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Mehta N, Scholle T, Chevez-Barrios P, Schefler AC, Weng CY. PRIMARY CENTRAL NERVOUS SYSTEM AND VITREORETINAL LYMPHOMA MIMICKING VIRAL RETINITIS IN A YOUNG PATIENT. Retin Cases Brief Rep 2023; 17:567-571. [PMID: 37643044 DOI: 10.1097/icb.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to report a young immunocompetent patient with primary central nervous system and vitreoretinal lymphoma initially presenting with peripheral retinitis. METHODS This study is a case report. RESULTS A 31-year-old woman presented with 20/60 vision in her left eye, vitreous haze, and peripheral retinal whitening. Intravitreal and oral antivirals were initiated for presumed acute retinal necrosis. Anterior chamber paracentesis was negative for viral nucleotide. Subretinal infiltrates developed, and vitreous biopsy was performed and interpreted as "negative except for rare yeast." Antifungal therapy was initiated. She developed multiple unilateral cranial neuropathies with multifocal areas of enhancement on neuroimaging. Lumbar puncture cytology was negative for neoplastic cells. After further worsening, aforementioned specimens were sent to a specialized ophthalmic pathology laboratory and the diagnosis revised to lymphoma of the diffuse B-cell type. Initial disease regression was seen after combined systemic and intraocular chemotherapy; unfortunately, the patient suffered a central nervous system recurrence and died from systemic complications 1 year later. CONCLUSION There has been an increased incidence of primary central nervous system and vitreoretinal lymphoma in young patients. Although vitreous biopsy is the diagnostic gold standard for vitreoretinal lymphoma, a risk of false negative interpretation exists. A high index of suspicion and expert interpretation of pathology may be necessary to secure the correct diagnosis.
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Affiliation(s)
- Nitish Mehta
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
| | - Tahira Scholle
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
| | - Patricia Chevez-Barrios
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Houston, Texas; and
| | - Amy C Schefler
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Houston, Texas; and
- Retina Consultants of Texas and Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Christina Y Weng
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
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Alsoudi AF, Parvus MN, Pulido J, Chevez-Barrios P, Teh BS, Bernicker E, Miles S, Schefler A. Multiplying Brown Spots. Retin Cases Brief Rep 2023; Publish Ahead of Print:01271216-990000000-00178. [PMID: 37307600 DOI: 10.1097/icb.0000000000001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a paraneoplastic syndrome affecting the eye that is a sign of poor prognosis of underlying malignancy.This is the first documented case to show serial and sustained improvement of BDUMP following immunotherapy in the setting of primary non-small cell carcinoma of the lung. OBSERVATIONS A 65-year-old man reported a gradual decrease in vision and floaters in the right eye after cataract surgery. Fundus examination demonstrated diffuse multiple brown subretinal lesions bilaterally. Next generation sequencing of melanocytic tissue of the patient described in this case revealed a specific RB1 c.411A>T (p.Glu137Asp) variant with an allele frequency of 44.8%, consistent with heterozygosity. Plasma samples from the patient and a control patient with no history of cancer and/or paraneoplastic syndrome were cultured with neonatal melanocytes, which revealed a greater than 180% increase in proliferation of normal neonatal melanocytes compared to the control. Pembrolizumab therapy was initiated which resulted in shrinkage and stabilization of the lesions documented in serial diagnostic testing. CONCLUSIONS In conclusion, we report a cytologically and serologically confirmed case of BDUMP in a patient with a primary non-small cell carcinoma of the lung. Next generation sequencing of melanocytic tissue of the patient described in this case revealed a specific RB1c.411A>T (p.Glu137Asp) variant with an allele frequency of 44.8%, consistent with heterozygosity. Furthermore, we show documented serial improvement in the patient's ocular and systemic disease with treatment. This case as one of the longest surviving confirmed cases of a patient with BDUMP.
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Affiliation(s)
| | | | - Jose Pulido
- Department of Ophthalmology, Sidney Kimmel College at Thomas Jefferson University
| | - Patricia Chevez-Barrios
- Department of Ophthalmology, Baylor College of Medicine
- Blanton Eye Institute, Weill Cornell Medicine, Houston Methodist Hospital
- Department of Pathology and Genomic Medicine, Weill Cornell Medicine, Houston Methodist Hospital
| | - Bin S Teh
- Department of Radiation Oncology, Weill Cornell Medicine, Houston Methodist Hospital
| | - Eric Bernicker
- Department of Medical Oncology, Weill Cornell Medicine, Houston Methodist Hospital
| | - Sarah Miles
- Department of Biomedical Sciences, Marshall University
| | - Amy Schefler
- Department of Ophthalmology, Retina Consultants of Texas
- Blanton Eye Institute, Weill Cornell Medicine, Houston Methodist Hospital
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3
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Pike S, Iyengar R, Peng CC, Chevez-Barrios P, Brown B, Shah R, Biegel J, Yellapantula V, Nagiel A, Reiser BJ, Xu L, Berry JL. Malignant teratoid intraocular ciliary body medulloepithelioma in a 5-year-old male with corresponding somatic copy number alteration profile of aqueous humor cell-free DNA. Ophthalmic Genet 2022; 43:855-861. [PMID: 36314385 PMCID: PMC9877122 DOI: 10.1080/13816810.2022.2138457] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Intraocular, ciliary body, medulloepithelioma (CBME) is a rare tumor of the nonpigmented ciliary body epithelium, typically presenting in childhood. We describe a case of CBME. MATERIALS AND METHODS Ocular examination and imaging guided diagnostic and treatment decisions. Aqueous humor (AH) liquid biopsy was collected from the affected eye at eventual enucleation. Whole genome sequencing (WGS) was employed to determine somatic copy number alterations (SCNA) in AH cell-free DNA (cfDNA). Tumor sample was analyzed using various assays to evaluate for oncogenic mutations and SCNAs. Histopathology determined diagnosis. RESULTS A 5-year-old male with glaucoma and cataract in the left eye (OS) experienced worsening left eye pain and redness. There was no light perception OS and the eye was hypotonus. Anterior segment exam showed complete cataract and rubeosis iridis. Ocular B-scan ultrasound OS revealed an intraocular lesion with calcifications and retinal detachment. Orbital MRI suggested left globe hypercellularity. An infiltrative lesion involving the ciliary body was seen in the left eye on examination under anesthesia. Left eye enucleation was performed in the setting of pain, blindness, and tumor, with anterior chamber paracentesis for AH liquid biopsy collection. SCNA profile of AH cfDNA demonstrated loss of copy of chromosomes 4, 6, and 9. Tumor was negative for clinically significant mutations or SCNAs. Histopathology diagnosed malignant teratoid CBME. CONCLUSIONS We present a case of CBME and include the unique SCNA profile of AH cfDNA from the enucleated eye. This case suggests utility of AH liquid biopsy in distinguishing between differential diagnoses for intraocular mass lesions.
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Affiliation(s)
- Sarah Pike
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Rahul Iyengar
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Chen-Ching Peng
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Brianne Brown
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Rachana Shah
- Cancer and Blood Disease Institute Retinoblastoma Program, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaclyn Biegel
- Center for Personalized Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Venkata Yellapantula
- Center for Personalized Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Aaron Nagiel
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA,The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Bibiana Jin Reiser
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA,The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Liya Xu
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jesse L. Berry
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA,The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA,Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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4
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Dalma-Weiszhausz J, Chacón-Camacho O, Chevez-Barrios P, Zenteno JC, Franco-Cárdenas V, García-Montaño LA, Pérez-Bravo J, García-Montalvo IA, Jiménez-Sierra JM, Dalma A. AUTOSOMAL DOMINANT MÜLLER CELL SHEEN DYSTROPHY: Clinical, Histopathologic, and Genetic Assessment in an Extended Family With Long Follow-Up. Retina 2022; 42:981-991. [PMID: 35125479 DOI: 10.1097/iae.0000000000003413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Autosomal dominant Müller cell dystrophy is a rare condition we described in 1991. It is characterized by a striking sheen appearance on the retinal surface with progressive retinal changes leading to disorganization and atrophy with a decreased b-wave electroretinograms. MATERIALS AND METHODS We examined 45 members of a 4-generation family. Fifteen subjects from three generations were found with the disease, without gender predilection. Seven patients underwent ophthalmic examination including fundus examination, intravenous fluorescein angiogram, spectral-domain optical coherence tomography, and electroretinogram. Six patients have a 30-year follow-up. Histopathology examination was performed on eyes of the eldest patient. Whole exome sequencing was done in four affected subjects. RESULTS Findings include a decreased visual acuity, abnormal cellophane-like sheen of the vitreoretinal interface, a "plush" nerve fiber layer, and characteristic macular changes. Electroretinogram showed a selective b-wave diminution. Intravenous fluorescein angiogram presented perifoveal hyperfluorescence and capillary leakage. Spectral-domain optical coherence tomography revealed cavitations involving inner and later outer retinal layers with later disorganization. Histopathologic findings included Müller cell abnormalities with cystic disruption of inner retinal layers, pseudoexfoliation in anterior segment, and amyloidosis of extraocular vessels. Pedigree analysis suggests an autosomal dominant inheritance with late onset. DNA analysis demonstrated a previously undescribed heterozygous missense p.Glu109Val mutation in transthyretin. CONCLUSION To the best of our knowledge, this is the first family reported with this disorder. Our data support the hypothesis that autosomal dominant Müller cell dystrophy is a distinct retinal dystrophy affecting Müller cells. Mutations in transthyretin gene may manifest as a predominantly retinal disorder.
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Affiliation(s)
- José Dalma-Weiszhausz
- Dr. Alejandro Dalma y Asociados, SC Mexico City, Mexico
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Oscar Chacón-Camacho
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | | | - Juan C Zenteno
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Biochemistry Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; and
| | - Valentina Franco-Cárdenas
- Dr. Alejandro Dalma y Asociados, SC Mexico City, Mexico
- Retina Department, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
- Biochemistry Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; and
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
| | - Leopoldo A García-Montaño
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
| | - Jehieli Pérez-Bravo
- Genetics Department, Instituto de Oftalmología "Conde de Valenciana", Mexico City, Mexico . Mr. García-Montaño is now with the Department of Cell Biology and Physiology, Brain Tumor Translational Laboratory, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Iván A García-Montalvo
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de México Campus Oaxaca (TECNM/ITO), Oaxaca, Mexico
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Kaliki S, Shields CL, Cassoux N, Munier FL, Chantada G, Grossniklaus HE, Yoshikawa H, Fabian ID, Berry JL, McKenzie JD, Kimani K, Reddy MA, Parulekar M, Tanabe M, Furuta M, Grigorovski N, Chevez-Barrios P, Scanlan P, Eagle RC, Rashid R, Coronado RD, Sultana S, Staffieri S, Frenkel S, Suzuki S, Ushakova TL, Ji X. Defining High-Risk Retinoblastoma: A Multicenter Global Survey. JAMA Ophthalmol 2021; 140:30-36. [PMID: 34762098 DOI: 10.1001/jamaophthalmol.2021.4732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance High-risk histopathologic features of retinoblastoma are useful to assess the risk of systemic metastasis. In this era of globe salvage treatments for retinoblastoma, the definition of high-risk retinoblastoma is evolving. Objective To evaluate variations in the definition of high-risk histopathologic features for metastasis of retinoblastoma in different ocular oncology practices around the world. Design, Setting, and Participants An electronic web-based, nonvalidated 10-question survey was sent in December 2020 to 52 oncologists and pathologists treating retinoblastoma at referral retinoblastoma centers. Intervention Anonymized survey about the definition of high-risk histopathologic features for metastasis of retinoblastoma. Main Outcomes and Measures High-risk histopathologic features that determine further treatment with adjuvant systemic chemotherapy to prevent metastasis. Results Among the 52 survey recipients, the results are based on the responses from 27 individuals (52%) from 24 different retinoblastoma practices across 16 countries in 6 continents. The following were considered to be high-risk features: postlaminar optic nerve infiltration (27 [100%]), involvement of optic nerve transection (27 [100%]), extrascleral tissue infiltration (27 [100%]), massive (≥3 mm) choroidal invasion (25 [93%]), microscopic scleral infiltration (23 [85%]), ciliary body infiltration (20 [74%]), trabecular meshwork invasion (18 [67%]), iris infiltration (17 [63%]), anterior chamber seeds (14 [52%]), laminar optic nerve infiltration (13 [48%]), combination of prelaminar and laminar optic nerve infiltration and minor choroidal invasion (11 [41%]), minor (<3 mm) choroidal invasion (5 [19%]), and prelaminar optic nerve infiltration (2 [7%]). The other histopathologic features considered high risk included Schlemm canal invasion (4 [15%]) and severe anaplasia (1 [4%]). Four respondents (15%) said that the presence of more than 1 high-risk feature, especially a combination of massive peripapillary choroidal invasion and postlaminar optic nerve infiltration, should be considered very high risk for metastasis. Conclusions and Relevance Responses to this nonvalidated survey conducted in 2020-2021 showed little uniformity in the definition of high-risk retinoblastoma. Postlaminar optic nerve infiltration, involvement of optic nerve transection, and extrascleral tumor extension were the only features uniformly considered as high risk for metastasis across all oncology practices. These findings suggest that the relevance about their value in the current scenario with advanced disease being treated conservatively needs further evaluation; there is also a need to arrive at consensus definitions and conduct prospective multicenter studies to understand their relevance.
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Affiliation(s)
- Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute India, Hyderabad, India
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nathalie Cassoux
- Department of Surgical Oncology, Insitut Curie Université de Paris, Paris, France
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | | | - Hans E Grossniklaus
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia
| | - Hiroshi Yoshikawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ido Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Jesse L Berry
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles
| | - John D McKenzie
- Department of Ophthalmology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - M Ashwin Reddy
- Retinoblastoma Service, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Manoj Parulekar
- Retinoblastoma Service, Birmingham Women's and Children's National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Mika Tanabe
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Minoru Furuta
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Natalia Grigorovski
- Department of Pediatric Oncology, Clinical Division, National Institute of Cancer, Rio de Janeiro, Brazil
| | | | - Patricia Scanlan
- Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Riffat Rashid
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | | | - Sadia Sultana
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Sandra Staffieri
- Department of Ophthalmology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Retinoblastoma Service, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Shahar Frenkel
- Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shigenobu Suzuki
- Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatiana L Ushakova
- Department of Pediatric Oncology and Hematology, N. N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russia.,Retinoblastoma Service, Medical Academy of Postgraduate Education, Moscow, Russia
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wong A, Teh B, Nguyen B, Pino R, Bretana M, Bernicker E, Chevez-Barrios P, Butler E, Schefler A. Late Midterm Outcomes of Uveal Melanoma Treated with Intraoperative Ultrasound Guided I125 Brachytherapy Using Custom Built Eye Plaques. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.163] [Citation(s) in RCA: 1] [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] [Indexed: 11/26/2022]
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Xu L, Polski A, Prabakar RK, Reid MW, Chevez-Barrios P, Jubran R, Kim JW, Kuhn P, Cobrinik D, Hicks J, Berry JL. Chromosome 6p Amplification in Aqueous Humor Cell-Free DNA Is a Prognostic Biomarker for Retinoblastoma Ocular Survival. Mol Cancer Res 2020; 18:1166-1175. [PMID: 32434859 PMCID: PMC7415535 DOI: 10.1158/1541-7786.mcr-19-1262] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 01/09/2020] [Revised: 04/10/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022]
Abstract
Aqueous humor contains tumor-derived cell-free DNA (cfDNA) and can serve as a liquid biopsy for retinoblastoma. We previously associated somatic copy-number alteration (SCNA) 6p gain with a 10-fold increased risk of enucleation. Here we provide a 2-year update to further explore 6p gain as a prognostic biomarker for ocular survival. Patients diagnosed with retinoblastoma from December 2014 to July 2019 from whom aqueous humor was sampled were included. cfDNA was extracted and shallow whole-genome sequencing performed to identify highly recurrent retinoblastoma SCNAs (gain of 1q, 2p, 6p, loss of 13q, 16q). 116 aqueous humor samples from 50 eyes of 46 patients were included: 27 eyes were salvaged, 23 were enucleated. Highly recurrent retinoblastoma SCNAs were found in 66% eyes. 6p gain was the most prevalent SCNA (50% eyes). It was particularly more prevalent in enucleated eyes (73.9%) than in salvaged eyes (29.6%; P = 0.004). 6p gain in aqueous humor cfDNA portended nearly 10-fold increased odds of enucleation (OR = 9.87; 95% confidence interval = 1.75-55.65; P = 0.009). In the enucleated eyes, 6p gain was associated with aggressive histopathologic features, including necrosis, higher degrees of anaplasia, and focal invasion of ocular structures. With extended follow-up and nearly double the aqueous humor samples, we continue to demonstrate 6p gain as a potential prognostic biomarker for retinoblastoma. IMPLICATIONS: Aqueous humor is a high-yield source of tumor-derived DNA in retinoblastoma eyes. Detection of 6p gain in the aqueous humor allows for targeted, patient-centered therapies based on this molecular prognostic marker. Prospective, multicenter studies with aqueous humor sampled from all eyes at diagnosis are warranted to validate these findings.
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Affiliation(s)
- Liya Xu
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashley Polski
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
| | - Rishvanth K Prabakar
- Department of Molecular and Computational Biology, University of Southern California, Los Angeles, California
| | - Mark W Reid
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Patricia Chevez-Barrios
- Departments of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist, Weill Cornell Medical College, Houston, Texas
| | - Rima Jubran
- Department of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
| | - Peter Kuhn
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - David Cobrinik
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James Hicks
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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8
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Assam JH, Miller AM, Chevez-Barrios P, Lee AG. Extraocular muscle biopsy during surgery for strabismus of unknown etiology. J AAPOS 2019; 23:356-359. [PMID: 31678481 DOI: 10.1016/j.jaapos.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
Most cases of strabismus have a chronic and stable or known etiologic diagnosis prior to surgery. In some cases, however, surgery is undertaken to correct a stable ocular misalignment without a definitive etiology. We present 2 cases, one with euthyroid Graves' orbitopathy and the other with amyloid light-chain amyloidosis, in which extraocular muscle biopsy performed intraoperatively allowed histopathologic confirmation of a clinical diagnosis.
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Affiliation(s)
- Jed H Assam
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston
| | - Aaron M Miller
- Ophthalmology, Institute for Academic Medicine Houston Methodist, Houston, Texas; Ophthalmology, Weill Cornell Medical College, New York, New York; Houston Eye Associates, The Woodlands, Texas
| | - Patricia Chevez-Barrios
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston; Departments of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist, Houston, Texas; Departments of Pathology and Laboratory Medicine and Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Andrew G Lee
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston; Ophthalmology, Institute for Academic Medicine Houston Methodist, Houston, Texas; Ophthalmology, Weill Cornell Medical College, New York, New York; Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York; Ophthalmology UT MD Anderson Cancer Center, Houston, Texas; Texas A and M College of Medicine, Houston; Ophthalmology, Baylor College of Medicine and the Center for Space Medicine, Houston, Texas; Ophthalmology, University of Iowa Hospitals, Iowa City; Ophthalmology, University of Buffalo, Buffalo, New York.
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9
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Zuhour R, Messer J, Haque W, Lewis G, Wong A, Schefler A, Bernicker E, Chevez-Barrios P, Quan M, Farach A, Butler E, Teh B. Trends in Eye Plaque Brachytherapy for the Treatment of Choroidal Melanoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Area C, Yen CJ, Chevez-Barrios P, Herzog C, Kan P, Zheng W, Lin F, Chintagumpala M, Gombos D, Chen SR. Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma. J Neurointerv Surg 2019; 11:1273-1276. [PMID: 31197028 DOI: 10.1136/neurintsurg-2019-014910] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/06/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy has an increasingly prominent role in the management of retinoblastoma. One concern regarding this technique is procedural radiation exposure. OBJECTIVES To examine the effects of our institution's procedural technique on fluoroscopy parameters for patients undergoing intra-arterial chemotherapy infusions for intraocular retinoblastoma. Secondary goals included describing the effect of anatomical variations of the carotid siphon and ophthalmic artery on radiation dose. METHODS A retrospective review of pediatric patients with retinoblastoma referred to interventional neuroradiology for chemosurgery was performed. Techniques were classified as: A (1.2 Fr or 1.5 Fr microcatheter with continuous verapamil flush, advanced without guide through a 2 Fr sheath) or B (1.5 Fr or 1.7 Fr microcatheter advanced within a 4 Fr base catheter, through a 4 Fr sheath). Statistical analysis was performed to determine if there was a significant difference in fluoroscopy parameters based on technique or due to anatomical variation. RESULTS 26 patients were treated with 94 intra-arterial chemotherapy infusions. 34 procedures were performed using technique A and 60 using technique B. Mean fluoroscopy time (4.75 min), fluoroscopy dose (23.3 mGy), and dose-area product (DAP; 85.2 μGy.m2) for technique A were significantly lower (p value <0.05) than for technique B, 14.0 min., 191 mGy, and 586 μGy.cm2, respectively. CONCLUSIONS Microcatheter-only technique with continuous verapamil infusion resulted in decreased fluoroscopy times, DAP, and radiation doses at our institution for the treatment of intraocular retinoblastoma. Furthermore, our fluoroscopy times using this technique are the lowest reported in the current literature. Additionally, our anatomical analysis has demonstrated a positive correlation between increasing vessel tortuosity and fluoroscopy times.
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Affiliation(s)
- Corey Area
- Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher J Yen
- Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Cynthia Herzog
- Pediatric Hematology/Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Kan
- Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Wei Zheng
- Statistics, Texas Children's Hospital, Houston, Texas, USA
| | - Frank Lin
- Hematology/Oncology, Texas Children's Hospital, Houston, Texas, USA
| | | | - Dan Gombos
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen R Chen
- Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
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Amin SD, Vickers A, Hong BY, Ponce CMP, Ibrahim IF, Chevez-Barrios P, Lee AG. Chronic myelomonocytic leukemia-related vasculitis mimicking giant cell arteritis. Can J Ophthalmol 2019; 54:e140-e145. [PMID: 31109503 DOI: 10.1016/j.jcjo.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Sima D Amin
- Texas A&M College of Medicine, College Station, Texas
| | - Aroucha Vickers
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Bennett Y Hong
- Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas
| | | | - Ibrahim F Ibrahim
- Department of Hematology and Oncology, Houston Methodist Hospital, Houston, Texas
| | - Patricia Chevez-Barrios
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Baylor College of Medicine, Houston, Texas; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, N.Y.; The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew G Lee
- Texas A&M College of Medicine, College Station, Texas; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology, Neurology, and Neurosurgery Ophthalmology, Weill Cornell Medicine, New York, N.Y.; Division of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Ophthalmology, Texas A&M College of Medicine, College Station, Texas..
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12
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Messer JA, Zuhour RJ, Haque W, Schefler AC, Bernicker EH, Chevez-Barrios P, Quan EM, Farach A, Butler EB, Teh BS. Eye Plaque Brachytherapy versus Enucleation for Ocular Melanoma: An Analysis from the National Cancer Database. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Golla A, Weikert MP, Chevez-Barrios P, Al-Mohtaseb Z. Anterior Segment Optical Coherence Tomography of Ocular Cystinosis Confirmed by Electron Microscopy. Ocul Oncol Pathol 2019; 5:110-113. [PMID: 30976588 DOI: 10.1159/000490389] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose To report a case of ocular cystinosis diagnosed by anterior segment optical coherence tomography (AS-OCT) and histopathology. Methods A 67-year-old man who presented with eye pain was found to have unilateral corneal crystal deposition. Ocular cystinosis was diagnosed by histopathology, AS-OCT, and lack of renal involvement of the disease. Results AS-OCT showed hyperreflective densities in the corneal epithelium. The patient underwent superficial keratectomy given irregular astigmatism prior to cataract surgery. Electron microscopy of the corneal scrapings revealed epithelial cells with intracystoplasmic membrane-bound crystals confirming the diagnosis of cystinosis. Conclusion To our knowledge, this is the first reported case of ocular cystinosis involving strictly the epithelial layer of the cornea that has been imaged by AS-OCT.
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Affiliation(s)
- Abhinav Golla
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Mitchell P Weikert
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Patricia Chevez-Barrios
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Zaina Al-Mohtaseb
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
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14
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Le N, Vickers A, Prospero Ponce C, Chevez-Barrios P, Lee AG. Vestibulocochlear symptoms as the initial presentation of giant cell arteritis. Can J Ophthalmol 2019; 54:e1-e3. [PMID: 30851784 DOI: 10.1016/j.jcjo.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/28/2018] [Accepted: 04/06/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Nhon Le
- Baylor College of Medicine, Houston, Texas
| | - Aroucha Vickers
- Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Claudia Prospero Ponce
- Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Patricia Chevez-Barrios
- Baylor College of Medicine, Houston, Texas; Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Departments of Pathology and Laboratory Medicine and Ophthalmology, Weill Cornell Medicine, New York, N.Y
| | - Andrew G Lee
- Baylor College of Medicine, Houston, Texas; Department of Ophthalmology and the Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, N.Y; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center, Houston, Texas; Texas A & M College of Medicine, Bryan, Texas; Weill Cornell Medicine; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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15
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Kim RS, Chevez-Barrios P, Divatia M, Bretana ME, Teh B, Schefler AC. Yield, Techniques, and Complications of Transvitreal and Transscleral Biopsies in Small Uveal Melanoma. JAMA Ophthalmol 2018; 136:482-488. [PMID: 29596552 DOI: 10.1001/jamaophthalmol.2018.0561] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Intraoperative adequacy check of biopsy samples can lead to a higher biopsy yield rate, and subsequent genomic analysis can provide patients with valuable prognostic information. Objectives To examine the yield rates for transscleral and transvitreal fine-needle aspiration biopsies of small uveal melanoma less than 3.6 mm in apical height and to discuss techniques that would maximize yield rates and minimize complications. Design, Setting, and Participants A retrospective, consecutive observational case series was conducted from January 29, 2013, to May 23, 2017, at Retina Consultants of Houston and Houston Methodist Hospital among 44 patients with uveal melanoma of the ciliary body or choroid. Interventions or Exposures Fine-needle aspiration biopsy and intraoperative histopathologic analysis prior to iodine 125 brachytherapy. Main Outcomes and Measures Tumor locations and dimensions were identified by histopathologic analysis and B-scan ultrasonography. Either transscleral or transvitreal biopsy was performed for tumors anterior to the equator and posterior to the equator, respectively. Biopsy specimens were checked for adequacy intraoperatively. Specimens were examined using hematoxylin-eosin, double immunostain with human melanoma black 45 and Ki67, and gene expression profile. Results A total of 44 patients were included in the study, with a mean (SD) age of 63.3 (12.7) years (21 men [47.7%]; 23 women [52.3%]). Median tumor height was 2.7 mm (interquartile range, 2.3- 2.9 mm). Forty of 44 biopsy samples (90.9%; 95% CI, 82.4%-99.4%) yielded adequate cells for gene expression profile analysis. Transscleral and transvitreal yield rates were 11 of 11 (100%) and 29 of 33 (87.9%), respectively. Most localized vitreous hemorrhages were resolved by 3 months. There was a moderate association between localized vitreous hemorrhage and transvitreal biopsy method, for which the phi value was -0.526 (95% CI, -0.712 to -0.157; P < .001). Conclusions and Relevance These findings suggest intraoperative adequacy evaluation of fine-needle aspiration biopsy specimens leads to high yield and is more informative for patients.
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Affiliation(s)
- Ryan Sangwoo Kim
- McGovern Medical School at The University of Texas Health Science Center, Houston.,Retina Consultants of Houston, Houston, Texas
| | - Patricia Chevez-Barrios
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.,Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Houston, Texas.,Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Mukul Divatia
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.,Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas
| | | | - Bin Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Amy Claire Schefler
- Retina Consultants of Houston, Houston, Texas.,Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas.,Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
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16
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Kim JW, Jacobsen B, Zolfaghari E, Ferrario A, Chevez-Barrios P, Berry JL, Lee DK, Rico G, Madi I, Rao N, Stachelek K, Wang LC, Gomer C. Rabbit model of ocular indirect photodynamic therapy using a retinoblastoma xenograft. Graefes Arch Clin Exp Ophthalmol 2017; 255:2363-2373. [DOI: 10.1007/s00417-017-3805-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/07/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022] Open
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17
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Christensen PA, Lee NE, Thrall MJ, Powell SZ, Chevez-Barrios P, Long SW. RecutClub.com: An Open Source, Whole Slide Image-based Pathology Education System. J Pathol Inform 2017; 8:10. [PMID: 28382224 PMCID: PMC5364738 DOI: 10.4103/jpi.jpi_72_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/23/2016] [Accepted: 01/18/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Our institution's pathology unknown conferences provide educational cases for our residents. However, the cases have not been previously available digitally, have not been collated for postconference review, and were not accessible to a wider audience. Our objective was to create an inexpensive whole slide image (WSI) education suite to address these limitations and improve the education of pathology trainees. MATERIALS AND METHODS We surveyed residents regarding their preference between four unique WSI systems. We then scanned weekly unknown conference cases and study set cases and uploaded them to our custom built WSI viewer located at RecutClub.com. We measured site utilization and conference participation. RESULTS Residents preferred our OpenLayers WSI implementation to Ventana Virtuoso, Google Maps API, and OpenSlide. Over 16 months, we uploaded 1366 cases from 77 conferences and ten study sets, occupying 793.5 GB of cloud storage. Based on resident evaluations, the interface was easy to use and demonstrated minimal latency. Residents are able to review cases from home and from their mobile devices. Worldwide, 955 unique IP addresses from 52 countries have viewed cases in our site. CONCLUSIONS We implemented a low-cost, publicly available repository of WSI slides for resident education. Our trainees are very satisfied with the freedom to preview either the glass slides or WSI and review the WSI postconference. Both local users and worldwide users actively and repeatedly view cases in our study set.
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Affiliation(s)
- Paul A Christensen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College of Cornell University, Houston, TX 77030, USA
| | - Nathan E Lee
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College of Cornell University, Houston, TX 77030, USA
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College of Cornell University, Houston, TX 77030, USA
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College of Cornell University, Houston, TX 77030, USA
| | - Patricia Chevez-Barrios
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College of Cornell University, Houston, TX 77030, USA
| | - S Wesley Long
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College of Cornell University, Houston, TX 77030, USA
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18
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Kim RS, Chevez-Barrios P, Bretana ME, Wong TP, Teh BS, Schefler AC. Histopathologic Analysis of Transvitreal Fine Needle Aspiration Biopsy Needle Tracts for Uveal Melanoma. Am J Ophthalmol 2017; 174:9-16. [PMID: 27818205 DOI: 10.1016/j.ajo.2016.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/20/2016] [Accepted: 10/26/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE Perform the first in vivo examination of fine needle aspiration biopsy (FNAB) scleral tracts to determine the incidence of iatrogenic extension of tumor cells. DESIGN A prospective, consecutive, observational case series. METHODS This study was performed in a clinical/surgical setting at Retina Consultants of Houston and Houston Methodist Hospital, Houston, Texas, and included 10 patients who were scheduled for enucleation as primary treatment for uveal melanoma. Treatment included FNAB, enucleation, and histopathologic analysis. The primary outcomes were tumor location and dimension as identified by B-scans and histopathologic analysis. Tumor type was classified by gene expression profile and American Joint Committee on Cancer staging. Twenty-five- or 27-gauge needles were used for FNAB under direct visualization. Cell blocks of acquired specimens were examined using hematoxylin-eosin stain and double immunostain using HMB45 with red chromogen and Ki67 with brown 3,3'-diaminobenzidine chromogen. RESULTS Mean follow-up after enucleation was 20.4 months (range 9.9-31.7). All biopsy specimens had adequate yields for genomic analysis. No enucleation specimen contained tumor cells within sclera, pars plana, or pars plicata. One specimen contained a small collection of tumor cells within the anterior vitreous in the quadrant of the biopsy site. No patient developed an orbital recurrence. Four patients developed nonorbital metastatic uveal melanoma during the study period. Three of them died, and 1 is alive with hepatic metastasis. CONCLUSIONS No iatrogenic extension of tumor was reported. FNAB is a safe procedure that produces a high cellular yield for cytologic and genomic analyses with minimal risk of extraocular dissemination.
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Affiliation(s)
- Ryan S Kim
- Retina Consultants of Houston, Houston, Texas
| | - Patricia Chevez-Barrios
- Ophthalmology, Pathology, and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Pathology and Laboratory Medicine, Weill Cornell Medicine, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | | | - Tien P Wong
- Retina Consultants of Houston, Houston, Texas
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Amy C Schefler
- Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.
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19
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Milgrom SA, Cheah CY, Pinnix CC, Smith GL, Dabaja BS, Horace P, Chevez-Barrios P, Fowler NH, Gombos DS. Acute and late toxicity of bilateral orbital irradiation in the management of primary intraocular lymphoma. Leuk Lymphoma 2016; 57:2612-8. [PMID: 27075636 PMCID: PMC6047351 DOI: 10.3109/10428194.2016.1166490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/13/2022]
Abstract
Primary intraocular lymphoma (PIOL) is a rare malignancy with poor outcomes. Concerns regarding toxicity lead some clinicians to exclude orbital radiation therapy (RT). We aimed to quantify the ocular toxicity of RT in 11 PIOL patients treated with chemoimmunotherapy and bilateral orbital RT (median 36 Gy). A multidisciplinary team, including an ocular oncologist, followed patients for a median of 42 months after RT. Common adverse events included dermatitis (100%), conjunctivitis (82%), xerophthalmia (64%), and keratopathy (45%). All phakic eyes developed cataracts (100%); correction resulted in good vision recovery. New, visually significant retinopathy was observed in only one eye (<5%) and affected a patient with preexisting diabetes. This report suggests that severe, vision-threatening complications following orbital RT are uncommon. In the absence of comorbidities, orbital RT should not be withheld due to fear of vision-threatening toxicity. The risk of toxicity may be augmented by comorbidities, so an individualized approach is recommended.
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Affiliation(s)
- Sarah A Milgrom
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Chan Y Cheah
- b Department of Medical Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Chelsea C Pinnix
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Grace L Smith
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Bouthaina S Dabaja
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Patricia Horace
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | | | - Nathan H Fowler
- b Department of Medical Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Dan S Gombos
- d Department of Ophthalmology , MD Anderson Cancer Center , Houston , TX , USA
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Green AL, Chintagumpala M, Krailo M, Langholz B, Albert D, Eagle R, Cockburn M, Chevez-Barrios P, Rodriguez-Galindo C. Correlation of Insurance, Race, and Ethnicity with Pathologic Risk in a Controlled Retinoblastoma Cohort: A Children's Oncology Group Study. Ophthalmology 2016; 123:1817-1823. [PMID: 27262763 DOI: 10.1016/j.ophtha.2016.04.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine whether insurance status, race, and ethnicity correlate with increased retinoblastoma invasiveness as a marker of both risk and time to diagnosis. DESIGN Retrospective case-control study. PARTICIPANTS All 203 patients from the United States enrolled in the Children's Oncology Group (COG) trial ARET0332, a study of patients with unilateral retinoblastoma requiring enucleation. MAIN OUTCOME MEASURES All surgical specimens underwent pathologic review to determine the presence of well-defined histopathologic features correlating with a higher risk of disease progression. Insurance status, race, and ethnicity were compiled from the study record for each patient. RESULTS On institutional pathologic review, nonprivate insurance, nonwhite race, and Hispanic ethnicity all correlated significantly with a greater rate of high-risk pathologic findings. Hispanic ethnicity remained a significant predictor on multivariate analysis. On central pathologic review, these correlations remained but did not reach statistical significance. The differences in results from institutional versus central pathologic reviews appeared to be due to a higher likelihood of patients in minority groups of being misclassified as high risk by institutional pathologists. CONCLUSIONS In this controlled study population of patients with retinoblastoma who had central pathologic review, our findings suggest a higher rate of more advanced disease associated with nonprivate insurance, nonwhite race, and Hispanic ethnicity; these findings may be due to delays in diagnosis for these groups. Future work should use direct methods to study the impact of other variables, including English-language proficiency and socioeconomic status. Further effort also should focus on where in the diagnostic process potential delays exist, so that interventions can be designed to overcome barriers to care for these groups. In addition, potential systematic differences in pathologic reads based on demographic variables deserve further study.
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Affiliation(s)
- Adam L Green
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
| | - Murali Chintagumpala
- Texas Children's Cancer Center, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Mark Krailo
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Bryan Langholz
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Daniel Albert
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ralph Eagle
- Pathology Department, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Myles Cockburn
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Carlos Rodriguez-Galindo
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
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Abstract
IgG4-related systemic disease is an inflammatory disorder that can affect many organs. This case report describes a patient who in 2004 was found to have an inflammatory pseudotumor with IgG4 pathology. Over the next 3 years, visual symptoms responded well to recurrent courses of prednisone. In 2009, the patient developed chest pain and bradycardia with subsequent third-degree heart block, necessitating placement of a pacemaker. A subsequent PET scan showed extensive involvement of multiple organs as described in IgG4 disease as well as involvement of the myocardium and SA node. Pseudotumors involving the heart have been reported but have not been shown to be related to IgG4 disease. Although there was no pathology confirmation of heart involvement, the nature and extent of the organ involvement led us to conclude that it was due to IgG4-related disease. The use of the PET scan may help identify involvement of the myocardium.
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Affiliation(s)
- Hector Carbajal
- Houston Methodist Hospital, Houston, Texas ; Weill Cornell Medical College, New York, New York
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22
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Butler MR, Prospero Ponce CM, Weinstock YE, Orengo-Nania S, Chevez-Barrios P, Frankfort BJ. Topical silver nanoparticles result in improved bleb function by increasing filtration and reducing fibrosis in a rabbit model of filtration surgery. Invest Ophthalmol Vis Sci 2013; 54:4982-90. [PMID: 23766475 PMCID: PMC3723376 DOI: 10.1167/iovs.13-12047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 03/16/2013] [Accepted: 06/06/2013] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To compare the effects of silver nanoparticles (AgNPs) and mitomycin C (MMC) on intraocular pressure (IOP) and external, histologic, and immunohistochemical bleb characteristics in a rabbit model of filtration surgery. METHODS Filtration surgery with concurrent topical application of either AgNPs or MMC was performed on 14 pigmented Dutch Belted rabbits. IOP and bleb characteristics were compared on postoperative day 1 and at weeks 1 through 6. Hematoxylin and eosin staining and smooth muscle actin (SMA) immunohistochemistry were performed at postoperative week 6. RESULTS Average IOP across all time points was reduced 5.8 and 3.8 mm Hg in AgNP- and MMC-treated eyes, respectively. At week 6, IOP was reduced 4.1 and 0.2 mm Hg in AgNP- and MMC-treated eyes, respectively. Blebs were smaller, thicker, and less ischemic in AgNP-treated eyes. AgNP-treated eyes showed less fibrosis and more stromal edema, suggesting increased filtration, and also had fewer SMA-positive myofibroblasts, suggesting reduced bleb contraction. AgNP-treated eyes showed more lymphocytes than MMC-treated eyes. There were few complications in both groups. CONCLUSIONS In a rabbit model of filtration surgery, AgNPs are a reasonable alternative to MMC as adjunctive therapy. Compared to MMC, AgNPs result in an improved and sustained reduction of IOP and promote blebs with decreased fibrosis and ischemia as well as increased filtration despite a smaller overall size. This combination may offer an opportunity to promote long-term surgical IOP reduction with an improved complication profile.
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Affiliation(s)
- Michelle R. Butler
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | | | - Y. Etan Weinstock
- Department of Otorhinolaryngology, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Silvia Orengo-Nania
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Patricia Chevez-Barrios
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
- Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas
| | - Benjamin J. Frankfort
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
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Green AL, Langholz B, Chintagumpala MM, Cockburn M, Chevez-Barrios P, Albert D, Eagle R, Rodriguez-Galindo C. Correlation of insurance status, ethnicity, and race with pathologic risk in retinoblastoma: A Children's Oncology Group (COG) study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17573 Background: Insurance status affects cancer diagnosis and outcome in adults, but the impact has not been well studied in pediatric cancer. In children with retinoblastoma, time to diagnosis correlates with tumor invasiveness and patient survival, and therefore the disease can be a model to study the effect of demographic variables on delays in diagnosis. Methods: Our patient population consisted of all 203 patients from the United States enrolled on Children’s Oncology Group ARET0332, a study of patients with unilateral retinoblastoma requiring enucleation. All surgical specimens underwent central review by three pathologists to determine the presence of well-defined histopathologic features that correlate with a higher risk of disease progression. Data on insurance status, ethnicity, and race were collected for each patient. For variables not collected, including English proficiency, income, and educational attainment, analyses were conducted indirectly by matching patient zip code with census data for each variable. Results: On univariate analysis, a higher rate of high-risk pathologic findings was found in patients of Hispanic ethnicity (p=0.021) and non-white race (p=0.037), and in those with Medicaid or no insurance (p=0.035). On multivariate analysis, although no one variable correlated with high-risk features independently from the others, Hispanic ethnicity had the greatest impact on risk. Zip code-based analysis did not show significant differences in rates of high-risk findings based on English proficiency, income, or education. Conclusions: Hispanic ethnicity, non-white race, and Medicaid or no insurance all correlated with high-risk pathologic features in a large group of retinoblastoma patients who had central pathology review, and we believe these findings are due to delays in diagnosis for these groups. Future work should use direct methods to study the impact of other variables, including English proficiency, since indirect, zip code-based analysis may be inadequately powered to do so. Further effort should also focus on where in the diagnostic process delays exist, so that interventions can be designed to overcome barriers to care for these groups.
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Affiliation(s)
- Adam L. Green
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Bryan Langholz
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | | | - Myles Cockburn
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | | | - Daniel Albert
- University of Wisconsin Eye Research Institute, Madison, WI
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Chintagumpala MM, Langholz B, Eagle R, Albert D, Ali MJ, Khetan V, Honavar S, O'Brien J, Leahey A, Matthay KK, Meadows AT, Chevez-Barrios P. A large prospective trial of children with unilateral retinoblastoma with and without histopathologic high-risk features and the role of adjuvant chemotherapy: A Children’s Oncology Group (COG) study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9515 Background: The definition of histopathologic high-risk features (HRF) in enucleated eyes of children with unilateral retinoblastoma and their contribution to metastases is controversial. The COG completed a large, prospective international study to determine the prevalence of strictly defined histopathologic HRF that are predictors of recurrence and the role of chemotherapy to prevent recurrences. Methods: All patients who underwent enucleation for unilateral retinoblastoma were eligible for the study. Pathology slides were submitted for central review within 21 days of enucleation. Patients with evidence of one or more high-risk features (posterior uveal invasion grades IIC and D, concurrent optic nerve and choroid involvement and post-lamina optic nerve involvement) as determined by central review, received 6 cycles of chemotherapy consisting of carboplatin, vincristine and etoposide. All others were observed. All patients were followed for extraocular recurrences. Results: Patients were enrolled from February of 2005 until May 2010. As of July 2011, the median follow-up from enrollment was 1.9 years (max=5.3 years). Of 312 patients with central histopathology review, 49 patients had their risk classification changed (13% with no HRF had HRF, 24% with HRF had no HRF). Two patients developed extraocular disease and one patient died of unknown cause. The death and one of the extraocular relapses occurred among the 93 (2/93=2.2%, upper 95% CI 3.4%) patients assigned by the central review to receive chemotherapy, while one patient experienced extraocular relapse among the 209 (1/209=0.5%, upper 95% CI 0.6%) assigned to observation only. There is no evidence of a difference in the EFS and OS in these two groups. Conclusions: Preliminary results strongly suggest that a central review of pathology can spare a significant number of patients from exposure to chemotherapy. Chemotherapy may have contributed to fewer relapses in patients with high-risk features as defined in this study. The preliminary results from this study indicate an excellent outcome with this approach.
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Affiliation(s)
| | | | | | - Daniel Albert
- University of Wisconsin Eye Research Institute, Madison, WI
| | | | | | | | | | - Ann Leahey
- Children's Hospital of Philadelphia, Philadelphia, PA
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Hwang CK, Aaberg TM, Chevez-Barrios P, Verner-Cole E, Gombos DS, Paysse E, Chintagumpala M, Gao W, Grossniklaus HE. Residual intraretinal retinoblastoma after chemoreduction failure. ACTA ACUST UNITED AC 2012; 130:246-8. [PMID: 22332223 DOI: 10.1001/archopthalmol.2011.1588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher K Hwang
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA
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Manzano RPDA, Peyman GA, Khan P, Kivilcim M, Chevez-Barrios P, Takahashi W. Testing intravitreal toxicity of rapamycin in rabbit eyes. Arq Bras Oftalmol 2009; 72:18-22. [DOI: 10.1590/s0004-27492009000100004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 11/25/2008] [Indexed: 11/22/2022] Open
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Rodriguez-Galindo C, Wilson MW, Chantada G, Fu L, Qaddoumi I, Antonelli C, Leal-Leal C, Sharma T, Barnoya M, Epelman S, Pizzarello L, Kane JR, Barfield R, Merchant TE, Robison LL, Murphree AL, Chevez-Barrios P, Dyer MA, O′Brien J, Ribeiro RC, Hungerford J, Helveston EM, Haik BG, Wilimas J. Retinoblastoma: one world, one vision. Pediatrics 2008; 122:e763-70. [PMID: 18762512 PMCID: PMC2844325 DOI: 10.1542/peds.2008-0518] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Retinoblastoma is curable when diagnosed early and treated appropriately; however, the prognosis is dismal when the basic elements of diagnosis and treatment are lacking. In developing countries, poor education, lower socioeconomic conditions, and inefficient health care systems result in delayed diagnosis and suboptimal care. Furthermore, the complexity of multidisciplinary care required is seldom possible. Whereas ocular salvage is a priority in the Western world, death from retinoblastoma is still a major problem in developing countries. To bring the 2 ends of this spectrum together and provide a forum for discussion, the "One World, One Vision" symposium was organized, at which clinicians and researchers from various cultural, geographic, and socioeconomic backgrounds converged to discuss their experiences. Strategies for early diagnosis in developing countries were discussed. Elements of the development of retinoblastoma centers in developing countries were discussed, and examples of successful programs were highlighted. An important component in this process is twinning between centers in developing countries and mentor institutions in high-income countries. Global initiatives by nongovernmental organizations such as the International Network for Cancer Treatment and Research, Orbis International, and the International Agency for Prevention of Blindness were presented. Treatment of retinoblastoma in developing countries remains a challenge; however, it is possible to coordinate efforts at multiple levels, including public administrations and nonprofit organizations, to improve the diagnosis and treatment of retinoblastoma and to improve the outcome for these children.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Department of Oncology, St Jude Children's Research Hospital, 332 N Lauderdale, Memphis, TN 38105, USA.
| | - Mathew W. Wilson
- Department of Ophthalmology and Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, US
| | - Guillermo Chantada
- Department of Oncology, Hospital Nacional de Pediatria J.P. Garrahan, Buenos Aires, Argentina
| | - Ligia Fu
- Department of Hematology-Oncology, Hospital de Niños, Tegucigalpa
| | - Ibrahim Qaddoumi
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Célia Antonelli
- Department of Pediatrics, Hospital do Câncer A.C. Camargo, São Paulo, Brazil
| | - Carlos Leal-Leal
- Department of Oncology, Instituto Nacional de Pediatria, Mexico City, Mexico
| | - Tarum Sharma
- The Sankara Nethralaya Foundation, Chennai, India
| | | | - Sidnei Epelman
- International Network for Cancer Treatment and Research, São Paulo, Brazil
| | - Louis Pizzarello
- International Agency for the Prevention of Blindness and Mailman School of Public Health, Columbia University, New York, US
| | - Javier R. Kane
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Ray Barfield
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Thomas E. Merchant
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Leslie L. Robison
- Department of Epidemiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - A. Linn Murphree
- Department of Ophthalmology, Children’s Hospital of Los Angeles, California, US
| | | | - Michael A. Dyer
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Joan O′Brien
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, US
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US,Department of International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - John Hungerford
- Department of Ophthalmology, St. Bartholomew’s Hospital, London, UK
| | - Eugene M. Helveston
- Orbis International and Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Barrett G. Haik
- Department of Ophthalmology and Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, US
| | - Judith Wilimas
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US,Department of International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
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Abd-El-Barr MM, Albini TA, Carvounis PE, He F, Manzano RPA, Chevez-Barrios P, Wensel TG, Wu SM, Holz ER. Safety and pharmokinetics of triamcinolone hexacetonide in rabbit eyes. J Ocul Pharmacol Ther 2008; 24:197-205. [PMID: 18355133 DOI: 10.1089/jop.2007.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate whether intravitreal triamcinolone hexacetonide (TH) is a safe, longer lasting alternative to intravitreal triamcinolone acetonide (TA) in the rabbit eye. METHODS Three groups, each comprising of 15 Dutch-belted rabbits, received a unilateral injection of 0.1 mL of drug and 0.1 mL of physiologic salt solution in the fellow eye. Group I received TA, group II received commercially available TH, and group III received reformulated iso-osmolar triamcinolone hexacetonide (rTH). Simultaneous bilateral dark-adapted electroretinography was performed following the injection. Retinal morphology was assessed by using histopathology in each group enucleated 12 weeks after injection. High-performance liquid chromatography of vitreous isolated from the enucleated eyes was used to determine drug concentrations. RESULTS A significant reduction in saturated a-wave and maximal scotopic b-wave was observed in the group II eyes relative to the fellow control eyes at both 2 and 12 weeks postinjection (P < 0.001 for each comparison) but not in the other groups. Histopathology showed no differences between drug-injected eyes and fellow control eyes in groups I and III, but in group II there was severe degeneration of all retina layers. In group I, the drug half-life was 17.7 +/- 1.7 days, group II 44 +/- 13 days, and group III 12.8 +/- 2.3 days. CONCLUSIONS The half-life of commercially available TH in the vitreous is double that of TA, but the former is toxic to the retina in this rabbit model. Reformulated iso-osmolar TH showed no evidence of deleterious effects to retina function or structure but had a similar half-life to TA.
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Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
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Chantada GL, Doz F, Orjuela M, Qaddoumi I, Sitorus RS, Kepak T, Furmanchuk A, Castellanos M, Sharma T, Chevez-Barrios P, Rodriguez-Galindo C. World disparities in risk definition and management of retinoblastoma: a report from the International Retinoblastoma Staging Working Group. Pediatr Blood Cancer 2008; 50:692-4. [PMID: 18059037 DOI: 10.1002/pbc.21427] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Following from the publication of the International Retinoblastoma Staging System, an open internet discussion group was created at the www.cure4kids.org resource. The results of a survey distributed among participants are discussed. Although most patients with retinoblastoma were treated under prospective protocols, there was a wide variation in the definition of risk criteria and in the criteria for giving adjuvant chemotherapy following enucleation. Definition of high-risk histological features and the criteria for use of adjuvant therapy will be standardized in future studies. Internet meetings are a valuable mechanism for enabling participation from under-resourced countries in the development of cooperative studies.
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Affiliation(s)
- Guillermo L Chantada
- Hospital JP Garrahan, Buenos Aires, Argentina and International Outreach Program, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
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Ho VH, Chevez-Barrios P, Jorgensen JL, Silkiss RZ, Silkis RZ, Esmaeli B. Receptor expression in orbital inflammatory syndromes and implications for targeted therapy. ACTA ACUST UNITED AC 2007; 70:105-9. [PMID: 17610415 DOI: 10.1111/j.1399-0039.2007.00863.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To investigate the expression of multiple therapeutic targets in tissue specimens from patients with orbital inflammatory syndromes, the clinical records of 16 patients treated for orbital inflammation between January 2003 and November 2005 for whom tissue blocks were available were reviewed retrospectively. Immunohistochemical staining was performed on archived specimens using commercially available monoclonal antibodies against CD3, CD20, CD22, CD23, CD25, and CD52 antigens. The histologic diagnoses were confirmed, and the immunohistochemical staining patterns were agreed upon by both collaborating pathologists (JLJ and PC-B). The study included 13 women and 3 men who ranged in age from 4 to 79 years (mean, 46 years). The histologic diagnoses were as follows: orbital pseudotumor in six patients; sarcoidosis, three; eosinophilic granuloma, one; necrobiotic xanthogranuloma, one; nonspecified granulomatous inflammation, one; Graves' ophthalmopathy, one; Wegener's granulomatosis, one; and reactive lymphoid hyperplasia, two. One orbital lymphoma specimen and one foreign body reaction specimen were used as controls. CD20 was strongly expressed in all specimens except three (Wegener's granulomatosis, eosinophilic granuloma, and nonspecified granulomatous inflammation specimens), and CD25 was strongly expressed in all specimens except the Wegener's granulomatosis specimen, in which this antigen was only moderately expressed. CD20 and CD25 were strongly or moderately expressed in most of the tested specimens of orbital inflammation. If our findings are confirmed in a larger study, rituximab, which targets CD20, and denileukin diftitox (ONTAK), which targets CD25, should be considered for future clinical trials for orbital inflammatory syndromes.
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Affiliation(s)
- V H Ho
- Section of Ophthalmology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Albini TA, Abd-El-Barr MM, Carvounis PE, Iyer MN, Lakhanpal RR, Pennesi ME, Chevez-Barrios P, Wu SM, Holz ER. Long-term Retinal Toxicity of Intravitreal Commercially Available Preserved Triamcinolone Acetonide (Kenalog) in Rabbit Eyes. ACTA ACUST UNITED AC 2007; 48:390-5. [PMID: 17197559 DOI: 10.1167/iovs.06-0145] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate whether intravitreal Kenalog (IVTK; Bristol Meyers Squibb Company, Princeton, NJ) produces histologic or electroretinographic changes in the rabbit retina up to 3 months after injection. METHODS Ten Dutch-belted rabbits were injected with 4 mg/0.1 mL Kenalog in one eye and 0.1 mL physiologic salt solution (PSS) in the fellow eye. Simultaneous bilateral dark-adapted electroretinography was performed 2 weeks and 12 weeks after injection in 10 and 6 rabbits, respectively. Saturated a-wave amplitude, maximal scotopic b-wave amplitude, and individual a-wave and b-wave amplitudes of IVTK-injected and control eyes were compared at 2 and 12 weeks after injection. Light microscopy was performed on both eyes of three animals 3 months after injection. Immunohistochemistry was performed with antibodies recognizing vimentin and human alveolar macrophage (HAM)-56, markers of glial cells and macrophages, respectively. RESULTS No significant difference was observed in the saturated a-wave or maximal scotopic b-wave amplitudes between the PSS-injected eyes and the IVTK-injected eyes at 2 weeks (P = 0.95 and P = 0.56, respectively) and 12 weeks (P = 0.82 and P = 0.17) after injection. Light microscopy and immunohistochemistry disclosed only rare macrophages in the vitreous of IVTK-injected eyes. Retinal layers, retinal pigment epithelium, and choriocapillaris in treatment and control eyes were unremarkable. CONCLUSIONS No demonstrable electroretinographic or histologic changes occurred to suggest immediate or delayed widespread retinal toxicity of IVTK.
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Affiliation(s)
- Thomas A Albini
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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Vejabhuti C, Harris GJ, Erickson BA, Nishino H, Chevez-Barrios P, Chang CC. BCL10 expression in ocular adnexal lymphomas. Am J Ophthalmol 2005; 140:836-843. [PMID: 16310461 DOI: 10.1016/j.ajo.2005.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 05/19/2005] [Accepted: 05/19/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To study BCL10 expression in ocular adnexal lymphoma in the US population and its association with clinical outcomes. DESIGN Institutional, retrospective study. METHODS Immunohistochemistry was performed with antibody against BCL10 on two tissue microarray blocks that were constructed with paraffin-embedded tissues from the same cohort of 48 patients with ocular adnexal lymphomas. The main outcomes that were measured include extraorbital involvement, recurrence rate, and time to recurrence. The median length of the follow-up period was 40 months. RESULTS Aberrant BCL10 expression (nuclear [moderate intensity] and cytoplasmic [weak to moderate intensity] staining) was observed in 10 of 33 cases (30.3%) of mucosa-associated lymphoid tissue (MALT) lymphoma, in 4 of 10 cases (40%) of follicular lymphoma (grade 1, 9 cases; grade 2, 1 case), in 0 of 2 cases of diffused large B-cell lymphoma, in 0 of 1 case of chronic lymphocytic leukemia/small lymphocytic lymphoma and in 1 of 1 case (100%) of mantle cell lymphoma. There were no differences in clinical parameters at examination (ie, average age, gender, site of occurrence, laterality, extraorbital involvement at diagnosis), recurrence rate, and time to recurrence for patients (MALT lymphoma or follicular lymphoma) with or without aberrant nuclear BCL10 expression. CONCLUSION Aberrant BCL10 expression can occur in other types of ocular adnexal lymphomas besides MALT lymphoma. Ocular adnexal MALT lymphoma may have slightly lower frequency of aberrant BCL10 expression than gastric/pulmonary MALT lymphomas that have been reported in the literature. Furthermore, aberrant BCL10 nuclear expression in ocular adnexal lymphoma does not seem to correlate with clinical outcome. Further studies that include a larger number of cases and longer follow-up period are needed to confirm our observation.
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Affiliation(s)
- Choladda Vejabhuti
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
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Allen TC, Chevez-Barrios P, Shetlar DJ, Cagle PT. Pulmonary and ophthalmic involvement with Erdheim-Chester disease: a case report and review of the literature. Arch Pathol Lab Med 2005; 128:1428-31. [PMID: 15578889 DOI: 10.5858/2004-128-1428-paoiwe] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Erdheim-Chester disease is a rare nonfamilial histiocytic disorder of unknown etiology with characteristic long bone findings. The 3-year survival rate for patients with Erdheim-Chester disease is 50%. Approximately 50% of patients have disease involvement in other tissues, including skin, retro-orbital and periorbital tissues, pituitary-hypothalamic axis, heart, kidney, retroperitoneum, breast, skeletal muscle, and sinonasal mucosa; about 20% of patients have lung involvement. Prognosis generally depends on the extent of the extraosseous disease. For patients with lung involvement, gender distribution is equal, but men typically present at an older age than do women. Approximately 80% of patients present with dyspnea, and most patients have diffuse interstitial infiltrates and pleural and/or interlobar septal thickening on chest radiology. Characteristic lung histopathology includes the accumulation of histiocytes with variable amounts of fibrosis and a variable lymphoplasmacytic infiltrate in a lymphangitic distribution. Immunostains are diagnostically useful, showing immunopositivity for CD68 and factor XIIIa and immunonegativity for CD1a. Birbeck granules are uniformly absent ultrastructurally.
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Affiliation(s)
- Timothy Craig Allen
- Department of Pathology, University of Texas Health Center at Tyler, Houston, Tex 75708-3154, USA.
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Parker JR, Powell S, Chevez-Barrios P, Haykal HA, Ostrowski ML. Aspiration biopsy findings in amyloid tumor of the cervical vertebra. A case report. Acta Cytol 2001; 45:399-403. [PMID: 11393073 DOI: 10.1159/000327637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The differential diagnosis of destructive lytic lesions of the spine includes amyloid tumors. The diagnosis of amyloid tumor with fine needle aspiration biopsy (FNA) is challenging. Previous reports of FNA of osseous amyloid tumors have detailed the cytologic appearance of amyloid along with lymphocytes, plasma cells and histiocytes, occasionally multinucleate or forming granulomatous lesions. CASE An 84-year-old man presented with neck pain. Radiologic studies showed a destructive, lytic lesion of C-6, with a large, soft tissue mass. FNA yielded many acellular smears containing abundant amyloid that was confirmed with special stains of corresponding tissue cores and subsequent surgical biopsies. CONCLUSION Osseous amyloid tumors are destructive, lytic lesions that mimic other processes. Amyloid can be distinguished from other substances in FNA samples and amyloid tumor identified, even when amyloid is present without typical cellular components.
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Affiliation(s)
- J R Parker
- Department of Pathology, Baylor College of Medicine and Methodist Hospital, Houston, Texas, USA
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Font RL, Samaha AN, Keener MJ, Chevez-Barrios P, Goosey JD. Corneal microsporidiosis. Report of case, including electron microscopic observations. Ophthalmology 2000; 107:1769-75. [PMID: 10964843 DOI: 10.1016/s0161-6420(00)00285-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To report a case of corneal stromal infection caused by a protozoon of the genus MICROSPORIDIA:, including clinical, histopathologic, and electron microscopic observations. DESIGN Case report. METHODS Light and electron microscopy studies were performed on keratectomy specimens from a 67-year-old immunocompetent man who had a unilateral chronic stromal keratitis that was refractory to medical treatment. Initial corneal biopsy followed by lamellar and penetrating keratoplasty were performed on the patient. All the specimens were studied histopathologically. RESULTS Light microscopy of the corneal biopsy and the subsequent keratectomy specimens demonstrated myriad small, round to oval microsporidial organisms measuring 3.5 to 5.0 micrometer in length that stained positively with the periodic acid-Schiff, Grocott-methenamine silver, and acid-fast methods and were gram positive. Electron microscopic observations demonstrated viable blastospores that had a thin osmiophilic outer cell wall and contained 11 to 13 coils of the filament. The light and electron microscopic features, the tinctorial characteristics, and the selective corneal stromal involvement are consistent with microsporidial keratitis. CONCLUSIONS Microsporidiosis should be considered in the differential diagnosis of a culture-negative stromal keratitis refractory to medical treatment. The diagnosis can be easily established based on the morphologic features of the protozoa in the keratectomy specimens. No effective medical treatment for the stromal disease is available. Full-thickness keratoplasty is suggested because, in our patient, lamellar keratoplasty did not preclude recurrence of the disease.
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Affiliation(s)
- R L Font
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.
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Abstract
Low-grade intraosseous osteosarcoma is an uncommon and well-differentiated osteosarcoma with a good prognosis. We report a proximal tibial low-grade intraosseous osteosarcoma with a prominent intratumoral lymphoid infiltrate, which led to an initial diagnosis of probable malignant lymphoma. The importance of this infiltrate, which exhibited reactive features on flow cytometric studies, is not known. Our patient is free of tumor 1 year after limb salvage surgery, without hematologic or lymphoid abnormalities.
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Affiliation(s)
- M L Ostrowski
- Department of Pathology and Laboratory Medicine, Baylor College of and Methodist Hospital, Houston, TX 77030, USA
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Visvesvara GS, Belloso M, Moura H, Da Silva AJ, Moura IN, Leitch GJ, Schwartz DA, Chevez-Barrios P, Wallace S, Pieniazek NJ, Goosey JD. Isolation of Nosema algerae from the cornea of an immunocompetent patient. J Eukaryot Microbiol 1999; 46:10S. [PMID: 10519226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- G S Visvesvara
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
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Truong LD, Williams R, Ngo T, Cawood C, Chevez-Barrios P, Awalt HL, Brown RW, Younes M, Ro JY. Adult mesoblastic nephroma: expansion of the morphologic spectrum and review of literature. Am J Surg Pathol 1998; 22:827-39. [PMID: 9669345 DOI: 10.1097/00000478-199807000-00005] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mesoblastic nephroma (MN) is a distinctive tumor that is seen mostly in early infancy and that consists of classic and cellular (atypical) variants. Mesoblastic nephroma rarely occurs in adulthood, but MN in this age group still is poorly characterized because there are only 17 reported cases. We describe five additional cases of adult MN, including one case of the cellular variant, characterize the immunohistochemical profiles in detail, and critically review the previously reported cases. The collective data obtained from these 22 cases of adult MN showed that the patients predominantly were women (20 cases), ranging in age from 19 to 78 years, who were asymptomatic (5 cases) or had nonspecific signs and symptoms referable to a renal mass. Twenty tumors were classified as classic and 2 as cellular. The tumors were 2-24 cm, well circumscribed, and partially encapsulated and displayed a solid/ cystic cut surface, with a predominantly solid component in most tumors. One tumor, however, was almost purely cystic. Most tumors extended to the renal sinus. and some appeared entirely intrapelvic on imaging studies; however, gross and microscopic evaluation did not show destructive invasion of the pelvic wall. Extension of the tumor beyond the renal capsule has not been described. Each tumor was composed of epithelial and stromal components both. The epithelial component, which displayed no difference between the classic and cellular variants, was composed of isolated or clustered tubules and cysts lined by a benign epithelium with a wide range of cytologic differentiation. The stromal cells were composed of fibroblasts, myofibroblasts, and smooth muscle cells in various combinations. Stromal cellularity was low for the classic variant but high for the cellular variant. Hemorrhage, necrosis, and high mitotic index were noted in the stroma of the cellular, but not in the classic variant. Immunohistochemical study applied to the five current cases and seven normal control kidneys confirmed the presence of fibroblasts, myofibroblasts, smooth muscle cells, and prominent vessels in the stroma of each tumor. Most cysts and tubules within the tumors had a distinctive immunohistochemical profile, similar to that of collecting duct but different from those of other portions of the nephron in the normal control kidneys. After total or partial nephrectomy, without adjuvant chemotherapy or radiotherapy, 19 patients, including the 2 with cellular MN, were alive and well at 8-months to 48-years follow-up. Follow-up was not available in two patients. The remaining patient had recurrence at the surgical site 24 years after nephrectomy. Adult MN displays a distinctive morphologic spectrum that parallels that of its pediatric congener. It probably is a benign tumor that can be treated successfully by complete excision. The collecting duct differentiation expressed by most tubules and cysts of adult MN implies ureteric bud, which is the exclusive embryologic origin of collecting duct, as an important element in the histogenesis of this rare but fascinating type of tumor.
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Affiliation(s)
- L D Truong
- Department of Pathology, Baylor College of Medicine, The Methodist Hospital, Houston, Texas 77030, USA
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Giordano GG, Chevez-Barrios P, Refojo MF, Garcia CA. Biodegradation and tissue reaction to intravitreous biodegradable poly(D,L-lactic-co-glycolic)acid microspheres. Curr Eye Res 1995; 14:761-8. [PMID: 8529414 DOI: 10.3109/02713689508995797] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We studied the biodegradation of and the tissue reaction to microspheres of 50:50 poly(D,L-lactic-co-glycolic)acid (PLGA) (viscosity-average MW: 3000 d), injected intravitreous in rabbits. These microspheres are under investigation as injectable devices for intravitreous sustained drug delivery. The rate of intravitreous degradation of PLGA microspheres has not been well documented in the literature. Twenty two pigmented rabbits underwent gas vitrectomy in one eye: 19 eyes received 2.5 mg of PLGA microspheres in 1 ml of balanced salt solution (BSS) and 3 control eyes received 1 ml of BSS only. Slit lamp exam and indirect ophthalmoscopy were performed periodically from day 1 to 6 months after surgery. The eyes were enucleated and studied by light microscopy and immunohistochemistry at various time points. The electroretinogram (ERG) was recorded in a subgroup of rabbits before injection and after 1 and 6 months. The amount of microspheres in the vitreous cavity progressively decreased. At 6 months microspheres were found in 1/4 rabbits at indirect ophthalmoscopy and in 4/4 rabbits histopathologically. A mild localized, non progressive foreign body reaction was observed. The cell reaction was composed mostly of vimentin and glial fibrillary acidic protein positive cells which probably represent glial cells and fibroblasts. The choroid and retina were normal. The ERG showed no abnormalities. No clinical inflammatory signs were observed 4 days postoperatively and thereafter.
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Affiliation(s)
- G G Giordano
- Department of Ophthalmology, University of Texas Health Science Center, Houston 77027, USA
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