Biomedical subjects
Publications and source records attributed to S Seregard.
Massive intracorneal spread from ocular malignant melanoma is an infrequent event. This case illustrates the histopathological features of a large ciliary body melanoma with massive wedge-like intracorneal invasion, but without extraocular extension.
Expression of proliferating cell nuclear antigen, a DNA polymerase delta auxiliary protein, was studied in 20 specimens from 20 patients with conjunctival malignant melanoma by means of the total number of cells that showed immunoreactivity per square millimeter. The countings were shown to be reproducible with minimal intraobserver variability. In a multifactor analysis of variance (ANOVA) that adjusted for possible confounders, patients who subsequently died of metastatic disease had significantly higher counts of cells that were positive for proliferating cell nuclear antigen per square millimeter (P = .0011) than patients with a minimum survival of five years without clinical signs of metastatic disease. A multivariate Cox regression model confirmed the independent prognostic value (P = .048) of the cell counts. Individual hazard ratios were estimated in a final Cox model and two groups of patients with low and high hazard ratios were formed. Five-year cumulated survival proportions of the two groups were 90% and 60%, respectively. The total count of cells displaying immunoreactivity for proliferating cell nuclear antigen per square millimeter may be used as a prognostic indicator in patients with conjunctival melanoma.
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CASE REPORT: An 85-year-old woman had a bluish tumor medially on the margin of the left upper eyelid. Malignant melanoma of the conjunctiva was presumed; the lesion was excised and submitted for routine histopathologic examination. There are no signs of recurrence or metastatic disease after follow-up for 1 year. METHODS: Light microscopy with routine and histochemical stains were used for diagnosis. Immunohistochemical analysis included the use of a broad-spectrum "cocktail" of cytokeratin antibodies (AE1/AE3). RESULTS: The features were those of a cystic cavity lined with apocrine epithelium in one part infiltrating the wall and consistent with an apocrine adenocarcinoma derived from a Moll gland cystadenoma. CONCLUSION: Malignant Moll gland tumors are extremely uncommon but may be confused with conjunctival malignant melanoma or metastatic disease. The differential diagnosis to other sweat gland tumors such as eccrine adenocarcinoma and benign apocrine tumor or to sebaceous carcinoma can be difficult.
A case of ocular melanocytosis with the simultaneous occurrence of a choroidal malignant melanoma, a ciliary body melanocytoma and a surface plaque iris naevus in an 80-year-old male Caucasian is reported. Patients with ocular or oculodermal melanocytosis are considered to be at risk for tumour formation and malignant transformation; the multiple melanocytic tumours of the present case support this hypothesis.
Clinical information, follow-up and histopathological parameters of the primary lesions were assessed for all (45) individuals with conjunctival malignant melanomas in Sweden presenting during a 22.5 year period (1969 to mid 1991). The annual incidence of conjunctival malignant melanoma in Sweden was 0.0240 per 100,000. On average, two new cases were diagnosed each year (population 8.6 million in 1991). Sixty-two per cent of the lesions recurred, but re-growth in itself was not correlated to reduced survival. The actuarial 10-year survival proportion using life-table analysis was 70%. A significantly reduced survival due to tumour-related death was noted in patients with tumours with high mitotic indices, many epithelioid cells and in lesions exceeding 10 mm in diameter. Other factors that may influence survival are presented in the context of previous reports. The present policy in Sweden for treating patients with malignant melanoma of the conjunctiva is outlined and discussed.
Using a silver staining technique, argyrophilic nucleolar organiser region-associated proteins (AgNORs) have been studied in routinely processed paraffin sections of 46 invasive malignant melanomas (MM) of the conjunctiva. The aim of this retrospective study was to assess the value of the AgNOR method as a prognostic indicator for this neoplasm. The 46 cases were divided into two groups: (A) 14 cases of MM that metastasised and caused death of the patient within 5 years of (histological) diagnosis, and (B) 32 cases of MM that did not metastasise and in which patients survived beyond 5 years. The mean of the AgNOR counts per nucleus was 7.03 (95% CI: 5.81-8.24) in group A, and 7.15 (95% CI: 6.53-7.77) in group B. A comparison using a multifactor analysis of variance (ANOVA) model, which corrected for possible confounding effect of tumour thickness, site, and cell type showed no significant difference in AgNOR counts between groups A and B (p = 0.8). Analysis by the Cox proportional hazards regression model showed that survival was not influenced significantly by the mean AgNOR number (hazard ratio: 0.92). Whereas the AgNOR technique may be used to distinguish benign from malignant melanocytic lesions of the conjunctiva, we conclude it has no value in predicting the outcome for patients with conjunctival MM.
Age-related macular degeneration (AMD) is the most common cause of blindness over the age of 50. The patho-physiological changes and clinical findings in AMD are outlined. Recent findings indicate that some cases of AMD-related choroidal neovascularization can be successfully treated with argonlaser. These results are discussed from a Swedish perspective, and the need of a meticulous work-up is emphasized.
The first two Swedish cases of primary bilateral malignant melanoma of the choroid are presented. In one case bilateral histological confirmation was obtained as both eyes were enucleated. In the other case one eye was enucleated and the other irradiated with an episcleral ruthenium plaque. Sweden has a population of 8.38 millions, so that bilateral choroidal melanomas may be less rare than previously thought.
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Conjunctival melanoma is an uncommon tumor that is likely to recur and carries an overall mortality rate of approximately 30%. The seemingly unpredictable and enigmatic character of this entity has initiated much debate over the past decades regarding the etiology, histogenesis, prognosis, and preferred management. This review outlines the historical perspective; incidence and demographics; etiologic factors; histogenesis; cytogenetic findings; clinical characteristics; histopathologic and ultrastructural features; differential diagnoses; classifications; management of primary, recurrent, and systemic disease; survival after conjunctival melanoma; and diverse factors of potential prognostic significance. Finally, a brief outlook on present and future research objectives is provided.
This study was an attempt to compensate for an alleged aetiological deficiency in melanoma by the prophylactic oral administration of the essential biological components missing. Nine random patients suffering from high-risk uveal melanoma (T3) were, in this preliminary study, treated secondarily with biological dietary adjuvants after primary standard therapy, enucleation or brachytherapy. Secondary treatment consisted of certain natural amino-acids, trace-element salts, folic acid and a diet containing neurogenic lipid components. It entailed no side-effects, no toxicity and was inexpensive. None of these nine patients has suffered recurrent disease. The mean follow-up time was over 80 months (median 69, range 58-140 months). Local tumour control was 100%. This clinical result is significantly better (p = 0.018) as compared to similar T3 uveal melanoma patients in standard care who did not receive adjuvant dietary remedies after primary treatment. The control patients consisted of similar adjusted T3 cases selected from the Swedish official registries, and T2 patients from Germany. Based on the previous positive clinical results obtained with cutaneous malignant melanoma in bioimmunotherapy this additional positive result supports the notion that biological components administered orally may compensate for the etiological deficiency leading to malignant melanoma.