Estudio epidemiológico y anatomopatológico del melanoma uveal / Epidemiologic and anatomopathologic study of uveal melanoma

Objetivo: Determinar el comportamiento epidemiológico y anatomopatológico del melanoma uveal. Método: Estudio descriptivo, longitudinal y retrospectivo en pacientes enucleados por diagnóstico de melanoma uveal en el Centro Oftalmológico de Villa Clara entre enero de 2010 a mayo de 2021. Resultados: La edad media de presentación del melanoma uveal fue de 61,3 años. Las mujeres fueron ligeramente más afectadas que los hombres-56,3 por ciento. El 81,3 por ciento de los melanomas uveales se originó en la coroide. Los tumores de células epitelioides y fusiformes fueron los más representativos; ambos con un 37,5 por ciento. El grosor y diámetro basal medio en los tumores estudiados fue de 11,2 mm y 15,8 mm respectivamente; prevalecieron los tumores medianos con un 56,3 por ciento. Se encontró infiltración tumoral en 37,5 por ciento de los ojos, la infiltración escleral fue la más frecuente. Conclusiones: El melanoma uveal se presenta con mayor frecuencia en personas con edad avanzada y en la coroide. El estudio histológico confirma el diagnóstico en la totalidad de los casos. Aproximadamente 2/3 de los tumores con algún grado de infiltración son grandes y la mitad de células epitelioides(AU)

Objective: To determine the epidemiologic and anatomopathologic behavior of uveal melanoma. Methods: Descriptive, longitudinal and retrospective study in patients enucleated for diagnosis of uveal melanoma in the Ophthalmologic Center of Villa Clara from January 2010 to May 2021. Results: The average age of presentation of uveal melanoma was 61.3 years. Women were slightly more affected than men-56.3 percent. 81.3 percent of uveal melanomas originated in the choroid. Epithelioid and spindle cell tumors were the most representative; both with 37.5 percent. The average thickness and basal diameter of the tumors studied were 11.2mm and 15.8mm respectively; medium-sized tumors prevailed with 56.3 percent. Tumor infiltration was found in 37.5 percent of the eyes, scleral infiltration was the most frequent. Conclusions: Uveal melanoma occurs more frequently in people with advanced age and in the choroid. Histological study confirms the diagnosis in all cases. Approximately 2/3 of the tumors with some degree of infiltration are large and half are epithelioid cells(AU)

Panoftalmitis: presentación atípica de un melanoma coroideo / Panophthalmitis: atypical presentation of choroid melanoma

RESUMEN La panoftalmitis es una forma rara y grave ocular de presentación del melanoma coroideo, por lo que, ante la presencia de una masa intraocular e inflamación de todas las estructuras intraoculares, con extensión extraescleral y los tejidos vecinos de la órbita, debe considerarse el diagnóstico diferencial de esta neoplasia maligna. Se presenta el caso de un paciente masculino de 83 años de edad, con diagnóstico de panoftalmitis como presentación atípica de un melanoma coroideo. Acudió a consulta de Cuerpo de Guardia de Oftalmología con dolor ocular intenso en ojo derecho, acompañado de náuseas y vómitos. Se constató, al examen, hipertensión ocular, que evolucionó tórpidamente durante su ingreso, con inflamación intraocular con extensión extraescleral. Se le realizaron ultrasonido ocular y tomografía axial computarizada de órbitas y se diagnosticó una panoftalmitis secundaria a un melanoma coroideo. Los hallazgos clínicos de esta forma atípica de presentación se mostraron, cuyo tratamiento definitivo es la enucleación. El diagnóstico histológico de melanoma maligno coroideo necrótico fue confirmado.

ABSTRACT Panophthalmitis is a rare and severe ocular form of presentation of choroid melanoma, therefore, in the presence of intraocular mass and inflammation of all intraocular structures, with extra-scleral extension and to the tissues neighboring the orbit, the differential diagnosis of this malignant neoplasia should be considered. The case presented deals with a male patient, aged 83 years, with diagnosis of panophthalmitis as atypical presentation of choroid melanoma. He assisted to the consultation of Ophthalmology Emergency with intense ocular pain in the right eye, accompanied by nausea and vomits. On examination, ocular hypertension was observed, that torpidly evolved during admission, with intraocular inflammation with extra-scleral extension. He had ocular ultrasound and computed axial tomography of orbits and was diagnosed with panophthalmitis secondary to choroid melanoma. The clinical findings of this atypical presentation form showed, whose definite treatment is enucleation. Histological diagnosis of necrotic choroid malignant melanoma was confirmed.

Long-term results of visual function in posterior uveal melanoma patients treated with I125 episcleral brachytherapy in a Spanish referral Ocular Oncology Unit / Resultados de longo prazo da função visual em pacientes com melanoma uveal posterior tratados com braquiterapia epiescleral com I125 em uma unidade de referência em Oncologia Oftalmológica na Espanha

ABSTRACT Purposes: We analyzed patient, tumor and dosimetric characteristics of subjects in a Spanish population diagnosed with uveal melanoma treated with iodine 125 (I125) episcleral brachytherapy, who presented with post-treatment loss of useful visual acuity and global evolution of visual acuity. Methods: A single historic observational cohort study was undertaken. Patients with uveal melanoma were recruited between September 1995 and June 2015. Clinical, tumor and dosimetric data collection and visual acuity evaluations were performed under everyday practice conditions based on a useful visual acuity >0.1 on the decimal scale. The baseline analysis was performed using descriptive and survival analyses according to Kaplan-Meier curves. Results: A total of 286 of the 665 patients diagnosed with uveal melanoma received episcleral brachytherapy, and 198 were included in the study. The mean follow-up time was 75.3 months (95% CI = 68.0-82.6). Patients with post-treatment useful visual acuity loss (n=94, 47%) presented the following characteristics: visual symptoms (n=80, p-value = 0.001); iris color (brown n=33, hazel green n=49, p-value = 0.047); Collaborative Ocular Melanoma Study size (medium n=80, p-value = 0.159); tumor, node, metastasis stage (T2: n=38, T3: n=38, p=0.012); shape (nodular n=67, mushroom-shaped n=26, p=0.001); posterior pole involvement (n=47, p=0.04); recurrence (n=10, p=0.001); and dose administered in the fovea, optic nerve and center of the eye (p<0.002). Using Kaplan-Meier analysis, the mean overall survival of useful visual acuity was 90.19 months, and the probability of preserving useful visual acuity was 66% for one year, 45% for five years and 33% for ten years. Conclusion: Patients most likely to present with visual acuity loss were those with the following profile: elderly males with dark irises who were diagnosed with visual symptoms and exhibited a medium/large melanoma with a mushroom shape in the posterior pole (near the fovea and/or optic nerve). All patients treated with episcleral brachytherapy are likely to present with visual acuity loss, which is more pronounced in the first few years following treatment.

RESUMO Objetivo: Analisar características individuais, tu morais e dosimétricas de pacientes diagnosticados com melanoma uveal, tratados através de braquiterapia epiescleral com iodo-125 (I125), que apresentaram perda da acuidade visual útil após o tratamento e analisar a evolução global da acuidade visual em uma população da Espanha. Métodos: Este é um estudo observacional de coorte histórica considerando pacientes com melanoma uveal diagnosticados entre setembro de 1995 e junho de 2015. Foram coletados dados clínicos, tumorais e dosimétricos e medida a acuidade visual em condições de prática clínica diária, considerando uma acuidade visual útil superior a 0,1 na escala decimal. A análise de base foi efetuada por curvas Kaplan-Meier descritivas de sobrevivência Resultados: Um total de 286 dos 665 pacientes diagnosticados com melanoma uveal recebeu braquiterapia epiescleral e 198 deles foram incluídos no estudo. O tempo médio de acompanhamento foi de 75,3 meses (IC 95%: 68,0-82,6). Os pacientes com perda da acuidade visual útil após o tratamento (n=94, 47%) apresentaram as seguintes características: sintomas visuais (n=80, p=0,001), cor da íris (castanha: n=33, castanho-esverdeada: n=49; p=0,047), tamanho de acordo com o Collaborative Ocular Melanoma Study (tamanho médio: n=80, p=0,159), tumor, nódulo, estágio de metástase (T2: n=38, T3: n=38, p=0,012), forma (nodular: n=67, em forma de cogumelo: n=26, p=0,001), envolvimento do polo posterior (n=47, p=0,04), recorrência (n=10, p=0,001) e dose administrada na fóvea, no nervo óptico e no centro do olho (p<0,002). Na análise de Kaplan-Meier, o tempo médio de sobrevivência geral da acuidade visual útil foi de 90,19 meses e a probabilidade de preservação da acuidade visual útil foi de 66% por um ano, 45% por 5 anos e 33% por 10 anos. Conclusão: O perfil de paciente com maior probabilidade de perda da acuidade visual útil é o de homem idoso com íris escura, diagnosticado com sintomas visuais e melanoma de tamanho médio a grande, em forma de cogumelo no polo posterior (próximo à fóvea, ao nervo óptico ou a ambos). Todos os pacientes tratados com braquiterapia epiescleral terão perda da acuidade visual, mais pronunciada nos primeiros anos após o tratamento.

Thermography in clinical ophthalmic oncology / Termografia em oncologia oftalmológica clínica

ABSTRACT Purpose: The aim of this study was to present our own experience with the use of thermography as a complementary method for the initial diagnosis and differentiation of intraocular tumors, as well as for the evaluation of the efficacy of treatment of intraocular melanomas. Methods: The study group comprised 37 patients with intraocular tumors, including 9 with uveal melanoma, 8 with uveal melanoma after I125 brachytherapy, 12 with a focal metastasis to the uvea, and 8 with retinal capillary hemangioblastoma. A FLIR T640 camera was used to capture images in the central point of the cornea, eye area, and orbital cavity area. Results: Eyes with uveal melanoma had higher temperature compared with the fellow normal eye of the patient in the range of all measured parameters in the regions of interest. In the group of patients with melanoma after unsuccessful brachytherapy, higher temperature was observed at the central point of the cornea. In patients with tumor regression, all measured parameters were lower in the affected eye. We observed lower tempe­ratures in the range of all tested parameters and areas in eyes with choroidal metastases. Eyes with diagnosed intraocular hemangioblastoma were characterized by higher parameters for the regions of interest versus eyes without this pathology. Conclusions: A thermographic examination of the eye can be used as an additional first-line diagnostic tool for the differentiation of intraocular tumors. Thermography can be a helpful tool in monitoring the treatment outcome in patients with intraocular melanoma.

RESUMO Objetivo: O objetivo deste estudo foi de apresentar a nossa experiência no uso da termografia como método complementar para o diagnóstico inicial e a diferenciação de tumores intraoculares, bem como para a avaliação da eficácia do tratamento de melanomas intraoculares. Métodos: O grupo estudado compunha-se de 37 pacientes com tumores intraoculares, sendo 9 com melanoma uveal, 8 com melanoma uveal após braquiterapia com I125, 12 com metástases focais na úvea e 8 com hemangioblastoma capilar retiniano. As imagens do ponto central da córnea, da área do olho e da área da cavidade orbital foram obtidas com uma câmera FLIR T640. Resultados: Os olhos dos pacientes com melanoma uveal tinham temperaturas mais elevadas do que as dos olhos normais dos mesmos, em toda a faixa dos parâmetros medidos nas regiões de interesse. No grupo de pacientes com melanoma após braquiterapia mal sucedida, encontrámos temperaturas maiores no ponto central da córnea. Nos pacientes com regressão do tumor, todos os parâmetros medidos foram menores no olho acometido. Encontrámos temperaturas mais baixas em toda a faixa dos parâmetros testados e das áreas medidas nos olhos com metástases na coroide. Os olhos com hemangioblastoma intraocular diagnosticado caracterizaram-se por parâmetros mais elevados nas regiões de interesse, em comparação com olhos sem essa patologia. Conclusões: O exame termográfico do olho pode usar-se como ferramenta de diagnóstico adicional de triagem na diferenciação de tumores intraoculares. A termografia pode ser uma ferramenta útil no acompanhamento do des­fe­cho do tratamento em pacientes com melanoma intraocular.

Effects of ranibizumab and amfenac on the functional abilities and radiosensitivity of uveal melanoma cells / Efeitos do ranibizumabe e do amfenac nas habilidades funcionais e na radiossensibilidade de células de melanoma uveal

ABSTRACT Purpose: To evaluate the effects of ranibizumab and amfenac in human uveal melanoma cell lines and to explore the ability of these compounds to sensitize uveal melanoma cells to radiation therapy. Methods: The 92.1 human uveal melanoma cell line was cultured and subjected to the proposed treatment (ranibizumab, amfenac, and a combination of both). Proliferation, migration, and invasion assays of the 92.1 uveal melanoma cell line were assessed after pretreatment with ranibizumab (125 mg/mL), amfenac (150 nM), or a combination of both. In addition, proliferation rates were assessed after treatment with ranibizumab and amfenac, and the cells were subsequently exposed to various radiation doses (0, 4, and 8 Gy). Results: Proliferation assay: cells treated with a combination of ranibizumab and amfenac had lower proliferation rates than controls (p=0.016) and than those treated with only ranibizumab (p=0.033). Migration assay: a significantly lower migration rate was observed in cells treated with amfenac than the control (p=0.014) and than those treated with ranibizumab (p=0.044). Invasion assay: there were no significant differences among the studied groups. Irradiation exposure: in the 4 Gy dose group, there were no significant differences among any groups. In the 8 Gy dose group, treatment with ranibizumab, amfenac, and their combination prior to application of the 8 Gy radiation led to a marked reduction in proliferation rates (p=0.009, p=0.01, and p=0.034, respectively) compared with controls. Conclusion: Combination of ranibizumab and amfenac reduced the proliferation rate of uveal melanoma cells; however, only amfenac monotherapy significantly decreased cell migration. The radiosensitivity of the 92.1 uveal melanoma cell line increased following the administration of ranibizumab, amfenac, and their combination. Further investigation is warranted to determine if this is a viable pretreatment strategy to render large tumors amenable to radiotherapy.

RESUMO Objetivo: Avaliar os efeitos do ranibizumabe em associação com o amfenac nas células de melanoma uveal humano e explorar a capacidade desses compostos em sensibilizar as células de melanoma uveal à radioterapia. Métodos: Células de melanoma uveal humano do tipo 92.1 foram cultivadas e submetidas ao tratamento proposto (ranibizumabe, amfenac e a combinação de ambos). Ensaios de proliferação, migração e invasão com as células de melanoma uveal do tipo 92.1 foram avaliados após tratamento com ranibizumabe (125 mg/ml), amfenac (150 nM) e a combinação de ambos. Além disso, as taxas de proliferação foram avaliadas após tratamento com ranibizumabe e amfenac com subsequente exposição das células a diferentes doses de radiação (0 Gy, 4 Gy e 8 Gy). Resultados: Ensaio de proliferação: células tratadas com ranibizumabe e amfenac combinados apresentaram taxas de proliferação inferiores em comparação ao grupo controle (p=0,016), do que as tratadas apenas com ranibizumabe (p=0,033). Ensaio de migração: foi observada uma taxa de migração significativamente mais baixa nas células tratadas com amfenac do que no grupo controle (p=0,014) e do que nas tratadas com ranibizumabe (p=0,044). Ensaio de invasão: não houve diferenças significativas entre os grupos estudados. Exposição à irradiação: no grupo da dose de 4 Gy, não houve diferença significante entre os grupos. No grupo da dose de 8 Gy, o tratamento com ranibizumabe, afenac e sua combinação antes da aplicação da radiação de 8 Gy levou a uma redução acentuada nas taxas de proliferação (p=0,009, p=0,01 e p=0,034, respectivamente) em comparação aos grupos controle. Conclusão: A combinação de ranibizumabe e amfenac reduziu a taxa de proliferação das células de melanoma uveal; no entanto, apenas o amfenac diminuiu significativamente a migração celular. A radiossensibilidade das células de melanoma uveal do tipo 92.1 aumentou após a administração de ranibizumabe, amfenac e sua combinação. Mais investigações são necessárias para determinar se esta é uma estratégia de pré-tratamento viável para tornar grandes tumores passíveis de radioterapia.

Caracterización clinicopatológica del melanoma uveal / Clinical and pathological characterization of uveal melanoma

Objetivo: Describir las características clinicopatológicas de los pacientes con diagnóstico de melanoma de la úvea. Métodos: Se realizó un estudio descriptivo y retrospectivo de serie de casos, en el Instituto Cubano de Oncología y Radiobiología de Cuba, desde enero del año 2011 hasta junio de 2016. El universo del estudio, en coincidencia con la muestra, estuvo constituido por 41 pacientes, el total de ellos diagnosticado y tratado en dicho período por melanoma uveal. Se estudiaron las variables edad, sexo, lateralidad, localización y tamaño tumoral, clasificación, tipo celular, grado de invasión y tratamiento. Resultados: El 56,1 por ciento de la muestra fue del sexo femenino. Los pacientes mayores de 50 años (75,6 por ciento) fueron los más afectados y el ojo izquierdo fue el más vulnerable (58,5 por ciento). La principal localización fue en la coroides (75,6 por ciento). Según el tamaño tumoral predominaron los tumores grandes (58,5 por ciento); histológicamente el tipo celular más frecuente fue el de células fusiformes (34,2 por ciento); según el grado de invasión, la más afectada fue la esclera (17,0 por ciento) y como único tratamiento practicado la enucleación (100 por ciento). Conclusiones: El melanoma de la úvea tiene su localización más frecuente en la coroides. Se presenta principalmente en pacientes mayores de 50 años y predominan los tumores grandes(AU)

Objective: To describe the clinical and pathological characteristics of patients diagnosed with uveal melanoma. Methods: A retrospective, descriptive and case series study was performed from January 2011 to June 2016 in the Institute of Oncology and Radiobiology of Cuba (INOR). The universe of study was the sample of 41 patients, all of them diagnosed with uveal melanoma and treated in this period of time. The study variables were age, sex, laterality, tumor location and tumor, classification, cell type, degree of invasion and treatment. Results: Females accounted for 56.1 percent of the sample. The patients aged 50 years or over (75.6 percent) were the most affected whereas left eye was the most vulnerable (58.5 percent). The main location were the choroids (75.6 percent) According to size, the large tumors predominated (58.5 percent); from the histological viewpoint, the most common cell-type was fusiform cell tumor (34.2 percent); according to the degree of invasion, the sclera was the most affected (17 percent) and the only treatment was enucleation. Conclusions: Uveal melanoma is more frequently located in the choroids. It mainly appears in patients aged over 50 years and most of tumors are large(AU)

Metastatic choroidal melanoma to the contralateral eye: a rare case / Melanoma de coróide metátastico para o olho contralateral: caso raro

ABSTRACT Uveal melanoma is the most common adult primary intraocular cancer. Although liver metastasis is common to the natural history of the disease, metastasis to the fellow eye is extremely rare. Here we report the case of a 59-year-old man with choroidal melanoma in his right eye who underwent enucleation at a different center. The patient was referred to our service 21 months postoperatively, complaining of decreased vision. He was found to have a new pigmented choroidal tumor in his left eye associated with liver disease. Ocular ultrasonography and liver biopsy with histopathological and immunohistochemical analysis were performed and confirmed the diagnosis. Few similar cases have been described in the literature. The differential diagnosis included primary bilateral choroidal melanoma and metastatic choroidal tumor from a primary skin melanoma.

RESUMO O melanoma uveal é o câncer intraocular primário mais frequente em adultos. Embora a metástase hepática seja comum à história natural da doença, a metástase para o outro olho é extremamente rara. Aqui relatamos o caso de um homem de 59 anos com melanoma de coroide em seu olho direito que foi submetido à enucleação em um centro diferente. O paciente foi encaminhado ao nosso serviço 21 meses após a cirurgia, com queixa de diminuição da visão. Foi encontrado um novo tumor de coróide pigmentado em seu olho esquerdo associado com doença hepática. Ultrassonografia ocular e biópsia hepática com exame histopatológico e imuno-histoquímico foram realizadas e confirmaram o diagnóstico. Poucos casos semelhantes foram descritos na literatura. O diagnóstico diferencial incluiu melanoma de coróide bilateral orimário e tumor coroidal metastático de um melanoma primário da pele.

Scleral necrosis in patients with posterior uveal melanomas evaluated by transcleral fine needle aspiration biopsy and treated by 125I plaque / Necrose escleral em pacientes com melanoma da úvea posterior avaliados pela biópsia aspirativa com agulha fina e tratados com placa de Iodo 125

ABSTRACT Purpose: To evaluate the incidence, potential correlation with transcleral fine needle aspiration biopsy, and treatment of scleral necrosis in patients with posterior uveal melanomas treated by 125I plaque radiotherapy and assessed by transcleral fine needle aspiration biopsy. Methods: We per­formed a retrospective review of posterior uveal melanoma treated by 125I plaque radiotherapy at a single academic institution between July 2006 and July 2013. Consecutive patients diagnosed with a posterior uveal melanoma during the study period that had an anterior margin at or anterior to the equator who were evaluated by transcleral fine needle aspiration biopsy prior to 125I plaque radiotherapy were included. The main outcome measure was development of scleral necrosis, and the secondary outcome was treatment of this complication. Statistical analysis included computation of conventional descriptive statistics, cross-tabulation and chi-square tests of potential factors related to the development of scleral necrosis, and summarizing of treatment approaches and results. The incidence of treatment of scleral necrosis was calculated using the Kaplan-Meier method. Results: During the 7-year study period, 87 posterior uveal melanomas were evaluated by transcleral fine needle aspiration biopsy and treated by 125I plaque radiotherapy. The median largest basal diameter of the tumor was 13.3 mm, and the median thickness was 6.8 mm. Eight patients (9.2%) developed scleral necrosis during follow-up. Thicker tumors (> 6.5 mm) were more likely to develop scleral necrosis (n=7) than thinner tumors (p=0.05). The median interval between 125I plaque radiotherapy and detection of scleral necrosis was 19.1 months. The overall cumulative probability of scleral necrosis was 6.2% at 6 months and 14.3% at 24 months, subsequently remaining stable. For thicker tumors, the probability of scleral necrosis was 23.5% at 45.4 months. Five patients were treated by scleral patch graft (62.5%) and three by observation (37.5%). One patient underwent enucleation after two failed scleral patch attempts and recurrent scleral necrosis. The mean follow-up period for patients with scleral necrosis was 34.5 months. Conclusions: Thicker posterior uveal melanomas are more likely to develop scleral necrosis after 125I plaque radiotherapy and transcleral fine needle aspiration biopsy. While observation is sufficient for managing limited scleral necrosis, scleral patch graft is a viable alternative for eye preservation in extensive scleral necrosis.

RESUMO Objetivo: Avaliar incidência, possível correlação da biópsia aspirativa com agulha fina trans-escleral e manejo da necrose escleral em pacientes com melanoma da úvea posterior tratados com placa de Iodo-125 (PLACA) avaliados pela biópsia aspirativa com agulha fina trans-escleral. Métodos: Revisão retrospectiva de melanoma da úvea posterior tratados com placa de Iodo-125 entre 07/2006 e 07/2013 em uma única instituição acadêmica. Pacientes diagnosticados consecutivamente com melanoma da úvea posterior durante o intervalo desse estudo cuja margem anterior está no equador ou anterior ao mesmo e foram avaliados pela biópsia aspirativa com agulha fina trans-escleral antes do tratamento com PLACA foram incluídos. O principal desfecho avaliado foi desenvolvimento de necrose escleral e o desfecho secundário foi o manejo dessa complicação. Análise estatística incluiu computação de variáveis descritivas convencionais; tabulação e teste do Chi-quadrado de fatores potencialmente relacionados com o desenvolvimento de necrose escleral e sumarização do manejo dessa complicação. A incidência de necrose escleral foi calculada usando o método de Kaplan-Meier. Resultados: Durante o período de 7 anos desse estudo, 87 melanomas da úvea posterior foram avaliados pela biópsia aspirativa com agulha fina trans-escleral e tratados com placa. A mediana do maior diâmetro basal tumoral foi 13,3 mm e a mediana da espessura foi 6,8 mm. Oito pacientes (9,2%) desenvolveram necrose escleral durante o período de acompanhamento. Tumores mais espessos (> 6,5 mm) foram mais propensos a desenvolver necrose escleral (n=7) que tumores mais finos (p=0,05). O intervalo mediano entre PLACA e a detecção da necrose escleral foi 19,1 meses. Probabilidade cumulativa de desenvolvimento de necrose escleral foi 6,2% em 6 meses e 14,3% em 24 meses permanecendo estável subsequentemente. Em tumores espessos, a probabilidade de necrose escleral foi 23,5% em 45,4 meses. Cinco pacientes foram manejados com enxerto escleral (62,5%), 3 foram observados (37,5%). Um paciente foi enucleado após 2 enxertos esclerais com necrose escleral recidivada. Tempo de seguimento médio dos pacientes com necrose escleral foi 34,5 meses. Conclusões: Tumores espessos pareceram mais propensos a desenvolver necrose escleral após PLACA e biópsia aspirativa com agulha fina trans-escleral para melanoma da úvea posterior. Apesar de observação para necrose escleral limitada ser suficiente, enxerto de esclera é uma alternativa viável para preservação ocular em necrose escleral extensa.

Prognoses and Clinical Outcomes of Primary and Recurrent Uveal Melanoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Uveal melanoma has a very poor prognosis despite successful local primary tumor treatment. In this study, we investigated prognostic factors that more accurately reflected the likelihood of recurrence and survival and delineated a prognostic model that could effectively identify different risk groups based on initial clinical parameters. MATERIALS AND METHODS: Prognostic factors associated with distant recurrence, recurrence-free survival (RFS), progression-free survival, and overall survival from distant recurrence to death (OS2) were analyzed in 226 patients with stage I-III uveal melanoma who underwent primary local therapy. RESULTS: Forty-nine patients (21.7%) had distant recurrences, which occurred most frequently in the liver (87.7%). In a multivariate analysis, local radiotherapy improved RFS among patients with multiple recurrence risk factors relative to excision (not reached vs. 19.0 months, p=0.004). Patients with BRCA1-associated protein-1 (BAP1)–negative primary tumors showed a longer RFS duration after primary treatments, while those with BAP1-negative metastatic tissues had a shorter OS2 compared to those with BAP1-positive tumors, both not statistically insignificance (RFS: not reached vs. 82.0 months, p=0.258; OS2: 15.7 vs. 24.4 months, p=0.216). Male sex (hazard ratio [HR], 3.79; p=0.012), a short RFS (HR, 4.89; p=0.014), and a largest metastatic tumor linear diameter ≥ 45 mm (HR, 5.48; p=0.017) were found to correlate with worse post-recurrence survival. CONCLUSION: Risk factors could be used to classify uveal melanoma cases and subsequently direct individual treatment strategies. Furthermore, metastasectomy appears to contribute to improved survival outcomes.

DNA Methylation and Uveal Melanoma / 中华医学杂志(英文版)

<p><b>Objective</b>The objective of the study was to summarize the role of DNA methylation in the development and metastasis of uveal melanoma (UM).</p><p><b>Data Sources</b>The relevant studies in MEDLINE were searched.</p><p><b>Study Selection</b>In this review, we performed a comprehensive literature search in MEDLINE using "uveal melanoma" AND ("DNA methylation" OR "epigenetics") for original research/review articles published before February 2018 on the relationship between DNA methylation and UM. References of the retrieved studies were also examined to search for potentially relevant papers.</p><p><b>Results</b>Previous studies on the relationship between DNA methylation and UM covered many genes including tumor suppressor genes (TSGs), cyclin-dependent kinase genes, and other genes. Among them, the TSG genes such as RASSF1A and p16INK4a, which encodes a cyclin-dependent kinase inhibitor, are relatively well-studied genes. Specifically, a high percentage of promoter methylation of RASSF1A was observed in UM cell lines and/or patients with UM. Promoter methylation of RASSF1A was also associated with the development of metastasis. Similarly, a high percentage of promoter hypermethylation of p16INK4a was found in UM cell lines. DNA promoter methylation can control the expression of p16INK4a, which affect cell growth, migration, and invasion in UM. Many other genes might also be involved in the pathogenesis of UM such as the Ras and EF-hand domain containing (RASEF) gene, RAB31, hTERT, embryonal fyn-associated substrate, and deleted in split-hand/split-foot 1.</p><p><b>Conclusions</b>Our review reveals the complex mechanisms underlying the tumorigenesis of UM and highlights the great needs of future studies to discover more genes/5'-C-phosphate-G-3' sites contributing to the development/metastasis of UM and explore the mechanisms through which epigenetic changes exert their function in UM.</p>

Evaluation of nicotinamide as an anti-inflammatory and anti-angiogenic agent in uveal melanoma cell lines / Avaliação da nicotinamida como agente anti-inflamatório e anti-angiogênico em linhas celulares de melanoma uveal

ABSTRACT Purpose: To investigate the effect of nicotinamide on the secretion of pro-an giogenic and pro-inflammatory cytokines in uveal melanoma cell lines. Methods: Two human uveal melanoma cell lines (92.1 and OCM-1) were treated with nicotinamide (10 mmol/L) or control media for 48 hours in culture. The su perna tant from each culture was used in sandwich enzyme-linked immuno sorbent assay-based angiogenesis and inflammation arrays to evaluate the effects of exogenously administered nicotinamide on the secretion of a total of 20 pro-an gio genic and pro-inflammatory proteins. Results: Seven pro-angiogenic cytokines were detected under control conditions for both uveal melanoma cell lines. Treatment with nicotinamide resulted in a significant decrease in secretion of the following pro-angiogenic cytokines: angiogenin, angiopoietin-2, epidermal growth factor, and vascular epithelial growth factor-A in the 92.1 cells; basic fibroblast growth factor in the OCM-1 cells; and placenta growth factor in both cell lines. Among the pro-inflammatory proteins, monocyte chemotactic protein-1 and interleukin-8 were expressed in both untreated cell lines and both were significantly reduced when treated with nicotinamide. Conclusions: Results from this in vitro model suggest that nicotinamide may have anti-inflammatory and anti-angiogenic properties, which may open the possibility of using it as a chemopreventive agent for uveal melanoma; however, further studies including animal models are warranted.

RESUMO Objetivo: Acredita-se que a nicotinamida (NIC) seja capaz de diminuir a angiogênese induzida pelo fator de crescimento endotelial vascular (VEGF). Investigar os efeitos da nicotinamida sobre a secreção de citocinas pró-angiogênicas e pró-inflamatórias em linhagens de células de melanoma uveal humano (UM). Métodos: Duas linhagens de células humanas de UM (92,1 e OCM-1) foram tratadas com NIC (10 mmol/L) ou apenas com meio de cultura por 48 horas. O sobrenadante das culturas obtido após a administração de nicotinamida foi comparado com o sobrenadante das culturas controle quanto à expressão de 20 fatores pró-angiogênicos e pró-inflamatórios, pela técnica de enzyme-linked immunosorbent assay (ELISA). Resultados: Sete citocinas pró-angiogênicas foram detectadas nas condições de controle em ambas as linhagens de células de UM. O tratamento com nicotinamida promoveu uma redução significativa da secreção das seguintes citocinas angiogênicas: Angiogenina, ANG2, EGF e VEGF-A em células 92.1; bFGF em células OCM-1; PIGF em ambas as linhagens celulares. Quanto às proteínas pró-inflamatórias, a expressão de MCP-1 e IL-8 foi significativamente reduzida com a administração de nicotinamida em relação às culturas de células que não receberam o tratamento. Conclusões: Nicotinamida apresenta propriedades anti-inflamatórias e anti-angiogênicas em modelo experimental in vitro. Tais efeitos sugerem a possibilidade de utilizar esta substância na quimioprevenção do UM. Entretanto, estudos com modelos experimentais in vivo são necessários para melhor avaliar o benefício do tratamento do UM com nicotinamida.

Apresentação incomum e agressiva de melanoma intraorbitário / Unusual and aggressive presentation of intraorbital melanoma

RESUMO O objetivo dos autores é relatar um caso de melanoma intraorbitário de apresentação atípica e agressiva, formando grande massa dolorosa de aspecto eritematoso e inflamatório projetando-se da órbita esquerda com o globo ocular danificado em seu ápice. A análise da peça identificou melanoma maligno com componentes celulares epitelióide, fusocelular e anaplásico.

ABSTRACT The purpose of this study is to report a intraorbital melanoma case with atypical and aggressive presentation, forming a large painful mass with erythematosus and inflammatory aspect protruding from the left orbit with eyeball damaged at its peak. Piece analysis identified malignant melanoma compound of epithelioid, spindle and anaplastic cells.

Internal eye wall resection of uveal tumors: long-term evaluation / Ressecção em bloco de tumores uveais: avaliação de longo prazo

The authors report five cases of uveal tumors managed with internal eye wall resection and evaluate the long-term results. Patient age varied from 31 to 61 years. Four patients were female and one was male. Uveal tumors involved ciliary body and choroid in three patients and choroid alone in the other two. Histopathological examination demonstrated three uveal melanomas, one leiomyoma, and one meduloepithelioma. The largest tumor diameter ranged from 8 to 15 mm and tumor thickness from 5 to 11 mm. Follow-up of the patients was over a period of 6 to 23 years. Final visual acuity was 20/20 in 3 patients and 20/200 in one patient, and in the fifth patient, the affected eye was enucleated. No cases of metastatic disease or local recurrence of the tumor were observed, suggesting that internal eye wall resection is a valid alternative for the treatment of selected cases of uveal tumors.

Os autores relatam 5 casos que apresentavam tumores uveais e foram submetidos à remoção cirúrgica em bloco do tumor, avaliando resultados de acuidade visual, índice de retenção do globo ocular e de doença metastática. Quatro mulheres e um homem, com idade entre 31 e 61anos foram submetidos ao procedimento. O tumor envolvia corpo ciliar e coroide em três olhos e somente a coroide em dois. A histopatologia demonstrou que 3 tumores eram melanomas, um leiomioma e um meduloepitelioma. O maior diâmetro dos tumores foi entre 8 e 15 mm e a espessura entre 5 e 11 mm. O tempo de seguimento dos pacientes foi de 6 a 23 anos. A acuidade visual final foi de 20/20 em 3 olhos, 20/200 em outro e um olho foi enucleado. Não foram observados casos de doença metastática ou recorrência tumoral, sugerindo que a ressecção em bloco de tumores uveais é uma alternativa válida para o tratamento destes tumores em casos selecionados.

Uveal Melanoma with Massive Extraocular Extension through the Sclerocorneal Limbus

No abstract available.

Clinical observation of local resection or enucleation for uveal melanoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Local resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation.</p><p><b>METHODS</b>Totally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality.</p><p><b>RESULTS</b>There were statistically significant differences in the largest basal diameter of the tumor (t = -3.441), the tumor thickness (t = -4.140), the ciliary body infiltration (χ(2) = 8.391), and the duration of follow-up (Z = 3.995) between the two groups (P < 0.05). The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis (RR = 1.752, 95% CI 1.066-2.880, P = 0.027), the largest basal diameter of the tumor (RR = 3.508, 95% CI 1.934-6.336, P = 0.000), and the histological type (RR = 2.444, 95% CI 1.106-5.877, P = 0.046). The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation (χ(2) = 1.214, P > 0.05); the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation (χ(2) = 1.304, P > 0.05). The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 (92.60%) among persons retaining eye.</p><p><b>CONCLUSIONS</b>The survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local resection may be an effective method for patients with uveal melanoma eligible for operation.</p>

MicroRNA 145 may play an important role in uveal melanoma cell growth by potentially targeting insulin receptor substrate-1 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>MicroRNAs (miRNAs) contribute to tumorigenesis by acting as either oncogenes or tumor suppressor genes. In this study, we investigated the role of miR-145 in the pathogenesis of uveal melanoma.</p><p><b>METHODS</b>Expression profiles of miRNAs in uveal melanoma were performed using Agilent miRNA array. Quantitative real-time polymerase chain reaction was used to screen the expression levels of miR-145 in normal uveal tissue, uveal melanoma tissue, and uveal melanoma cell lines. Lenti-virus expression system was used to construct MUM-2B and OCM-1 cell lines with stable overexpression of miR-145. Cell proliferation, cell cycle, and cell apoptosis of these miR-145 overexpression cell lines were examined by MTT assay and flow cytometry respectively. The target genes of miR-145 were predicted by bioinformatics and confirmed using a luciferase reporter assay. The expression of insulin-like growth factor-1 receptor (IGF-1R), insulin receptor substrate-1 (IRS-1) proteins was determined by Western blotting analysis. IRS-1 was knocked down in OCM-1 cells. TUNEL, BrdU, and flow cytometry assay were performed in IRS-1 knocked down OCM-1 cell lines to analyze its function.</p><p><b>RESULTS</b>Forty-seven miRNAs were up regulated in uveal melanoma and 61 were down regulated. miR-145 expression was significantly lower in uveal melanoma sample and the cell lines were compared with normal uveal sample. Overexpression of miR-145 suppressed cell proliferation by blocking the G1 phase entering S phase in uveal melanoma cells, and promoted uveal melanoma cell apoptosis. IRS-1 was identified as a potential target of miR-145 by dual luciferase reporter assay. Knocking down of IRS-1 had similar effect as overexpression of miR-145.</p><p><b>CONCLUSION</b>miR-145 might act as a tumor suppressor in uveal melanoma, and downregulation of the target IRS-1 might be a potential mechanism.</p>

Prognostic implications of cytopathologic classification of melanocytic uveal tumors evaluated by fine-needle aspiration biopsy / Implicação prognóstica da classificação citopatológica dos tumores melanocíticos da úvea avaliados pela biópsia aspirativa com agulha fina

PURPOSE: Determine whether cytopathologic classification of melanocytic uveal tumors evaluated by fine-needle aspiration biopsy (FNAB) is a significant prognostic factor for death from metastasis. METHODS: Retrospective analysis of cases of clinically diagnosed uveal melanoma evaluated by fine-needle aspiration biopsy from 1980 to 2006. Main outcome evaluated was death from metastasis. Associations between baseline clinical variables and cytopathologic classification were evaluated using cross-tabulation. Prognostic significance of cytopathologic classification was evaluated by Kaplan-Meier and Cox proportional hazards analysis. RESULTS: Of 302 studied biopsies, 260 (86.1%) yielded sufficient cells for cytopathologic classification. Eighty of the 260 patients who had a sufficient specimen have already died (P=0.021), 69 from metastatic uveal melanoma. Cell type assigned by cytopathology was strongly associated with metastasis/metastatic death in this series (P=0.0048). Multivariate analysis showed cytopathologic classification to be an independently significant prognostic factor for metastatic death (P=0.0006). None of the 42 patients whose tumor yielded insufficient aspirates (sampled in at least two sites) have developed metastasis or died of metastasis thus far. CONCLUSION: In this series, cytopathology of fine-needle aspiration biopsy samples obtained from uveal melanomas was strongly prognostic of death from metastasis. Insufficiently aspirates (2 or more sites sampled) proved to be prognostic of a favorable outcome (i.e., not developing metastasis).

OBJETIVO: Determinar se a classificação citopatológica de tumores melanocíticos da úvea avaliados pela biópsia aspirativa com agulha fina (BAAF) é um fator prognóstico significativo para óbito por metástases. Métodos: Análise retrospectiva de casos diagnosticados clinicamente como melanoma uveal e avaliados pela biópsia aspirativa com agulha fina entre 1980 e 2006. O evento principal analisado foi óbito por metástase. Associações entre variáveis clínicas à apresentação e classificação citopatológica foram avaliadas usando tabulação cruzada. Significância prognóstica da classificação citopatológica foi avaliada por análise de riscos proporcionais de Cox e Kaplan-Meier. RESULTADOS: Das 302 biópsias estudadas, 260 (86,1%) renderam um número suficiente de células para classificação citopatológica. Oitenta dos 260 pacientes que obtiveram um espécime suficiente (adequado) foram a óbito (P=0,021), 69 destes por melanoma uveal metastático. O tipo celular designado pela citopatologia apresentou forte associação com metástase/óbito por metástase nessa série (P=0,0048). Análise multivariada mostrou que a classificação citopatológica foi um fator prognóstico independente significativo para o óbito por metástase (P=0,0006). Nenhum dos 42 pacientes cujos tumores renderam um aspirado insuficiente (quando foram amostrados pelo menos 2 sítios) desenvolveu metástase e foi a óbito por metástase até o presente momento. CONCLUSÃO: Nessa série, a citopatologia dos espécimes obtidos pela biópsia aspirativa com agulha fina de melanomas uveais foi fortemente prognóstica para óbito por metástase. Os aspirados insuficientes (se duas ou mais áreas foram amostradas) provou ser um resultado prognóstico favorável (i.e., de não desenvolvimento de metástases).

American joint committee on cancer staging of uveal melanoma

In January 2010, the American Joint Committee on Cancer [AJCC] updated its staging criteria for uveal melanoma. Here, we discuss the staging classifications and evaluate an interesting case to demonstrate. The development of a uniform means of staging cancer, such as defined by the AJCC, is critical for information sharing among the research community