iae.0b013e318030e81e] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Optic nerve melanocytoma is a variant of melanocytic nevus that has typical clinical and histopathologic features. In addition to occurring in the optic nerve, melanocytoma can also be found in the uveal tract, including the iris, ciliary body, and choroid. Most ophthalmologists are not familiar with these extrapapilary melanocytomas. This review covers the history, terminology, demographics, clinical futures, clinical course, histopathology, differential diagnosis, diagnostic techniques, management, and prognosis for melanocytomas that develop in the uveal tract, separate from the optic nerve. Like standard uveal nevi, melanocytoma can rarely spawn a malignant melanoma.
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Affiliation(s)
- Jerry A Shields
- Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Sagoo MS, Shields CL, Eagle RC, Materin MA, Ehya H, McQueen B, Shields JA. Brown trabeculectomy bleb from necrotic iris melanocytoma. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1755-3768.2006.00833.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sagoo MS, Shields CL, Eagle RC, Materin MA, Ehya H, McQueen B, Shields JA. Brown trabeculectomy bleb from necrotic iris melanocytoma. ACTA ACUST UNITED AC 2007; 85:571-2. [PMID: 17655614 DOI: 10.1111/j.1600-0420.2006.00833.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mandeep S Sagoo
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Haruta M, Miyamoto K, Horii T, Hirata Y, Yoshimura N. Iridociliary melanocytoma with suspected pulmonary metastasis. Jpn J Ophthalmol 2005; 49:545-546. [PMID: 16365811 DOI: 10.1007/s10384-005-0235-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 05/18/2005] [Indexed: 11/30/2022]
Affiliation(s)
- Masatoshi Haruta
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Miyamoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takahiro Horii
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuya Hirata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Agarwal S, Shanmugam MP, Gopal L, Krishnakumar S, Biswas J. NECROTIC MELANOCYTOMA OF THE OPTIC DISK WITH CENTRAL RETINAL VASCULAR OBSTRUCTION. Retina 2005; 25:364-7. [PMID: 15805917 DOI: 10.1097/00006982-200504000-00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Swati Agarwal
- Vitreoretinal Service, Sankara Nethralaya, Vision and Medical Research Foundations, Chennai, India.
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Demirci H, Mashayekhi A, Shields CL, Eagle RC, Shields JA. Iris melanocytoma: clinical features and natural course in 47 cases. Am J Ophthalmol 2005; 139:468-75. [PMID: 15767055 DOI: 10.1016/j.ajo.2004.10.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe the clinical features, natural course, management and histopathologic features of iris melanocytoma. DESIGN Single-center retrospective case series. METHODS PATIENT POPULATION Forty-seven consecutive patients (47 eyes) with iris melanocytoma. INTERVENTION PROCEDURE: Data regarding patient and tumor features were analyzed for their impact on the main outcome measures using univariate and multivariate regression models. Kaplan-Meier estimates were used to analyze the main outcomes as a function of time. MAIN OUTCOME MEASURES Increased intraocular pressure (IOP), tumor seeding, and tumor growth. RESULTS Associated findings at initial presentation included iris stromal seeds in 20 patients (43%), and anterior chamber angle seeds in 12 (26%). Intrinsic vascularization and sector cataract were not seen in any eyes. The management at presentation included observation in 39 patients (83%), tumor removal by sector iridectomy/iridocyclectomy in 7 (15%), and enucleation for blind painful eye with secondary increased IOP in 1 (2%). The diagnosis was confirmed by histopathologic examination in 11 patients (23%). The mean follow-up was 58 months. Using Kaplan-Meier estimates, clinical evidence of growth was observed in 23% at 5 years, 48% at 10 years, and 74% at 15 years. New tumor seeds developed in 34% at 5 years, 63% at 10 years, and 75% at 15 years. Increased IOP was observed in 11% at 5 years, 11% at 10 years, and 55% at 15 years. CONCLUSIONS Iris melanocytoma represented only 3% of all iris nevi. Related iris stromal and anterior chamber angle seeds were common, and secondary glaucoma occurred in 11% at 5 years. Growth was observed in 23% at 5 years but no malignant transformation was found.
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Affiliation(s)
- Hakan Demirci
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Zhao JC, Zacks DN, Gragoudas ES, Pasquale LR. Pupil sparing excision of an atypical iris melanocytoma induces remission of secondary glaucoma. Br J Ophthalmol 2004; 88:842-3. [PMID: 15148231 PMCID: PMC1772164 DOI: 10.1136/bjo.2003.037150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The most common anterior segment tumors are primary neuroepithelial cysts, uveal melanomas, metastatic tumors, and benign tumors. In the majority of cases, the diagnosis can be made utilizing a careful clinical history and ocular examination. Ultrasound examination (low and high frequency) has become an indispensable tool used to determine tumor extension and involvement of the surrounding structures. In particular, high-frequency ultrasound has been used to uncover iris pigment epithelial cysts, to allow for the diagnosis of small ciliary body melanomas, and to measure tumors for plaque radiation planning. Whereas fluorescein angiography and computerized tomography have come to play a limited role, fine-needle aspiration biopsy has been found to be quite helpful in selected cases. Once the diagnosis is established, treatment decisions depend on the tumors' location, size, local extension, patterns of growth, and secondary complications. Most anterior segment tumors can be observed for growth prior to treatment. Other options include local resection (iridectomy, lamellar sclerouvectomy, or eye-wall resection) and radiation (ophthalmic plaque or external beam). Enucleation is typically employed if these eye- and vision-sparing treatments are not possible and for uncontrollable secondary glaucoma. This review examines the unique role of high-frequency ultrasonography for the diagnosis and treatment of anterior segment tumors as well as an overview of clinical practice.
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Affiliation(s)
- Flavio A Marigo
- The New York Eye Cancer Center; The Federal University of Minas Gerais and Instituto da Visão, Belo Horizonte, Brazil
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Dinakaran S, Rundle PA, Parsons MA, Rennie IG. Adenoma of ciliary pigment epithelium: a case series. Br J Ophthalmol 2003; 87:504-5. [PMID: 12642323 PMCID: PMC1771600 DOI: 10.1136/bjo.87.4.504] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Dinakaran
- Department of Ophthalmology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Demirci H, Shields CL, Shields JA, Eagle RC, Honavar SG. Diffuse iris melanoma: a report of 25 cases. Ophthalmology 2002; 109:1553-60. [PMID: 12153810 DOI: 10.1016/s0161-6420(02)01104-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Diffuse iris melanoma is a rare variant of iris melanoma that has a flat growth pattern and often presents as unilateral hyperchromic heterochromia and glaucoma. There have been no large clinical reports of diffuse iris melanoma. DESIGN Single-center retrospective case series. PARTICIPANTS Twenty-five consecutive patients with diffuse iris melanoma. METHODS A review of the clinical features, management, histopathologic analysis, and prognosis was performed. MAIN OUTCOME MEASURES Clinical features, histopathologic features, management, and prognosis. RESULTS At the time of diagnosis, the mean patient age was 49 years. The initial complaint was unilateral darker eye color in 13 cases (52%) and blurred vision in 6 (24%). Six patients (24%) were symptom free. On presentation elsewhere, the initial diagnosis was iris melanoma or nevus in 11 cases (44%) and glaucoma in 14 (56%), 8 (32%) of whom had prior laser or surgical treatment for glaucoma. The 25 patients were observed for a mean of 30 months before the diagnosis of melanoma was suspected and referral to our center for evaluation. The mean intraocular pressure at referral was 36 mmHg, and the mean number of clock hours involved by tumor was 11. Heterochromia iridis was present in all 25 cases (100%), corectopia in 23 (92%), and ectropion iridis in 21 (84%). Associated findings included unilateral cataract in 8 (32%), a prominent episcleral (sentinel) vessel in 7 (28%), and anterior chamber inflammation in 5 (20%), and synechiae (anterior or posterior) in none. The tumor was managed by enucleation in 22 cases (88%) and by plaque brachytherapy in 3 (12%). Five cases (20%) were classified as spindle melanoma, 17 (68%) as mixed cell type, and 3 (12%) as epithelioid cell type. Therefore, histopathologic examination showed that 80% of cases contained epithelioid cells. All 22 enucleated cases were found to have tumor invasion in the trabecular meshwork. Tumor invasion of Schlemm's canal was found in 18 (82%), minor pars plicata in 12 (55%), and episclera in 7 cases (28%). Of seven cases with episcleral invasion, four underwent surgical treatment for glaucoma. Excluding one recent case, the patients were observed for a mean of 78 months. Liver metastasis developed in 3 cases (13%). CONCLUSIONS Diffuse iris melanoma is a serious ocular condition that causes unilateral hyperchromic heterochromia and secondary glaucoma, often leading to a delay in diagnosis. Local invasion of adjacent ocular structures is common, and distant metastasis occurs in 13% of cases at mean follow-up of 78 months.
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Affiliation(s)
- Hakan Demirci
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Shields JA, Eagle RC, Shields CL, Nelson LB. Progressive growth of an iris melanocytoma in a child. Am J Ophthalmol 2002; 133:287-9. [PMID: 11812446 DOI: 10.1016/s0002-9394(01)01305-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Jerry A Shields
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Demirci H, Shields CL, Shields JA, Eagle RC, Honavar S. Ring melanoma of the anterior chamber angle: a report of fourteen cases. Am J Ophthalmol 2001; 132:336-42. [PMID: 11530045 DOI: 10.1016/s0002-9394(01)01051-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Ring melanoma of the anterior chamber angle is a rare variant of uveal melanoma that manifests as circumferential, flat tumor growth predominantly confined to the trabecular meshwork and other anterior chamber angle structures. We report the clinical and histopathological features, management, and prognosis of ring melanoma of anterior chamber angle. METHODS A retrospective review of clinical features, management, histopathologic features, and prognosis was performed. Of 8800 patients with uveal melanoma examined on the Oncology Service at Wills Eye Hospital over a 25-year period, only 14 patients (0.2%; 14 eyes) were classified clinically as ring melanoma of the anterior chamber angle. In no case was there appreciable involvement of the iris or ciliary body on clinical examination. RESULTS The patients were followed elsewhere for a mean of 8 months before intraocular malignancy was suspected. Upon referral to the Oncology Service, the intraocular pressure was greater than 22 mm Hg in the affected eye in all patients (mean, 36 mm Hg; median, 35 mm Hg; range, 24 to 48 mm Hg), and all patients were using at least two glaucoma medications. The melanoma infiltrated the anterior chamber angle for a mean of 10 clock hours (range, 8 to 12 clock hours). Tumor management consisted of enucleation in 13 cases and plaque radiotherapy in one case. Histopathologic examination revealed epithelioid cell type melanoma in one case, mixed cell type in nine, and spindle cell type in four. Of the 13 patients who underwent enucleation, tumor cells were found within the Schlemm canal in all cases. Five cases displayed invasion of the intrascleral canals, and three showed episcleral invasion. With the exception of two recent cases, 12 patients were followed for a mean of 64 months (median, 47 months; range, 23 to 225 months). Distant metastasis to the liver was detected in three of 12 patients (25%) after a mean follow-up of 78 months (median, 70; range, 37 to 128 months). CONCLUSIONS Ring melanoma of the trabecular meshwork and angle structures is a rare variant of diffuse uveal melanoma. It often masquerades as unilateral glaucoma and can be difficult to recognize clinically unless careful comparative gonioscopy is performed. Despite the relatively small tumor volume, life prognosis is guarded with distant metastasis in 25% at mean 6 years follow-up.
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Affiliation(s)
- H Demirci
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut St., Philadelphia, PA 19107, USA
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Shields CL, Shields JA, Materin M, Gershenbaum E, Singh AD, Smith A. Iris melanoma: risk factors for metastasis in 169 consecutive patients. Ophthalmology 2001; 108:172-8. [PMID: 11150284 DOI: 10.1016/s0161-6420(00)00449-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify risk factors that predict distant metastases of iris malignant melanoma. DESIGN Retrospective case series. PARTICIPANTS The participants included 169 consecutive patients with microscopically confirmed iris malignant melanoma managed on the Oncology Service at Wills Eye Hospital between 1974 and 1999. MAIN OUTCOME MEASURES The main outcome measure was the development of distant tumor metastasis. Cox proportional regression models were used to calculate the risk of eventual metastatic spread. RESULTS Of 1054 patients referred with suspicious iris melanocytic tumors (rule out malignant melanoma) over a 25-year period, 169 patients (16%) had microscopically proven iris melanoma, and the remainder (84%) had clinically diagnosed iris nevus. Of the patients with iris melanoma, the mean age at the time of diagnosis was 43 years (median, 45 years; range, 1-90 years). All patients were Caucasian. The mean tumor base was 6 mm (median, 5 mm; range, 1-17 mm), and mean tumor thickness was 2 mm (median, 2 mm; range, 1-4 mm). The mean number of clock hours of tumor involvement in the iris was four, tumor seeding on the iris was four, and tumor seeding into the anterior chamber angle was four. Extraocular extension was present in 10 eyes (6%). The tumor management consisted of local resection (iridectomy, iridocyclectomy, or iridocyclogoniectomy) in 102 patients (60%), enucleation in 51 (30%), plaque radiotherapy in 9 (5%), and observation in 7 patients (4%). Metastasis developed in nine patients (5%). Using Kaplan-Meier life table analysis, metastasis was found in 3% of patients at 5 years, 5% at 10 years, and 10% at 20 years. The clinical factors at initial evaluation predictive of eventual metastasis from iris melanoma included increasing age at diagnosis (P = 0.03), elevated intraocular pressure (P = 0.03), posterior tumor margin at angle or iris root (versus midzone) (P = 0.02), extraocular extension (P: = 0.02), and prior surgical treatment of the tumor elsewhere before referral (versus observation) (P = 0.006). The method of management (resection, radiotherapy, or enucleation) did not have an impact on metastasis. CONCLUSIONS Microscopically confirmed iris melanoma demonstrates distant metastasis in 5% of patients at 10 years follow-up. Metastases are more likely to develop in those patients who are older and show tumor features of iris root/angle location with elevated intraocular pressure and extraocular extension.
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Affiliation(s)
- C L Shields
- Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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