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VITREOUS AND PRERETINAL SEEDING AFTER TRANSVITREAL FINE NEEDLE ASPIRATION BIOPSY OF CHOROIDAL MELANOMA. Retin Cases Brief Rep 2021; 15:713-717. [PMID: 31403972 DOI: 10.1097/icb.0000000000000905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE To report vitreous and epiretinal seeding of choroidal melanoma after transvitreal fine-needle aspiration biopsy (FNAB). METHODS A 74-year-old Caucasian man with a medium-sized, dome-shaped choroidal melanoma without Bruch membrane rupture, retinal invasion, or vitreous seeding. Transvitreal FNAB was performed for cytopathologic evaluation using a long 27-gauge needle attached to a 10-mL syringe by connector tubing. After passing through the pars plana, vitreous cavity, neurosensory retina, and Bruch membrane, the needle was inserted into the tumor and aspiration was performed. RESULTS Cytopathologic evaluation revealed spindle B melanoma cells, and the tumor was subsequently treated with an 18-mm round Iodine-125 radioactive plaque delivering a tumor apex radiation dose of 7,000 cGy. Transscleral FNAB for cytogenetic evaluation performed at the time of plaque application disclosed chromosome three monosomy and chromosome six and eight disomy. Vitreous pigmented cells were first noted 14 months after brachytherapy. Funduscopy and optical coherence tomography at 24 months after plaque radiotherapy showed extensive vitreous and preretinal pigmented seeding that completely covered the optic disk. Fine-needle aspiration biopsy of the vitreous confirmed the presence of malignant melanoma cells, and the right eye was enucleated. Histopathologic evaluation showed a totally necrotic choroidal melanoma and an extensive malignant epiretinal membrane that covered and extended into the substance of the optic nerve head and focally invaded the neurosensory retina. The patient developed liver metastasis 3 years after the initial presentation and died 10 months later. CONCLUSION This case demonstrates the rare development of extensive vitreous and preretinal seeding with retinal and optic nerve invasion after transvitreal FNAB of choroidal melanoma.
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Raval V, Bowen RC, Soto H, Biscotti C, Yeaney G, Sears J, Singh A. VITREOUS SEEDING OF CHOROIDAL MELANOMA. Retina 2021; 41:890-894. [PMID: 33009220 DOI: 10.1097/iae.0000000000002989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of vitreous seeding in a medium-sized choroidal melanoma and review the literature. METHODS Observational case report and review of literature for pathogenesis, role of vitreous biopsy, and treatment outcomes. RESULTS A case of 57-year-old man diagnosed with vitreous seeding in the left eye 1 year after episcleral brachytherapy for medium-sized choroidal melanoma. The patient was initially diagnosed to have subretinal and vitreous hemorrhage due to rupture of a retinal artery macroaneurysm for which focal laser and intravitreal antivascular endothelial growth factor injections were administered. Over the next 9 months, the vitreous hemorrhage cleared and choroidal melanoma with retinal invasion became evident. One year after brachytherapy, the primary tumor regressed with resolution of surrounding subretinal fluid and hemorrhage. However, gradual decline in the visual acuity from 20/50 to 20/500 with increase of pigmented debris over the retinal surface and in the vitreous cavity was noted. A vitreous biopsy confirmed the presence of viable melanoma cells (epithelioid type), and the eye was enucleated. Histopathology showed microscopic persistence of primary tumor with diffuse vitreous seeding. CONCLUSION Vitreous seeding of choroidal melanoma poses a diagnostic and management challenge.
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Affiliation(s)
- Vishal Raval
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Randy C Bowen
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hansell Soto
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles Biscotti
- Department of Anatomic Pathology, R. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Gabrielle Yeaney
- Department of Anatomic Pathology, R. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Jonathan Sears
- Retina department, Cole Eye Institute, Cleveland Clinic, Cleveland
| | - Arun Singh
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Masoomian B, Mashayekhi A, Malik K, Shields CL. INTRAVITREAL MELPHALAN FOR TREATMENT OF VITREOUS SEEDING FROM CHOROIDAL MELANOMA. Retin Cases Brief Rep 2021; 15:97-100. [PMID: 30048404 DOI: 10.1097/icb.0000000000000798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To report treatment of vitreous seeding of choroidal melanoma with monthly injections of intravitreal melphalan. METHODS Case report. RESULTS A 70-year-old white woman noted floaters in her left eye, and further examination revealed visual acuity of 20/30 in both eyes. Funduscopically, there was a mushroom-shaped choroidal melanoma in her left eye, measuring 9 mm in basal dimension and 4.8 mm in thickness. Notably, there was apical retinal invasion of melanoma with mild vitreous hemorrhage, without vitreous seeding. The tumor was treated with iodine-125 plaque radiotherapy using an apex dose of 70 Gy over 99 hours, designed to include the retinal invasion. The melanoma demonstrated complete regression into a nearly flat scar of 1 mm and remained stable over 4 years. Five years after radiotherapy, there were diffuse vitreous pigmented seeds of presumed melanoma origin, emanating from the site of retinal necrosis. This progressively worsened over the following 18 months, suspicious for viable melanoma cells, as visual acuity concurrently declined to 20/100. Treatment with intravitreal melphalan (10 μg/0.05 mL) was delivered on a monthly basis for 12 cycles, resulting in vitreous seeds regression, and preservation of the eye. Final visual acuity was 20/200. There were no treatment-related complications. CONCLUSION Intravitreal melphalan can be considered in cases of vitreous seeding from uveal melanoma.
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Affiliation(s)
- Babak Masoomian
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Paez-Escamilla M, Walter SD, Mohsenin A, Decatur CL, Harocopos GJ, Dubovy S, Harbour JW. Intraocular Dissemination of Uveal Melanoma Cells Following Radiotherapy: Evolving Management Over the Past Decade. Ophthalmic Surg Lasers Imaging Retina 2020; 50:573-579. [PMID: 31589755 DOI: 10.3928/23258160-20190905-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the presentation and the authors' evolving management strategy for intraocular dissemination of uveal melanoma cells following radiotherapy during the past decade. PATIENTS AND METHODS Patients with uveal melanoma who developed intraocular dissemination of pigmented cells following radiotherapy. Histopathology was available in two cases. RESULTS Four patients underwent treatment for progressive intraocular dissemination of uveal melanoma cells at 9 to 41 months following I-125 plaque radiotherapy (three patients) or proton beam radiotherapy (one patient). Treatments included primary enucleation (one patient), vitrectomy followed later by enucleation (one patient), and vitrectomy followed by intravitreal chemotherapy (two patients). Enucleated eyes demonstrated diffuse invasion of intraocular tissues by viable melanoma cells. No patient has developed systemic metastasis to date. CONCLUSIONS Intraocular dissemination of pigmented cells following radiotherapy for uveal melanoma should raise suspicion for viable invasive melanoma cells. Prompt vitrectomy with intravitreal chemotherapy can be effective in avoiding enucleation in selected cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:573-579.].
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Cheng WH, Chang CH, Lin HC, Chen YC, Wu CC. Malignant choroidal melanoma with suspected vitreous seeding - A case report. Taiwan J Ophthalmol 2017; 7:168-171. [PMID: 29034158 PMCID: PMC5637384 DOI: 10.4103/tjo.tjo_37_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Retinal perforation with vitreous seeding is an uncommon condition of treatment-naïve choroidal malignant melanoma. We reported a 52-year-old male who had a pigmented tumor protruding from choroid of his right eye. He had only black shadow sensation for 4 months then a rapid deterioration of vision. Fundus examination showed vitreous haze with many pigmented materials. B-scan ultrasonography revealed a mass with low internal reflectivity and vitreous opacity. The eyeball was enucleated and a stage IIIA melanoma was confirmed by the pathologist. No local recurrences or metastases were found during 31-month follow-up. Although vitreous seeding may indicate rapid tumor growth, early enucleation may insure a better prognosis.
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Affiliation(s)
- Wen-Hsin Cheng
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsien-Chung Lin
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Ophthalmology, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Ya-Chi Chen
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Ophthalmology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Metz CHD, Bornfeld N, Metz KA, Gök M. Suspected vitreous seeding of uveal melanoma: relevance of diagnostic vitrectomy. Br J Ophthalmol 2015; 100:660-4. [DOI: 10.1136/bjophthalmol-2014-306443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/06/2015] [Indexed: 11/03/2022]
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Gold AS, Bermudez E, Latiff A, Wildner AC, Ehlies FJ, Murray TG. Posterior uveal melanoma coexistent with macular hole. Optom Vis Sci 2013; 90:e156-60. [PMID: 23604299 DOI: 10.1097/opx.0b013e3182924a9b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Three rare cases of macular holes coexistent with posterior uveal melanoma are presented. The possible pathogenesis of a macular hole secondary to uveal melanoma growth is discussed, as well as strategies to treat uveal melanoma before attempting macular hole repair. CASE REPORT Each patient from all three cases had a macular hole and uveal melanoma at the initial presentation. The macular holes were present before uveal melanoma treatment in cases 1 and 2. The patient in case 3 had already been treated elsewhere with iodine-125 plaque brachytherapy for her melanoma. It was not known if macular hole formation occurred before or after that treatment. Macular hole repair was performed in case 1, and the hole was successfully closed. CONCLUSIONS To the best of the authors' knowledge, there are now only nine documented cases of macular holes accompanying posterior uveal melanoma. Successful macular hole repair may prove difficult because the melanoma must first be properly treated and then monitored carefully to establish tumor inactivity.
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Affiliation(s)
- Aaron S Gold
- Murray Ocular Oncology and Retina, Miami, FL 33143, USA.
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Gonzalez P, Kemp EG, Roberts F. Recurrent choroidal melanoma after transscleral local resection with diffuse vitreous seeding. Graefes Arch Clin Exp Ophthalmol 2010; 248:741-6. [DOI: 10.1007/s00417-009-1261-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 10/15/2009] [Accepted: 11/19/2009] [Indexed: 12/01/2022] Open
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Lindegaard J. Primary and secondary tumours of the optic nerve, with emphasis on invasion by uveal malignant melanoma. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1600-0420.2006.00907.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Shen SC, Yang CH, Lin HC, Chen SN. Aggressive small choroidal melanoma presenting as a dense cataract. J Cataract Refract Surg 2007; 33:336-8. [PMID: 17276283 DOI: 10.1016/j.jcrs.2006.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 09/17/2006] [Indexed: 11/19/2022]
Abstract
A 58-year-old woman with an aggressive, invasive, small post-equatorial choroidal melanoma presented with progressively blurred vision and a dense cataract in the affected eye. During phacoemulsification surgery, heavily pigmented retrolental vitreous was identified. Fine needle aspiration biopsy revealed heavily pigmented epithelioid cells without diagnostic features of malignancy. Small epithelioid-type choroidal melanoma (2.5 mm x 2.5 mm x 1.5 mm) was confirmed following enucleation. Diffuse preretinal space seeding, vitreous infiltration, forward spreading of tumor cells into the lens capsule and trabecular meshwork resulted in a complicated cataract.
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Affiliation(s)
- Su-Chin Shen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Abstract
The aim of the study was to identify the histopathological characteristics associated with the invasion of the optic nerve of uveal melanoma and to evaluate the association between invasion of the optic nerve and survival. In order to achieve this, all uveal melanomas with optic nerve invasion in Denmark between 1942 and 2001 were reviewed (n=157). Histopathological characteristics and depth of optic nerve invasion were recorded. The material was compared with a control material from the same period consisting of 85 cases randomly drawn from all choroidal/ciliary body melanomas without optic nerve invasion. Prelaminar/laminar optic nerve invasion was in multivariate analysis associated with focal retinal invasion, neovascularization of the chamber angle, and scleral invasion. Postlaminar invasion was further associated with non-spindle cell type and rupture of the inner limiting membrane of the retina. The optic nerve was invaded in four different ways: 1) by tumor extension from the neuroretina through the lamina cribrosa; 2) by direct extension into the optic nerve head between Bruch's membrane and the border tissue of Elschnig; 3) by direct invasion through the border tissue of Elschnig; and 4) in one case a tumor spread along the inner limiting membrane to the optic nerve through the lamina cribrosa. Invasion of the optic nerve had no impact on all-cause mortality or melanoma-related mortality in multivariate analyses. The majority of melanomas invading the optic nerve are large juxtapapillary tumors invading the optic nerve because of simple proximity to the nerve. A neurotropic subtype invades the optic nerve and retina in a diffuse fashion unrelated to tumor size or location.
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Merbs SL, Green WR. Pathology of Choroidal Melanoma. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
AIMS To define a retinoinvasive phenotype of uveal melanoma based on an informative case and survey of literature. METHODS A 65-year-old woman developed a circumscribed mixed cell type melanoma of the ciliary body that was locally excised. After 6 years, secondary glaucoma evolved. Three years later a ring melanoma was diagnosed and the eye was enucleated. The histopathological material was analysed by immunohistochemistry. RESULTS A spindle cell type ring melanoma infiltrated the iris and ciliary body diffusely, and extended through the aqueous outflow channels and iridocyclectomy flap extrasclerally. The choroid was uninvolved. Instead, tumour cells spread to the vitreous and along the ciliary epithelium, adhered to the hyaloid face and retinal surface, and extensively invaded the neuroretina, the retrobulbar optic nerve, and perineural space. They were labelled for S-100 protein, vimentin, and in the neuroretina for cytokeratins 8 and 18. No evidence of systemic disease is evident 5 years after enucleation. Three identical tumours of the iris and ciliary body that extensively infiltrated the neuroretina and retrobulbar optic nerve were identified from previous literature. CONCLUSION Retinoinvasive melanoma is a rare but distinct phenotype of uveal melanoma, different from circumscribed and most diffuse melanomas that may erode the overlying retina and infiltrate the optic nerve that do not invade non-adjacent retina. Retinoinvasive tumours tend to evolve from a ring melanoma and they grow slowly, which may favour emergence of tumour clones able to migrate, adhere to, and invade into the neuroretina, analogous to the metastatic cascade. Frequent secondary angle closure glaucoma may promote invasion into the optic nerve.
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Affiliation(s)
- T Kivelä
- Department of Ophthalmology, Helsinki University Central Hospital, Finland
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