[Size-based classification of choroidal melanoma and its role in treatment decision-making].

AIM: To specify indications for brachytherapy (BT) in large choroidal melanoma (CM) so that tumor size and vital prognosis were considered. MATERIAL AND METHODS: We retrospectively analyzed data from 161 CM patients who were treated with BT and followed-up at either the Ophthalmological Clinical Hospital or some other Moscow medical facility and also registered by the City Cancer Registry. RESULTS: Patient age at the time of starting the treatment lied within the range of 17 to 84 years and averaged 56.89±1.93 years. During the follow-up period (12-275 months, 95.65±8.4 months on average) hematogenous metastases were found in 23 (14.29%) patients. Liver involvement was diagnosed in 8 patients within the average of 23.13 months after treatment. Their average survival time was 11 months. A total of 142 patients were followed up for more than 36 months (104.87 months on average). Of them, 15 patients were diagnosed with metastatic CM within 37-167 months after BT (80.27 months on average). Despite metastatic disease they generally survived 2.8 time longer than the aforementioned patients (30.8 months). The cases were then divided into 3 groups according to J. Shields classification of CM. Small melanoma patients did not develop metastases within 99.96±12.47 months of follow-up. In medium melanomas, as many as 13.35% of cases were metastatic (with the average survival time of 20.66 months); in large melanomas - 19.51% (with the average survival time of 13.5 months). CONCLUSION: Treatment modality and follow-up periods being the same (7-8 years after BT), larger choroidal melanomas has been shown to be associated with higher risk of hematogenous metastases. For local treatment to be successive, the maximal diameter of the tumor should not exceed 10 mm. Every fifth patient of those with CM larger than 15 mm is likely to develop hematogenous metastases. The results obtained indicate the necessity of decreasing the size thresholds for choroidal melanomas, small and medium in the first place.

Vascular tumors of the choroid and retina.

Vascular tumors of the retina and choroid can be seen occasionally. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.

Frequency and implications of discordant gene expression profile class in posterior uveal melanomas sampled by fine needle aspiration biopsy.

PURPOSE: To determine the frequency of discordant gene expression profile (GEP) classification of posterior uveal melanomas sampled at 2 tumor sites by fine-needle aspiration biopsy (FNAB). DESIGN: Prospective single-institution longitudinal study performed in conjunction with a multicenter validation study of the prognostic value of GEP class of posterior uveal melanoma cells for metastasis and metastatic death. METHODS: FNAB aspirates of 80 clinically diagnosed primary choroidal and ciliochoroidal melanomas were obtained from 2 tumor sites prior to or at the time of initial ocular tumor treatment and submitted for independent GEP testing and classification. Frequency of discordant GEP classification of these specimens was determined. RESULTS: Using the support vector machine learning algorithm favored by the developer of the GEP test employed in this study, 9 of the 80 cases (11.3% [95% confidence interval: 9.0%-13.6%]) were clearly discordant. If cases with a failed classification at 1 site or a low confidence class assignment by the support vector machine algorithm at 1 or both sites are also regarded as discordant, then this frequency rises to 13 of the 80 cases (16.3% [95% confidence interval: 13.0%-19.6%]). CONCLUSION: Sampling of a clinically diagnosed posterior uveal melanoma at a single site for prognostic GEP testing is associated with a substantial probability of misclassification. Two-site sampling of such tumors with independent GEP testing of each specimen may be advisable to lessen the probability of underestimating an individual patient's prognostic risk of metastasis and metastatic death.

Choroidal melanoma: clinical features, classification, and top 10 pseudomelanomas.

PURPOSE OF REVIEW: To review the current features and classification of choroidal melanoma, and to identify the lesions that clinically simulate choroidal melanoma (pseudomelanoma). RECENT FINDINGS: Uveal melanoma is a serious life-threatening intraocular malignancy, most often found in Caucasians (98%) and primarily involving the choroid (90%), ciliary body (7%), or iris (2%). This review will concentrate on choroidal melanoma. At diagnosis, choroidal melanoma usually appears as a pigmented (85%) tumor underlying the retina with a median basal dimension of 11 mm and a mean thickness of 4.5 mm. The American Joint Committee on Cancer classification allows for categorization and staging of melanoma. Following ocular therapy, adjuvant systemic therapy is provided for patients with high-risk melanoma who demonstrate alterations in chromosomes 3, 6, and 8 or those with class 2 on gene-expression profiling, detected by needle biopsy or solid tumor biopsy. The prognosis of choroidal melanoma depends most importantly on the genetic alterations and tumor size. Every millimeter increase in thickness leads to a 5% increased risk for metastasis. The leading conditions that simulate choroidal melanoma include choroidal nevus, peripheral exudative hemorrhagic chorioretinopathy, congenital hypertrophy of the retinal pigment epithelium (RPE), hemorrhagic RPE detachment, choroidal hemangioma, age-related macular degeneration, RPE hyperplasia, and others. These pseudomelanomas can be differentiated from choroidal melanoma by their unique clinical features. SUMMARY: Choroidal melanoma is a serious malignancy with characteristic features. Early detection and therapy is important. Pseudomelanomas can lead to diagnostic confusion; however, clinical features aid in differentiation.

Choroidal lymphoma: clinical features and association with systemic lymphoma.

PURPOSE: To describe the clinical and histopathologic features of choroidal lymphoma (CL) and its association with systemic lymphoma. DESIGN: Observational case series. PARTICIPANTS: Fifty-nine patients (73 eyes) with CL. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Clinical features, histopathology, and systemic lymphoma. RESULTS: Of 59 patients with CL, systemic lymphoma was absent in 41 (primary CL; 69%) and present in 18 (secondary CL; 31%). Of 18 patients with systemic lymphoma at presentation, 14 (78%) had known systemic lymphoma and 4 (22%) were diagnosed with systemic lymphoma shortly after presentation. The most common types of systemic lymphoma in patients with secondary CL were diffuse large cell lymphoma (n = 5, 28%), chronic lymphocytic leukemia/lymphoma (n = 4, 22%), multiple myeloma (n = 2, 11%), Waldenstrom's macroglobulinemia (n = 2, 11%), extranodal marginal zone lymphoma (n = 2, 11%), plasmablastic lymphoma (n = 1, 6%), and unspecified non-Hodgkin lymphoma (n = 2, 11%). Compared with patients with primary CL, patients with secondary CL had a shorter mean duration of ocular symptoms (5 vs. 17 months), had less often received steroids before referral (11% vs. 46%), and were more likely to have bilateral ocular involvement (33% vs. 20%). Eyes with secondary CL had a higher rate of poor vision (≤20/200) (46% vs. 12%), iris (20% vs. 4%) or ciliary body (30% vs. 8%) lymphoma, episcleral vascular congestion (40% vs. 16%), anterior chamber reaction (30% vs. 14%), hyphema (15% vs. 0%), vitreous cellular infiltration (30% vs. 4%), and severe media haziness (20% vs. 0%). Secondary CL was morphologically more high grade (50% diffuse large cell lymphoma) compared with primary CL (37% low-grade non-Hodgkin lymphoma, 27% extranodal marginal zone lymphoma). None of the 33 patients with primary CL and subsequent follow-up developed systemic lymphoma during a mean follow-up of 50 months (median, 35 months; range, 2-231 months). CONCLUSIONS: Secondary CL is morphologically high grade and associated with more severe ocular findings. Patients with CL and no known systemic lymphoma at presentation should undergo systemic evaluation to rule out the possibility of undiagnosed concurrent systemic lymphoma. However, none of the patients with primary CL in our study had late development of systemic lymphoma.

Sufficiency of FNAB aspirates of posterior uveal melanoma for cytologic versus GEP classification in 159 patients, and relative prognostic significance of these classifications.

OBJECTIVE: To determine the relative sufficiency of paired aspirates of posterior uveal melanomas obtained by FNAB for cytopathology and GEP, and their prognostic significance for predicting death from metastasis. METHODS: Prospective non-randomized IRB-approved single-center longitudinal clinical study of 159 patients with posterior uveal melanoma sampled by FNAB in at least two tumor sites between 09/2007 and 12/2010. Cases were analyzed with regard to sufficiency of the obtained aspirates for cytopathologic classification and GEP classification. Statistical strength of associations between variables and GEP class was computed using Chi-square test. Cumulative actuarial survival curves of subgroups of these patients based on their cytopathologic versus GEP-assigned categories were computed by the Kaplan-Meier method. The endpoint for this survival analysis was death from metastatic uveal melanoma. RESULTS: FNAB aspirates were insufficient for cytopathologic classification in 34 of 159 cases (21.9 %). In contrast, FNAB aspirates were insufficient for GEP classification in only one of 159 cases (0.6 %). This difference is statistically significant (P < 0.001). Six of 34 tumors (17.6 %) that yielded an insufficient aspirate for cytopathologic diagnosis were categorized as GEP class 2, while 43 of 125 tumors (34.7 %) that yielded a sufficient aspirate for cytopathologic diagnosis were categorized as GEP class 2. To date, 14 of the 49 patients with a GEP class 2 tumor (28.6 %) but only five of the 109 patients with a GEP class 1 tumor (5.6 %) have developed metastasis. Fifteen of 125 patients (12 %) whose tumors yielded sufficient aspirates for cytopathologic classification but only four of 34 patients (11.8 %) whose tumors yielded insufficient aspirates for cytopathologic classification developed metastasis. The median post-biopsy follow-up time for surviving patients in this series was 32.5 months. Cumulative actuarial 5-year probability of death from metastasis 14.1 % for those with an insufficient aspirate for cytopathologic classification versus 22.4 % for those with a sufficient aspirate for cytopathologic classification (log rank P = 0.68). In contrast, the cumulative actuarial 5-year probability of metastatic death was 8.0 % for those with an insufficient/unsatisfactory aspirate for GEP classification or GEP class 1 tumor, versus 45.0 % for those with a GEP class 2 tumor (log rank P = 0.005). CONCLUSION: This study confirmed that GEP classification of posterior uveal melanoma cells obtained by FNAB is feasible in almost all cases, including most in which FNAB yields an insufficient aspirate for cytodiagnosis. The study also confirmed that GEP classification is substantially better than cytologic classification for predicting subsequent metastasis and metastatic death.

Diffuse versus nondiffuse small (≤ 3 MM thickness) choroidal melanoma: comparative analysis in 1,751 cases. The 2012 F. Phinizy Calhoun lecture.

OBJECTIVE: To determine prognosis of small choroidal melanoma (≤ 3 mm thickness) comparing diffuse versus nondiffuse variants. METHODS: Retrospective chart review of 1,751 patients with small choroidal melanoma classified as diffuse (thickness/base ≤ 20%) versus nondiffuse (thickness/base >20%). RESULTS: Of 1,751 patients with small choroidal melanoma, 297 (17%) were diffuse and 1,454 (83%) nondiffuse. Features with statistical differences (diffuse vs. nondiffuse) included mean distance to optic disk (3 vs. 4 mm), mean tumor base (12 vs. 8 mm), and mean tumor thickness (1.9 vs. 2.5 mm). Using Kaplan-Meier estimates, melanoma-related metastasis (diffuse vs. nondiffuse) was 8% versus 4% at 5 years, 16% versus 10% at 10 years, and 19% versus 16% at 15 years (P = 0.0344). Melanoma-related death was 6% versus 2% at 5 years, 11% versus 4% at 10 years, and 16% versus 6% at 15 years (P < 0.0001). In the subgroup of thin melanoma 2 mm or less in thickness, melanoma-related death was 7% versus 2% at 5 years, 10% versus 2% at 10 years, and 16% versus 4% at 15 years (P = 0.0077). By multivariate analysis, factors predictive of metastasis from diffuse melanoma included larger tumor basal dimension (P = 0.0027) and plateau/flat tumor configuration (P = 0.0257). CONCLUSION: Of 1751 patients with small (≤ 3 mm thickness) choroidal melanoma, those with diffuse tumor show higher probability of metastasis and death than those with nondiffuse tumor. This finding is evident even in the thinnest melanomas (≤ 2 mm thickness).

[WHO classification of tumours of the CNS: revised edition of 2007 with critical comments on the typing und grading of common-type diffuse gliomas]. / WHO-Klassifikation der ZNS-Tumoren: Revidierte Fassung von 2007 mit kritischen Anmerkungen zum "Typing" und "Grading" diffuser Gliome.

The fourth edition of the WHO classification of tumours of the CNS was published in 2007. Six new entities were codified: angiocentric glioma (AG); papillary glioneuronal tumour (PGNT); rosette-forming glioneuronal tumour of the fourth ventricle (RGNT); papillary tumour of the pineal region (PTPR); spindle cell oncocytoma of the adenohypophysis (SCO); and pituicytoma. Furthermore, six histological variants of well-known brain tumours have been added, partially because they show different biological behaviour and/or prognosis: pilomyxoid astrocytoma; atypical choroid plexus papilloma; medulloblastoma with extensive nodularity; anaplastic medulloblastoma; extraventricular neurocytoma; non-specific variant of dysembryoplastic neuroepithelial tumour (DNT). The new entities and variants are discussed in this review. Moreover, the typing und grading of common-type diffuse gliomas, as well as the WHO grading system, are critically reviewed, particularly with regard to the prognostically important differential diagnosis of diffuse astrocytomas und oligodendrogliomas.

Size overlap between benign melanocytic choroidal nevi and choroidal malignant melanomas.

PURPOSE: To estimate size overlap between large choroidal nevi and small choroidal melanomas by using plotted frequency distributions of tumor size. METHODS: Frequency distributions of largest linear basal diameter (LBD) and thickness (TH) of choroidal nevi and melanomas were plotted from published data and cases in the senior author's practice. Relative frequencies of choroidal nevi and melanomas were estimated from published data. Relative frequency distributions of the tumors were plotted to illustrate the extent of overlap between them. RESULTS: Comparison of plotted frequency distribution curves for thickness indicated that there were approximately 125 nevi for every melanoma in the TH range 1.5 to 2 mm, approximately 25 nevi for every melanoma in the TH range 2 to 2.5 mm, and approximately 5 nevi for every melanoma in the TH range 2.5 to 3 mm. Similarly, comparison of the plotted frequency distribution curves for LBD of these tumor types indicated that there were approximately 70 nevi for every choroidal melanoma in the LBD range 5 to 6 mm, approximately 10 nevi for every melanoma in the LBD range 6 to 7 mm, and approximately 3 nevi for every melanoma in the LBD range 7 to 8 mm. CONCLUSIONS: Because of the markedly greater cumulative lifetime incidence of choroidal nevi, the results of this analysis suggest considerable size overlap between larger nevi and smaller melanomas. Attempts to classify small melanocytic choroidal tumors clinically as benign nevi versus malignant melanomas on the basis of tumor size appear likely to result in multiple misclassifications.

Tumor, node, metastasis classification of malignant ciliary body and choroidal melanoma evaluation of the 6th edition and future directions.

PURPOSE: The tumor, node, metastasis classification of malignant uveal melanoma has been revised. We evaluated how the 6th edition (TNM6) improves on the previous one (TNM5). DESIGN: Population-based, retrospective, cross-sectional study. PARTICIPANTS: Two hundred eighty-nine consecutive patients who had a ciliary body and choroidal melanoma treated in the district of the Helsinki University Central Hospital, Finland, between 1962 and 1981. METHODS: Tumor dimensions, ciliary body involvement, and extraocular extension were evaluated from histopathologic sections and pathology reports. Tumors were assigned into categories and stages according to TNM6, TNM5, and 2 previously proposed size classifications. MAIN OUTCOME MEASURES: Proportion of tumors classified in each category and melanoma-specific survival by category and stage. RESULTS: Of the 289 melanomas, 5% were classified as pT1, 63% as pT2, 22% as pT3, and 7% as pT4 according to TNM6. The corresponding percentages based on TNM5 were 8%, 17%, 63%, and 10%. Of pT2 tumors in TNM6, 4% came from pT1, 65% from pT3, and 4% from pT4 category of TNM5. Of 28 melanomas with extraocular growth, 29% were classified as pT2 in TNM6 rather than pT4 in TNM5. The 10-year survival estimate was 2 percentage points lower for pT1, 7 percentage points higher for pT2, 17 percentage points lower for pT3, and 13 percentage points lower for pT4 by TNM6 compared with TNM5; TNM6 (P<0.0001) and the modified alternative size classifications (P = 0.0022 and P = 0.0026) divided tumors according to prognosis better than TNM5. The 10-year survival for stage I, II, and III tumors was 2 percentage points lower, 7 points higher, and 23 points lower by TNM6, which was not better than TNM5 in separating patients according to prognosis (P = 0.47). The alternative size classifications provided more equal categories and fitted the data set better than TNM5 regarding prognosis. CONCLUSIONS: TNM6 is an improvement over TNM5 in some, but not all, respects. Areas for development include taking into account ciliary body involvement and extraocular extension in more detail and combining into each stage tumor categories with similar rather than different prognosis. An evidence-based, multicenter approach would be beneficial.

Immunophenotypic differences between uveal and cutaneous melanomas.

OBJECTIVE: To determine the immunophenotypic differences between uveal and cutaneous melanomas, employing standard melanoma markers as well as p75 neurotrophin receptor (p75NTR) and microphthalmia transcription factor (MITF). DESIGN: Fifteen uveal melanomas (5 spindle, 5 epithelioid, and 5 mixed uveal subtypes) were immunolabeled with a panel of antibodies that included S100, tyrosinase, melan-A, HMB-45 and HMB-50 combination, MITF, and p75NTR. The results were tabulated on the basis of intensity and pervasiveness of the labeling and compared with a prior study on cutaneous spindle and epithelioid melanomas. RESULTS: In contrast to its strong labeling of cutaneous melanomas, S100 immunolabeling of uveal melanomas was weak and variable. p75NTR, known to differentiate spindle from epithelioid melanomas of the skin, did not immunolabel uveal melanomas. HMB-45, HMB-50, tyrosinase, melan-A, and MITF immunolabeled all uveal melanomas strongly, irrespective of the histologic subtype, but not cutaneous melanomas. Microphthalmia transcription factor was especially clear in its labeling of uveal melanomas. CONCLUSIONS: Although cutaneous and uveal melanomas share many molecular markers in common, there are differences between the 2 types of melanoma. First, the level of expression of S100 differs between cutaneous and uveal melanomas. Second, while cutaneous melanomas can be further subdivided into spindle and epithelioid types based on their immunophenotype, the uveal melanomas cannot.

Consistency of observations from echograms made centrally in the Collaborative Ocular Melanoma Study COMS Report No. 13.

PURPOSE: To describe the methods used by the Collaborative Ocular Melanoma Study (COMS) Echography Center for grading tumor echograms and to assess reliability of the grading system. METHODS: Tumor echograms were graded at the COMS Echography Center using a specific protocol. To assess consistency, a five-percent random sample of all echographic gradings received as of June 30, 1996 was selected by the COMS Coordinating Center for re-evaluation at the COMS Echography Center. The results were compared with original data. Agreement between the two sets of gradings was evaluated by calculating overall percent agreement, and by using the kappa statistic for categorical features and intra-class correlation coefficients (ICC) for continuous measures. RESULTS: Overall agreement between original gradings and regradings was high. Agreement, based on the kappa statistic, between the original grading and the regrading was classified as 'moderate,' 'substantial,' or 'almost perfect' for nearly every variable graded. Kappas ranged from 0.47 for extrascleral extension to 0.82 for tumor shape. Intra-class correlation coefficients were 0.99 or higher for tumor height measurements and for the clock hour designation of the tumor apex. The only variable graded by the COMS Echography Center that did not have good agreement was 'confidence in tumor measurement.' CONCLUSIONS: The level of agreement (after adjusting for chance agreement) ranged from 'moderate' to 'almost perfect.' Grading for 'confidence of tumor measurement' differed between the original grading and the regrading but there was little difference in the tumor measurements. The COMS Echography Center has demonstrated that its grading protocol is consistent over time.

[Morphologic classification of choroidal invasion of retinoblastoma]. / Histomorphologische Stadieneinteilung des infiltrativen Wachstums in der Aderhaut beim Retinoblastom.

In order to inquire into standard for morphologic classification of choroidal invasion of retinoblastoma and to study the tumor clinic--pathologic further under the integrated scale, the changes of retinal pigment epithelium, Bruch's membrane and choroid on the histopathological sectins of 297 cases of primary enucleated eyes of retinoblastoma were retrospectively observed under the light microscopy. The choroidal invasion was morphologically divided into four stages: Stage 1, only retinal pigment epithelium involved, the Bruch's membrane was intact; Stage 2, the Bruch's membrane was destroyed and the choroidal capillaris was not infiltrated; Stage 3, choroial capillary and middle blood vessel layer in small limits were infiltrated; Stage 4, invasion involved in choroid in great limits and involvement of sclera existed simultaneously. This classification (also called pigment epithel--choroid stage, PEC--stage) reflected both infiltrated procedure of tumor cells and preventive mechanism in eye and morphological criterion half--quantitatively. It can be used as a united standard to compare the infiltration degree of retinoblastoma among different individuals and different studies.

Video-angiografía con indocianina verde (V-ICG) de tumores de coroides / Video-angiography with indocyanine green (ICG-V) of choroidal tumors

Determinar el valor de la Video-angiografía con indocianina verde (V-ICG) en la evaluación de tumores de coroides. Se realizó en forma prospectiva la V-ICG en 151 pacientes consecutivos (ojos) con tumores coroideos, incluyendo 110 con melanoma maligno de coroides (MM), 25 con hemangioma circunscrito coroideo (HCC) y 16 con metástasis coroidea (MC). En el grupo de ojos con MM se observó una fluorescencia máxima a los 21.1 (rango: 0.4 a 66) minutos después de la inyección del contraste. Durante el momento de máxima fluorescencia el patrón varió de hipofluorescente (58 casos) a isofluorescente (32 casos) e hiperfluorescente (20 casos). El melanoma amelanótico de coroides mostró un inicio de la fluorescencia mas temprano que el MM pigmentado (p=0.04). En el grupo de ojos con HCC la hiperfluorescencia mas temprana se observó 0.5 (rango: 0.2 a 1) minutos después de la inyección del contraste, mientras que la máxima hiperfluorescencia se observó 3.7 (rango 0.5 a 11.7) minutos después de la inyección. En la fase tardía del estudio 18 (72 por ciento) casos mostraron un "lavado del contraste". En el grupo de las MC 12 (75 por ciento) de los casos demostraron una fluorescencia difusa homogénea con isofluorescencia tardía, mientras que 4 (25 por ciento) casos demostraron una hipofluorescencia temprana con persistencia de una hipofluorescencia menos intensa en la fase tardía. La V-ICC puede ser un examen complementario no invasivo útil en el diagnóstico diferencial de tumores coroideos

Echographic classification of intraocular tumours. A 15-year retrospective analysis.

The data on echographic routine diagnosis of intraocular tumours (prominence equal to, or larger than 2 mm) during the years 1976-1990 in the authors' department, were analyzed by multivariate statistical methods, using the final diagnosis either from pathology after enucleation or from the confirmed clinical diagnosis. The material consisted of melanomas (n = 325), metastases (n = 44), haemangiomas (n = 19) and other intraocular tumours (n = 16). The best set of echographic parameters in descending order of significance was: reflectivity (A-mode), choroidal excavation (B-mode), shape (B-mode), and regularity (A/B mode). Echographic differentiation by computer analysis of data on the three main kinds of tumours (melanoma/metastasis/haemangioma) separate from all the remaining tumours was expressed by the correct fraction: melanoma 89%, metastasis 80% and haemangioma 97%. The clinical echographic classification for these cases was 89%, 93% and 99.5%, respectively. The simultaneous differentiation between the three classes was found to yield a correct fraction of 85% by computer statistics and 95% by routine echography. The results of the present study might be used for prospective classification through the use of the parameter 'knowledge base' contained in the statistical classification procedure.

[The morphological forms of malignant uveal melanoma]. / Forme morfologice ale melanomului malign uveal.

They are presented the histopathological forms of the uveal malignant melanoma, its characteristics in electronic microscopy and also an attempt to correlate the histological type with the vital prognosis. They are reviewed the main classifications of this uveal malignant tumour, elaborated over time, and the criteria used for their establishment by the authors.

Echographic differentiation of intraocular melanomas by computer analysis.

The aim of this study was to assess the differentiation of histologically different types of choroidal melanomas by means of clinical and quantitative acoustic/texture parameters of echograms. Clinical parameters were graded by morphological, kinetic and quantitative statements about the A- and B-mode echograms by a skilled diagnostician. Acoustic/texture parameters were obtained by processing and analysing radio frequency, AM-demodulated and FM-demodulated echograms. The latter data were preprocessed to remove influence induced by beam diffraction and focusing. The best set of four clinical echographic parameters enabled a retrospective classification of spindle type melanomas vs. mixed+epithelioid type melanomas with an accuracy of 77% (area under the ROC-curve of 86%). The discriminant analysis performed with the best four acoustic/texture parameters (n = 30) yielded a sensitivity of 89%, a specificity of 92%, and an area under the ROC-curve which corresponds to a probability of correct classification of 96.6%. When using these data prospectively to classify tumours of unknown cell type (n = 21), this classification could be performed in 86% of cases.

[Histological classification of uveal melanoma]. / Histologiczna klasyfikacja czerniaków naczyniówki.

Cytological classification of choroidal malignant melanomas recommended by WHO and based on the Callender classification (spindle A and B, mixed and epithelioid) is presented. Prognosis according to the histological types is discussed.

Differential diagnosis of choroidal neoplasms.

Experienced ophthalmologists who appropriately employ ancillary diagnostic testing, including fluorescein angiography, ocular ultrasonography, MRI, and fine needle aspiration biopsy, are remarkably accurate in the diagnosis of intraocular neoplasms. Recognizing the classic clinical features of the more commonly encountered lesions, such as choroidal melanoma, choroidal nevus, metastatic carcinoma to choroid, lymphoid tumors, and circumscribed choroidal hemangioma, and understanding the applicability and limitations of the various diagnostic tests are the keys to accurate detection.