Uveal melanoma management.
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Choroid Neoplasms↗
Biomedical subjects
D H Char
Publications and source records attributed to D H Char.
Cytomorphometry of uveal melanomas: fine needle aspiration biopsy versus standard histology.
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Biopsy, Needle↗
Bilateral ciliary body melanomas.
We describe a 78-year-old woman with bilateral primary ciliary body melanomas. The tumours presented 6 months apart and were treated with iridocyclectomy. Histopathological examination revealed type B spindle cell melanomas. To our knowledge this is the first reported case of bilateral ciliary body melanomas.
Aged↗
Coincident systemic malignant disease in uveal melanoma patients.
Differentiation of a primary uveal melanoma from a uveal metastasis can be difficult. Review of the records of 627 patients with choroidal or ciliary body melanoma seen at our institution between September 1977 and November 1987 showed that 53 (8%) had a second, systemic malignant disorder. A complete ophthalmologic evaluation, including indirect ophthalmoscopy, fundus photography, ultrasonography and general medical studies, should minimize incorrect ocular diagnosis and inappropriate therapy.
Adolescent↗
Uveal melanoma radiation. 125I brachytherapy versus helium ion irradiation.
The optimum radiation therapy for uveal melanoma is uncertain. Both helium ion irradiation and 125I brachytherapy have been used to treat this neoplasm. This investigation analyzed the control and complication rates of uveal melanomas treated with helium ions of 125I plaques. In both a retrospective and a prospective dynamically balanced study, the control rates appeared to be similar. There were more posterior segment complications after 125I plaques and more anterior segment complications, including neovascular glaucoma, after helium ion irradiation. The follow-up period is too short to draw definitive conclusions on the radiation complications. Overall, approximately 89% of eyes were retained and less than 4% of treated eyes were removed because of failure to control the tumor.
Adult↗
Current treatments and trials in uveal melanoma.
Treatment options for uveal melanomas include radiation using brachytherapy or charged particle beams, photocoagulation, laser, eye wall resection, and enucleation. Goals of therapy are to avoid metastatic disease and, if possible, retain both the eye and good vision. Obviously, treatment options are controversial. Questions remain regarding enucleation vs other forms of therapy, and the author presents guidelines to consider in structuring clinical trials to answer them. They include: Will entry in a trial provide optimum clinical care for the patient? Does the trial ask a valid, important question? Does the trial produce significant answers in a short enough time so that the information is relevant?
Clinical Trials as Topic↗
Failure of preenucleation radiation to decrease uveal melanoma mortality.
We analyzed uveal melanoma metastases in a group of 41 patients who received 20 Gy of preenucleation radiation in a Northern California Oncology Group preliminary phase I/II study, and compared their survival rates with a retrospective control group of 31 patients with characteristics matching the entrance criteria but treated with enucleation alone. Using the Cox proportional hazards model, we found that increased tumor diameter, mixed or epithelioid cell type, and radiation adversely affected survival. In vivo studies of cell cycling indicated that 20 Gy of preenucleation radiation appeared to diminish the reproductive integrity of the tumor cells. It is most likely that the failure of preenucleation irradiation to prolong patient survival was because of micrometastases that occurred before treatment.
Adult↗
Ferrous intraocular foreign bodies and magnetic resonance imaging.
We placed various sized ferrous foreign bodies in and around the eye, sclera, and orbit in a rabbit model before performing magnetic resonance imaging studies. All foreign bodies were detected on plain x-rays. Only one of the largest fragments (3 x 1 x 1 mm) demonstrated movement on exposure to the magnetic field.
Animals↗
Melanoma metastatic to the orbit.
Cutaneous malignant melanoma often metastasizes to the lung, bone, liver, subcutaneous tissue, and lymph nodes. Six cases of malignant melanoma metastatic to the orbit are presented, five from cutaneous melanomas and one from a contralateral choroidal melanoma. Melanoma rarely metastasizes to the orbit, but when orbital involvement occurs, widespread metastases are already present. Twenty-two cases were reviewed from the literature; 13 of 14 patients, with sufficient follow-up data, had widespread metastases when they presented with orbital disease. Extraocular muscles appear to be a favored site of metastases. The mean time from orbital presentation to death was 4 months. Orbital metastases from a distant melanoma is, therefore, part of a widespread metastatic process. Treatment should be directed toward palliation.
Aged↗
Primary intraocular lymphoma (ocular reticulum cell sarcoma) diagnosis and management.
The authors retrospectively reviewed the diagnosis and management of 20 intraocular lymphoma patients who initially presented with either ocular or central nervous system (CNS) disease. As the ophthalmic community has become more aware of this entity, the interval between symptoms and diagnosis has significantly shortened. Diagnosis can usually be made on cytopathologic examination of vitreous cells. However, in three cases more than one vitreous biopsy was necessary. Results of cytologic examination appeared to be more accurate than those of conventional lymphocyte surface marker studies in the diagnosis of an intraocular lymphoma. Long-term survival occurred in some patients treated with a combination of intrathecal chemotherapy and ocular/CNS irradiation.
Adult↗
Vision following helium ion radiotherapy of uveal melanoma: a Northern California Oncology Group study.
One hundred eighty-six uveal melanoma patients were treated with helium ion radiotherapy at Lawrence Berkeley Laboratory and followed for at least 6 months. (Follow-up times ranged from 6 to 90 months; median 26.4 months.) At last examination, 92 of 186 patients (49%) had visual acuity of 20/200 or better in the treated eye. Univariate statistical analysis revealed that post-treatment vision correlated with tumor size, distance between tumor and optic disc, distance between tumor and fovea, pretreatment visual acuity, dose delivered to the optic disc, and dose delivered to the fovea (p less than .05). Neither the maximum tumor dose nor site of tumor origin (ciliary body vs. choroid) correlated with post-treatment vision on a univariate basis. However, multivariate statistical analysis revealed that the strongest independent risk factors influencing vision outcome (p less than .05) were tumor size, pretreatment visual acuity, tumor-fovea distance, and maximum tumor dose. Neither the fovea dose nor the dose to optic disc appeared to significantly affect vision outcome when other variables were taken into account. These results suggest that post-treatment visual acuity of 20/200 or better can be achieved in one-half of uveal melanoma patients treated using helium ion irradiation. Several independent risk factors affecting vision outcome have been identified.
Helium↗
Bilateral orbital cavernous haemangiomas.
Simultaneous bilateral orbital lesions are rare. The differential diagnosis includes orbital pseudotumour, metastasis, leukaemia, lymphoma, Wegener's granulomatosis, and neurofibromatosis. We report what we believe to be the first case of bilateral orbital cavernous haemangiomas.
Hemangioma, Cavernous↗
Intraocular lymphoma: immunological and cytological analysis.
We retrospectively reviewed the cytology and immunohistology of vitreous specimens from nine patients with intraocular lymphoma (ocular reticulum cell sarcoma). A single vitreous biopsy specimen was not always adequate to establish the diagnosis in this condition. Cytological evaluation was more accurate than lymphocyte surface marker analysis to differentiate lymphoma from uveitis. The immunological features of these tumours indicate a heterogeneous group of intraocular lymphomas.
Adult↗
Activated T lymphocytes in uveitis.
Two colour flow cytometry techniques were used to assess the activation stages of peripheral and intraocular T lymphocytes in uveitis. Increased numbers of T lymphocytes bearing the interleukin-2 (IL-2) receptors were found in intraocular fluids or peripheral blood or both of 35/51 patients with uveitis. This increased expression of IL-2 receptors on lymphocytes correlated with increased expression of other early T lymphocyte activation markers, HLA-DR and L-35. Both T helper cells (Leu-3A+) and suppressor cells (Leu 2A+) were activated in vivo. A positive correlation was seen between lymphocyte activation and clinical uveitis activity. In idiopathic uveitis activation of Leu-3A lymphocytes (helper/inducer) was significantly increased, and intraocular activation of the Leu-2A lymphocytes (cytotoxic/suppressor) was significantly decreased. These data show that some patients with idiopathic uveitis have a perturbation of T helper cells. Twenty-two of 31 patients with idiopathic uveitis, not associated with systemic disease, had increased peripheral T lymphocyte activation. This finding indicates that in some inflammations believed to be restricted to the eye an abnormal systemic immune activation exists.
Antigens, Differentiation, T-Lymphocyte↗
DNA cell cycle studies in uveal melanoma.
We analyzed the cell cycling status of a group of irradiated and nonirradiated uveal melanomas using BrdUrd techniques. These data demonstrate that melanomas are relatively slow-growing tumors with a few cells actively cycling at a given time. Radiation has a profound effect on the number of cycling cells (P less than .0001). After treatment with either 20 Gy of pre-enucleation photon or 60 Gy or more of helium ion irradiation, virtually no cells are detected in the synthesis phase of the DNA cell cycle. It is unclear whether the absence of cycling cells after 20 Gy of photon irradiation is permanent or represents a transient cell cycle block, since these tumors were studied within 48 hours after irradiation. In contrast, all melanomas treated with helium ion had been irradiated several months prior to enucleation (mean, 2 years). In the latter group of tumors, the length of time between treatment and cell cycle analysis suggests that these cells had lost their reproductive integrity. These data were substantiated by tissue culture studies. Growth of tumor explants was significantly less (P less than .007) in irradiated than in nonirradiated melanomas. The optimum technology used for measurement of cell cycle status remains to be determined. Measurement of BrdUrd uptake using immunofluorescent microscopy on either standard sections or fine-needle biopsies can be performed. In general, flow cytometric analysis yields similar results. It is difficult with the latter technique to be certain that nontumor cells are not artifactitiously counted in the cell cycle studies. The incorporation of BrdUrd cell cycle analysis with fine-needle biopsy may be useful in the clinical management of irradiated melanomas that have questionable growth after treatment. In a few cases studied, results appeared to correlate with tumor growth activity.
Aged↗
Uveal melanoma with opaque media: absence of definitive diagnosis before enucleation.
It is often difficult to make a correct diagnosis of a uveal melanoma in an eye with opaque media. A patient with a blind, painful eye and opaque media was evaluated clinically and with computed axial tomography and ultrasonography. We were unable to establish the definitive diagnosis of a uveal melanoma until the eye was examined histologically. Necrotic melanomas usually present with inflammatory signs, may produce opaque media and can be difficult to diagnose with clinical and imaging studies.
Aged↗
Radiation therapy for ocular necrobiotic xanthogranuloma.
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Eye Diseases↗
Phorbol ester-induced orbital myositis.
A single injection of TPA (12-0-tetradecanoyl-phorbol-13-acetate) into the superior rectus muscle of New Zealand white rabbits produced inflammation and edema, followed by fibrosis and muscle restriction. Strain gauge measurements showed a 60% increase in muscle restriction at 24 hours and an increase greater than 400% at 12 weeks. Clinical and histologic characteristics paralleled those of human idiopathic orbital myositis and thyroid orbital myopathy. The combination of initial muscular inflammation and enlargement, subsequent fibrosis and restricted extraocular motility, and histologic evidence of these changes creates a useful model of orbital myositis.
Animals↗