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Mitamura M, Kase S, Suimon Y, Kanno-Okada H, Ishida S. A case of choroidal melanocytoma treated by transscleral resection: A clinicopathological study. Am J Ophthalmol Case Rep 2024; 34:102043. [PMID: 38584718 PMCID: PMC10997995 DOI: 10.1016/j.ajoc.2024.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Choroidal melanocytoma is a rare benign melanocytic tumor. We report a case of choroidal melanocytoma that was definitively diagnosed by histopathological findings after local resection. Observation A 71-year-old female complained of blurred vision in her left eye. Her best-corrected visual acuity (BCVA) was 1.0. A dark-brown elevated lesion, measuring 5 papilla-diameter was found in the periphery of the fundus in her left eye. The mass showed hyperfluorescence on fluorescein angiography, early hypofluorescence and late hyperfluorescence on indocyanine green angiography. B-mode echography indicated the mass was originated from the choroid. Orbital magnetic resonance imaging showed isointense signal intensity on T1-weighted images (WI) and hypointense signal intensity on T2-WI, and poor Gadolinium enhancement on T1WI. The tumor was suspected to be melanocytoma, but it was difficult to differentiate from malignant melanoma. Transscleral tumor resection combined with 25-gauge vitrectomy was performed. Histopathological examinations led to the diagnosis of choroidal melanocytoma. Two years after local resection, her BCVA was 1.0 with no tumor recurrence. Conclusions/importance Local resection was useful as a diagnostic treatment for choroidal tumors confined to the periphery of the fundus that were difficult to clinically differentiate from malignant melanoma.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuka Suimon
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiromi Kanno-Okada
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
- Department of Surgical Pathology, Kushiro Rosai Hospital, Kushiro, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Wang R, Su L, Wang H, Zhang X, Wang W, Liu K, Yang X. Local resection via partial lamellar sclerouvectomy for ciliary body tumors - a case series. BMC Ophthalmol 2024; 24:190. [PMID: 38658861 PMCID: PMC11040928 DOI: 10.1186/s12886-024-03444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Ciliary body tumor is extremely rare and treatment is challenging. The aim of this study is to present our experience in treating this rare entity, especially large tumors with more than 5 clock hours of involvement, and to evaluate the surgical outcomes and complications of local resection via partial lamellar sclerouvectomy in four cases of ciliary body tumors in China. METHODS Four patients with ciliary body tumors underwent partial lamellar sclerouvectomy between October 2019 and April 2023 in Shanghai General Hospital, China. Tumor features, histopathologic findings, complications, visual acuity, and surgical outcomes were reviewed at a mean follow-up of 20.8 months. RESULTS Four patients with a mean age of 31.8 years were included in this study. The histopathological diagnosis was adenoma of non-pigmented ciliary epithelium (ANPCE), schwannoma, and multiple ciliary body pigment epithelial cysts. The mean largest tumor base diameter was 6.00 mm (range: 2.00-10.00) and the mean tumor thickness was 3.50 mm (range: 2.00-5.00). Preoperative complications included cataract in 3 (75%) eyes, lens dislocation in 2 (50%), and secondary glaucoma in 1 (25%). Temporary ocular hypotonia was observed in one case and no other postoperative complications were observed. At a mean follow-up of 20.8 months, the best corrected visual acuity increased in 3 eyes and was stable in 1 eye. Tumor recurrence was absent in all eyes. All patients were alive at the end of follow-up. CONCLUSIONS Local tumor resection via PLSU is useful in the treatment of ciliary body tumors, including large tumors occupying more than five clock hours of pars plicata. Surgery-related complications were manageable with adequate preoperative assessment and careful operation during surgery.
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Affiliation(s)
- Ruonan Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, 200080, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, 200080, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, 200080, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Li Su
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, 200080, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, 200080, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, 200080, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Hong Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, 200080, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, 200080, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, 200080, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Xuemei Zhang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
| | - Weijun Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, 200080, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, 200080, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, 200080, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, 200080, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, 200080, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, 200080, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Xiaolu Yang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, 200080, Shanghai, China.
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China.
- Shanghai Key Laboratory of Ocular Fundus Diseases, 200080, Shanghai, China.
- Shanghai Engineering Center for Visual Science and Photomedicine, 200080, Shanghai, China.
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
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Mirzayev I, Gündüz AK, Okçu Heper A. Partial lamellar sclerouvectomy surgery for anteriorly located uveal tumour resection: a 20-year experience. Eye (Lond) 2022; 36:969-977. [PMID: 33941875 PMCID: PMC9046411 DOI: 10.1038/s41433-021-01545-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To investigate the results of partial lamellar sclerouvectomy (PLSU) for anteriorly located uveal tumours. METHODS We reviewed the tumour features, histopathologic findings, complications, visual acuity outcomes, eye preservation, metastasis, and mortality data of 56 cases with uveal tumours who underwent PLSU between February 1999 and February 2019. RESULTS The mean largest tumour base diameters were 5.8 × 3.4 mm and the mean tumour thickness was 3.3 mm. Histopathologically, 30 (53.6%) eyes had malignant melanoma, 13 (23.2%) had nevus, 5 (8.9%) had iris stromal cyst, 4 (7.1%) had melanocytoma, 2 (3.6%) had Fuchs' adenoma, 1 (1.8%) had iris pigment epithelial cyst, and 1 (1.8%) had invasive breast cancer metastasis. The most common postoperative complications included cataract in 21 (37.5%) eyes, vitreous haemorrhage in 15 (26.8%), scleral thinning in 10 (17.9%), and hyphema in 6 (10.7%). At a mean follow-up of 40.4 (range: 10-201) months, tumour recurrence was observed in 2/30 (6.7%) eyes with melanoma and 1/5 (20.0%) eye with iris stromal cyst. Eyes with recurrent melanoma were treated with enucleation. Liver metastasis developed in only 1 (3.3%) melanoma case. All patients were alive at the end of follow-up. CONCLUSIONS PLSU is a successful treatment method for many anteriorly located uveal tumours. In our series, the overall tumour recurrence and globe salvage rates were 5.4% and 96.4% respectively. Among melanoma cases, the metastasis rate was 3.3% and survival rate was 100%.
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Affiliation(s)
- Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Department of Ophthalmology, Dünya Göz Hospital, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.
- Private Office, Farilya Business Center 8/38, Çukurambar, Ankara, Turkey.
| | - Aylin Okçu Heper
- Departmant of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
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Gündüz AK, Mirzayev I. Surgical Approach in Intraocular Tumors. Turk J Ophthalmol 2022; 52:125-138. [PMID: 35481734 PMCID: PMC9069084 DOI: 10.4274/tjo.galenos.2021.24376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Surgery in intraocular tumors is done for excision/biopsy and the management of complications secondary to the treatment of these tumors. Excision/biopsy of intraocular tumors can be done via fine-needle aspiration biopsy (FNAB), transretinal biopsy (TRB), partial lamellar sclerouvectomy (PLSU), and endoresection. FNAB, TRB, and PLSU can be used in tumors that cannot be diagnosed by clinical examination and other ancillary testing methods. PLSU is employed in tumors involving the iridociliary region and choroid anterior to the equator. Excisional PLSU is performed for iridociliary and ciliary body tumors with less than 3 clock hours of iris and ciliary body involvement and choroidal tumors with a base diameter less than 15 mm. However, for biopsy, PLSU can be employed with any size tumor. Endoresection is a procedure whereby the intraocular tumor is excised using vitrectomy techniques. The rationale for performing endoresection is based on the fact that irradiated uveal melanomas may cause complications such as exudation, neovascular glaucoma, and intraocular pigment and tumor dissemination (toxic tumor syndrome), and removing the dead tumor tissue may contribute to better visual outcome. Endoresection is recommended 1-2 weeks after external radiotherapy. Pars plana vitrectomy is also used in the management of complications including vitreous hemorrhage, retinal detachment, and epiretinal membrane that can occur after treatment of posterior segment tumors using radiotherapy and transpupillary thermotherapy. It is important to make sure the intraocular tumor has been eradicated before embarking on such treatment.
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Affiliation(s)
- Ahmet Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ibadulla Mirzayev
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Zhou N, Wang P, Xu X, Liu Y, Wei W. Surgical Resection of Intraocular Tumors (Partial Transscleral Sclerouvectomy Combined With Mircoinvasive Vitrectomy and Reconstruction of the Eyeball) in Asian Patients: Twenty-Five Years Results. Front Oncol 2022; 12:768635. [PMID: 35371976 PMCID: PMC8965069 DOI: 10.3389/fonc.2022.768635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To describe the outcome of intraocular tumor resection by partial transscleral sclerouvectomy (PTSU) combined with micro-invasive vitrectomy and reconstruction of the eyeball (MVRE) in Asian patients. Design Methods and Participants This retrospective, interventional cohort study included 366 patients who underwent PTSU combined with MVRE for intraocular tumors both in adult and pediatric age groups. The medical records of these patients were reviewed for clinical, operative, and histopathological features. Main Outcome Measures Globe salvage, best corrected visual acuity (BCVA), surgical side effects, tumor control, and tumor-related metastasis and death. Results The mean follow-up duration was 87 months (median, 66; range, 1-303 months). Among the 366 patients, the mean age was 8.5 years (median, 7; range, 1-19 years) in the 37 pediatric patients, and was 43 years (median, 42; range, 20-51) in 329 adult patients. The tumor mainly involved the ciliary body (n=136; 37.2%) and choroid (n=86; 23.5%). The common pathologic diagnosis of the 366 patients was as follows. In the pediatric age group, histopathologic examination revealed positive tumor margins in 37 patients mainly including ciliary body medulloepithelioma (8/37), ciliary body melanocytoma (13/37) and uveal melanoma (5/37). In the adult group, the pathological diagnosis mainly included melanoma (195/329), RPE adenoma (21/329), amelanotic melanoma (13/329), ciliary body adenoma of nonpigmented epithelium (19/329), schwannoma/neurilemmoma (11/329), melanocytoma (24/329), and leiomyoma (9/329). The globe salvage rate was 81.1% in the pediatric age groups (<20 years), and 93.6% in the adult group (≥20 years), respectively. Of the 338 salvaged eyes, final BCVA was 20/20 to 20/40 in 16 (4.7%), 20/40 to 20/80 in 58 (17.2%), 20/80 to 20/200 in 160 (47.3%), and ≤ 20/200 in 104 (30.8%). Early side effects included corneal edema in 28 (7.7%) patients, hyphema in 46 (12.6%), and vitreous hemorrhage in 76 (21%) patients. Postoperative side effects included proliferative vitreoretinopathy (PVR) in 67 (18.3%), late cataract in 42 (11.5%), and glaucoma in 18 (5%) patients. Local tumor recurrence was detected in 20 patients (5.5%) at a mean interval of 23.6 months, including melanoma (n=19) and medulloepithelioma (n=1). Enucleation was necessary in 28 (7.7%) cases owing to recurrence in 15 (53.6%), eye prophylaxis with high-grade malignancy in 5 (17.8%), and blind painful eye in 8 (28.6%) cases. Kaplan-Meier estimated for 5, 10-year metastasis rate and metastasis-related death rate (95%CI) in 213 UM patients were 3.2% (1.4%-7.0%), 6.9% (3.8%-12.3%); and 3.5% (1.6%-7.6%), 7.6% (4.2%-13.5%), respectively. Conclusions As a surgically challenging procedure, PTSU combined with MVRE offers several theoretical advantages over enucleation and radiotherapy. It can achieve control of most intraocular tumors, preserve useful vision, and maintain a cosmetically normal eye.
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Affiliation(s)
- Nan Zhou
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ping Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaolin Xu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yueming Liu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wenbin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Karimi S, Arabi A, Shahraki T. Plaque brachytherapy in iris and iridociliary melanoma: a systematic review of efficacy and complications. J Contemp Brachytherapy 2021; 13:46-50. [PMID: 34025736 DOI: 10.5114/jcb.2021.103586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/06/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the efficacy and vision-threatening complication rate of plaque brachytherapy with iodine-125 (125I), palladium-103 (103Pd), and ruthenium-106 (106Ru) for treatment of iris and iridociliary melanoma. Material and methods A literature review was done based on results yielded from searching PubMed, Embase, and Cochrane database, using following key words: iris melanoma, iridociliary melanoma, brachytherapy, iodine-125 brachytherapy, palladium-103 brachytherapy, and ruthenium-106 brachytherapy. Initially, relationships between mean radiation dose to apex and local recurrence and complication rate were analyzed, and then, a comparison was performed between 125I, 103Pd, and 106Ru studies. Results Twelve retrospective and prospective studies were selected, with 491 patients treated primarily with plaque brachytherapy. The range of radiation dose to tumor apex were from 84 to 151.5 Gy. Ranges of mean and median of follow-up time were from 27 to 96 months. Local recurrence rate following brachytherapy ranged from 0 to 8%. A decrease in the average study dose was not associated with an increased local recurrence or metastasis rate (p = 0.373 and 0.195, respectively); however, an increase in radiation dose was associated with higher radiation-related cataract and glaucoma (p < 0.05). The rate of post-treatment glaucoma was higher in studies with 125I plaque brachytherapy (p = 0.004). Conclusions For brachytherapy of iris and iridociliary melanoma, in a range of 84 to 150 Gy, an increase in radiation dose may increase the risk of complications, while the tumor control rate does not change.
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Biewald E, Schlüter S, Kiefer T, Dalbah S, Bornfeld N, Bechrakis NE. [Tumors and Pseudotumors of the Retina and the Ciliary Epithelium]. Klin Monbl Augenheilkd 2020; 237:1359-1378. [PMID: 32777829 DOI: 10.1055/a-1229-0946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The variety of retinal tumors ranges from harmless lesions to benign, locally destructive tumors and life-threatening diseases, and they are not always easy to distinguish from each other. The differential diagnosis includes real neoplasia, reactive inflammatory pathologies and vascular anomalies of the fundus as well. If possible, the diagnosis should be made clinically in order to avoid the danger of tumor cell spread via invasive diagnostic tools. Nevertheless, genetic analysis of the pathology is gaining more importance and adds to the precise characterization of the diagnosis. Depending on the tumor entity, therapy in a specialized center is necessary.
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Biewald E, Schlüter S, Kiefer T, Dalbah S, Bornfeld N, Bechrakis NE. Tumoren und Pseudotumoren der Netzhaut und des Ziliarepithels. Augenheilkunde up2date 2020. [DOI: 10.1055/a-1128-8784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie Varietät retinaler Tumoren reicht von harmlosen Läsionen über benigne, lokal destruierende Tumoren bis hin zu lebensbedrohlichen Erkrankungen. Nicht immer lassen sie sich einfach voneinander unterscheiden. Die Diagnose sollte nach Möglichkeit klinisch gestellt werden wegen der Gefahr einer Tumorzellverschleppung durch invasive Diagnostik. Jedoch rückt die genetische Charakterisierung der Läsion immer mehr in den Vordergrund. Je nach Entität ist eine Therapie in einem spezialisierten Zentrum notwendig.
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Tadepalli SH, Shields CL, Shields JA, Honavar SG. Intraocular medulloepithelioma - A review of clinical features, DICER 1 mutation, and management. Indian J Ophthalmol 2019; 67:755-762. [PMID: 31124483 PMCID: PMC6552580 DOI: 10.4103/ijo.ijo_845_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Intraocular medulloepithelioma is a nonhereditary neoplasm of childhood arising from primitive medullary epithelium. It most often involves the ciliary body. Most patients present between 2 and 10 years of age with loss of vision, pain, leucocoria, or conjunctival congestion. The mass appears as a grey-white ciliary body lesion with intratumoral cysts. Presence of a neoplastic cyclitic membrane with extension to retrolental region is characteristic. Secondary manifestations like cataract and neovascular glaucoma may be present in up to 50% and 60% patients, respectively. These could be the first signs for which, unfortunately, about 50% patients undergo surgery before recognition of the hidden tumor. Systemic correlation with pleuropulmonary blastoma (DICER1 gene) has been documented in 5% cases. Histopathology shows primitive neuroepithelial cells arranged as cords closely resembling the primitive retina. Histopathologically, the tumor is classified as teratoid (containing heteroplastic elements) and nonteratoid (containing medullary epithelial elements), each of which are further subclassified as benign or malignant. Retinoblastoma-like and sarcoma-like areas may be seen within the tissue. The treatment modality depends on tumor size and extent of invasion. For small localized tumors (≤3-4 clock hours), conservative treatments with cryotherapy, plaque radiotherapy, or partial lamellar sclerouvectomy (PLSU) have been used. Plaque brachytherapy is generally preferred for best tumor control. Advanced and extensive tumors require enucleation. Rare use of intra-arterial and intravitreal chemotherapy has been employed. Systemic prognosis is favorable, but those with extraocular extension and orbital involvement show risk for local recurrence and metastatic disease, which can lead to death.
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Affiliation(s)
- Sameeksha H Tadepalli
- Department of Ocular Oncology, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ocular Oncology, Centre for Sight, Hyderabad, Telangana, India
| | - Carol L Shields
- Department of Ocular Oncology, Wills Eye Hospital, Philadelphia, PA, USA, India
| | - Jerry A Shields
- Department of Ocular Oncology, Wills Eye Hospital, Philadelphia, PA, USA, India
| | - Santosh G Honavar
- Department of Ocular Oncology, Centre for Sight, Hyderabad, Telangana, India
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Abstract
PURPOSE To describe a method of surgical management for cases of localized epithelial downgrowth (EDG). METHODS Single-center retrospective chart review of patients with histologically confirmed localized EDG of stratified squamous epithelium. Each patient underwent a partial lamellar sclerokeratouvectomy encompassing the area of suspected EDG. The main outcome measure was recurrence of EDG. RESULTS At a mean of 51 months of postoperative follow-up (range: 31-86), no patient had evidence of recurrent EDG. One eye developed worsening of preexisting glaucoma. All 3 eyes developed localized corneal edema, but only 1 required corneal transplantation. CONCLUSIONS EDG is a potentially devastating complication of intraocular surgery or penetrating injury. In cases of localized involvement of the anterior chamber structures, definitive management of EDG can be achieved via resection of the involved scleral, corneal, and uveal tissue. A lamellar approach minimizes tissue loss and maintains a structurally sound, pressurized globe.
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Abstract
Biopsy involves the surgical removal of a tissue specimen for histopathologic evaluation. Most intraocular tumors are reliably diagnosed based on the clinical evaluation or with noninvasive diagnostic techniques. However, accurately diagnosing a small percentage of tumors can be challenging. A tissue biopsy is thus needed to establish a definitive diagnosis and plan the requisite treatment. From fine-needle aspiration biopsy (FNAB) to surgical excision, all tissue collection techniques have been studied in the literature. Each technique has its indications and limitations. FNAB has been reported to provide for 88–95% reliable and safe ophthalmic tumor diagnosis and has gained popularity for prognostic purposes and providing eye conserving treatment surgeries. The technique and instrumentation for biopsy vary depending upon the tissue involved (retina, choroid, subretinal space, vitreous, and aqueous), suspected diagnosis, size, location, associated retinal detachment, and clarity of the media. The cytopathologist confers a very important role in diagnosis and their assistance plays a key role in managing and planning the treatment for malignancies.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Abhinav Dhami
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Larsen and Toubro Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Popovic M, Ahmed IIK, DiGiovanni J, Shields CL. Radiotherapeutic and surgical management of iris melanoma: A review. Surv Ophthalmol 2017; 62:302-311. [DOI: 10.1016/j.survophthal.2016.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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Shields JA, Eagle RC Jr, Ferguson K, Shields CL. TUMORS OF THE NONPIGMENTED EPITHELIUM OF THE CILIARY BODY: The Lorenz E. Zimmerman Tribute Lecture. Retina 2015; 35:957-65. [PMID: 25545484 DOI: 10.1097/IAE.0000000000000445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 1970, Dr. Lorenz Zimmerman delivered the Norman McAlister Gregg Lecture entitled "The remarkable polymorphism of tumors of the ciliary epithelium." Therein, he proposed a classification of these tumors that included congenital lesions (mainly medulloepithelioma) and acquired lesions (mainly adenoma and adenocarcinoma). The classification was based on histopathologic observations without detailed clinical information. METHODS Review of the published literature and personal experience with tumors of the nonpigmented ciliary body epithelium. RESULTS Since 1970, further observations through clinical examination and advanced testing with ultrasound biomicroscopy, anterior segment optical coherence tomography, and magnetic resonance imaging have expanded our knowledge regarding tumors of the nonpigmented ciliary body epithelium. Regarding medulloepithelioma, we have learned of the common associated features of neovascular glaucoma, retrolenticular neoplastic or vascular cyclitic membrane, intralesional cysts, response to radiotherapy, and association with Dicer-1 mutation. Regarding adenoma/adenocarcinoma, improved management with surgical resection (sparing globe) can be achieved. Fuchs adenoma, also termed coronal adenoma, is commonly found histopathologically, despite its rare clinical visualization, and should be added to the Zimmerman classification. CONCLUSION Since Zimmerman's report on histopathologic features of tumors of the nonpigmented ciliary body epithelium, there have been numerous publications and further observations on the clinical features and management of these intriguing neoplasms.
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Goto H, Usui Y, Nagao T. Perivascular Epithelioid Cell Tumor Arising from Ciliary Body Treated by Local Resection. Ocul Oncol Pathol 2014; 1:88-92. [PMID: 27231690 DOI: 10.1159/000369330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS Perivascular epithelioid cell tumor (PEComa) is a mesenchymal neoplasm originating from perivascular myoid cells. We report a case of PEComa arising from the ciliary body. METHODS Case report. RESULTS A 13-year-old girl was referred to our department with a clinical diagnosis of ciliary body melanoma in her right eye. Her visual acuity was 20/600 OD. Slit-lamp examination revealed a brown tumor behind the iris. The ocular fundus could not be observed due to a cataract. Ultrasonography depicted an oval mass approximately 10 mm in diameter at the ciliary body. The tumor was successfully treated by local resection, and the patient's visual acuity improved to 20/20. Histopathological and immunohistochemical findings of the excised tumor were compatible with the diagnosis of PEComa of the ciliary body. No local recurrence of the tumor was observed for over 4 years after surgery. CONCLUSION A very rare case of PEComa of the ciliary body was successfully treated by local resection, with favorable visual outcome and no recurrence for several years. PEComa can be differentiated from other ciliary body tumors by immunohistochemical study.
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Affiliation(s)
- Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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Kaliki S, Shields CL, Eagle RC, Vemuganti GK, Almeida A, Manjandavida FP, Mulay K, Honavar SG, Shields JA. Ciliary Body Medulloepithelioma. Ophthalmology 2013; 120:2552-2559. [DOI: 10.1016/j.ophtha.2013.05.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/26/2022] Open
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Shields CL, Shields JA. Surgical removal of intraocular tumors: dismissing old wives' tales. Am J Ophthalmol 2013; 156:3-4.e1. [PMID: 23791370 DOI: 10.1016/j.ajo.2013.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 01/25/2013] [Accepted: 01/29/2013] [Indexed: 10/26/2022]
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