RESUMO
A 3-year-old boy was referred because of the presence of a non-pigmented, highly vascular mass with tapioca appearance involving the superior portion of the left iris. Iris fluorescein angiography revealed early hyperfluorescence of the iris tumor with diffuse, intense late leakage of dye throughout the entire iris, not just in the region of the tumor. Cytopathologic examination revealed Touton giant cells and the presence of histiocytes, confirming the diagnosis of iris juvenile xanthogranuloma. The patient was prescribed topical prednisolone acetate, and the lesion resolved during the next 3 months. Fluorescein angiography may be useful in differentiating iris juvenile xanthogranuloma from malignant or non-inflammatory benign iris lesions.
Assuntos
Angiofluoresceinografia , Doenças da Íris/diagnóstico , Xantogranuloma Juvenil/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Iris/irrigação sanguínea , Doenças da Íris/tratamento farmacológico , Masculino , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Xantogranuloma Juvenil/tratamento farmacológicoRESUMO
OBJECTIVE: To evaluate the technique and complications of fine-needle aspiration biopsy (FNAB) for iris tumors. DESIGN: Retrospective, nonrandomized, single-center case series. PARTICIPANTS: One hundred eyes of 100 patients with diagnostically challenging iris tumors evaluated with FNAB. MAIN OUTCOME MEASURES: Biopsy technique and complications. RESULTS: Of more than 1400 patients referred with an iris tumor over a 24-year period, 100 underwent FNAB for diagnostic purposes. The median patient age was 44 years. The median basal dimension of the lesion was 9.0 mm and median thickness was 2.5 mm. A limbal entry with transaqueous approach parallel to the iris was used in 100% of patients. Entry was from the superotemporal (52%) or inferotemporal (42%) direction. Needle gauge size was 22 (9%), 25 (55%), 27 (25%), or 30 (9%), depending on the friability and vascularity of the tumor. Adequate tumor sample was achieved in 99 eyes (99%). At the time of FNAB, the only immediate complication was partial hyphema (34%). Two weeks after FNAB, persistent hyphema was found in 6 eyes (6%), requiring surgical washout in 1 patient. There were no cases of recurrent hyphema, vitreous hemorrhage, prolonged hypotony, lens damage, endophthalmitis, or extraocular tumor seeding. At mean follow-up of 5 years, there was no incident of tumor recurrence on the iris, along the needle tract, or on the corneal or epibulbar surface. CONCLUSIONS: Using our technique, FNAB for diagnostically challenging iris tumors can achieve high yield with relatively few complications.
Assuntos
Biópsia por Agulha Fina/normas , Neoplasias da Íris/patologia , Iris/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Hifema/etiologia , Lactente , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Iris/irrigação sanguínea , Neovascularização Patológica/fisiopatologia , Neoplasias da Retina/tratamento farmacológico , Retinoblastoma/tratamento farmacológico , Carboplatina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Angiofluoresceinografia , Glaucoma Neovascular/patologia , Glaucoma Neovascular/prevenção & controle , Humanos , Lactente , Neovascularização Patológica/diagnóstico , Retinoblastoma/patologia , Vincristina/uso terapêuticoAssuntos
Neoplasias da Coroide/complicações , Síndrome de Klippel-Trenaunay-Weber/complicações , Melanoma Amelanótico/complicações , Adolescente , Osso e Ossos/anormalidades , Braquiterapia , Neoplasias da Coroide/patologia , Neoplasias da Coroide/radioterapia , Assimetria Facial/complicações , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Masculino , Melanoma Amelanótico/patologia , Melanoma Amelanótico/radioterapiaRESUMO
PURPOSE OF REVIEW: The outcome of patients diagnosed with uveal metastases from breast carcinoma, all of whom were treated with one of the new generation of hormone therapies named aromatase inhibitors, is reported. RECENT FINDINGS: Charts of all patients with uveal metastases from breast cancer seen at Wills Eye Hospital between 1995 and 2005 are reviewed. Seventeen patients were diagnosed with uveal metastases from estrogen-receptor-positive breast cancer and subsequently treated with one of the aromatase inhibitors (anastrozole, letrozole, exemestane). SUMMARY: The interval between initial diagnosis of breast cancer and choroidal metastases ranged from 1 month to 17 years. Thirteen patients had received tamoxifen either at the time of breast surgery or as part of the metastases treatment. In 10 cases, both the systemic and choroidal metastases remained regressed over a mean of 20 months follow-up (4-50 months). There was no toxicity or intolerance to the medication. Aromatase inhibitors represent a new generation of hormone therapy for metastatic breast cancer. They were effective in 59% of the patients with estrogen-receptor-positive breast cancer, many of them nonresponding to prior treatment with tamoxifen. Aromatase inhibitors avoid the need for external beam radiation therapy as a treatment for the ocular metastases.
Assuntos
Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Coroide/tratamento farmacológico , Neoplasias da Coroide/secundário , Idoso , Idoso de 80 Anos ou mais , Anastrozol , Androstadienos/uso terapêutico , Neoplasias da Mama/metabolismo , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Letrozol , Mastectomia Radical , Mastectomia Segmentar , Mastectomia Simples , Pessoa de Meia-Idade , Neoplasias Hormônio-Dependentes/metabolismo , Neoplasias Hormônio-Dependentes/patologia , Neoplasias Hormônio-Dependentes/terapia , Nitrilas/uso terapêutico , Receptores de Estrogênio/metabolismo , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Tamoxifeno/uso terapêutico , Resultado do Tratamento , Triazóis/uso terapêuticoRESUMO
OBJECTIVE: To evaluate the effect of intravitreal triamcinolone acetonide on patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma. DESIGN: In this prospective, nonrandomized, single-center case series of 31 patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University, triamcinolone acetonide (4 mg/1 mL) was injected through the pars plana into the vitreous cavity using sterile technique. Status of radiation maculopathy and final visual acuity were the main outcome measures. RESULTS: At the time of diagnosis of choroidal melanoma, visual acuity was 20/20 to 20/50 in 90% (n = 28), 20/60 to 20/200 in 10% (n = 3), and 20/400 or worse in none of the patients. The mean radiation dose to the foveola was 5,122 cGy (median, 3,280 cGy; range, 1,000-16,100 cGy). Radiation maculopathy developed at a mean of 22 months (median, 16 months; range, 6-96 months) after plaque radiotherapy. In all cases, the choroidal melanoma was regressed, and there was no retinal detachment or neovascularization of the retina, optic disk, or iris. At the time of diagnosis of radiation maculopathy, visual acuity was 20/20 to 20/50 in 19% (6/31), 20/60 to 20/200 in 58% (18/31), and 20/400 or worse in 23% (7/31) of patients. After intravitreal injection of triamcinolone acetonide, visual acuity was stable or improved in 91% (20/22) of patients by 1 month and 45% (14/31) by 6 months. Mean foveal thickness by optical coherence tomography was 417 microm at injection and 207 microm at 1 month and 292 microm at 6 months after injection. CONCLUSIONS: Intravitreal triamcinolone acetonide can stabilize or improve visual acuity in some patients with radiation-induced maculopathy, but its effect might not be lasting.