Results of comprehensive ELISA tests of blood serum for the presence of IgM-, IgA-, and IgG-antibodies to herpes simplex virus types 1 and 2, cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, human herpes virus 8 type, Chlamydia trachomatis in 38 patients with uveal melanoma are presented. The polymerase chain reaction was used to detect DNA of these pathogens in tumor biopsies, vitreous body of 10 enucleated eyes, as well as in plasma IgG-antibodies to HHV 6 were revealed in 50% of patients; IgG-antibodies to HHV 8, in 5.3% of patients. Among the 16 patients with uveal melanoma at advanced stages, 6 patients had antibodies indicative of EBV reactivation (1.2-3.3). Chlamydia trachomatis genome was detected in both biopsies; in one of them, in conjunction with EBV and CMV DNA . Tissue samples from the identified infectious agents were related only to the spindle-cell histologic type AB of uveal melanoma. In plasma, genomes of pathogens were not determined. The results indicate the presence of infectious agents in patients with uveal melanoma and require further study of the pathogenetic role of infections in the pathogenesis of uveal melanoma.
Меланома хориоидеи (МХ) -злокачественная опухоль, склонная к раннему метастазированию. Ее клиническая картина полиморфна, вследствие чего она может симулировать множество заболеваний глазного дна, названных в литературе «псевдомеланомами». К ним относятся: невус хориоидеи, отграниченная гемангиома хориоидеи, меланоцитомы, метастатическая карцинома хориоидеи, врожденная гипертрофия ретинального пигментного эпителия, поздняя стадия возрастной макулярной дегенерации, очаговые ретинохориоидиты, организованное субретинальное кровоизлияние, гемангиомы сетчатки. Однако работы, посвященные сравнению клинических признаков всех перечисленных псевдомеланом с начальной МХ, малочисленны. В данной части обзора приведено описание офтальмоскопической картины начальной МХ и псевдомеланом. Ключевые слова: начальная меланома хориоидеи; невус хориоидеи; отграниченная гемангиома хориоидеи; меланоцитома; метастатическая карцинома хориоидеи; врожденная гипертрофия ретинального пигментного эпителия; поздняя стадия возрастной макулярной дегенерации; задний очаговый ретинохориоидит; организованное субретинальное кровоизлияние; гемангиома сетчатки Конфликт интересов: отсутствует. Прозрачность финансовой деятельности: автор не имеет финансовой заинтересованности в представленных материалах или методах. Для цитирования: Мякошина Е.Б. Начальная меланома хориоидеи и псевдомеланомы: методы дифференциальной диагностики. Часть 1. Офтальмоскопия. Российский офтальмологический журнал. 2019; 12 (4): 99-108. Choroidal melanoma is a malignant tumor prone to early metastasis. Its clinical picture is polymorphic, as a result of which it can simulate many diseases of the fundus, which are referred to in the literature as pseudomelanomas. Among these are: choroidal nevus, localized choroidal hemangioma, melanocytomas, choroidal metastatic carcinoma, congenital hypertrophy of retinal pigment epithelium, late stage of age-related macular degeneration, focal retinal choroiditis, organized subretinal hemorrhage, retinal hemangiomas. However, studies comparing the clinical signs of all listed pseudomelanomas and small choroidal melanoma are few. The first part of the review describes the ophthalmoscopic picture of the small choroidal melanoma and pseudomelanomas. Keywords: small сhoroidal melanoma; choroidal nevus; circumscribed choroidal hemangioma; melanocytoma; choroidal metastatic carcinoma, congenital hypertrophy of retinal pigment epithelium; late stage of age-related macular degeneration; posterior focal retinal choroiditis; organized subretinal hemorrhage; retinal hemangioma
The first part of the literature review described the ophthalmoscopic picture of the small choroidal melanoma and pseudomelanomas [ROJ, 2019; 12 (4): 99–108]. This is the second part of the review, which describes the features characteristic of small uveal melanoma and pseudomelanomas, revealed by fluorescence angiography and autofluorescence. Typical properties of fluorescence and autofluorescence are presented for every disease of the eye fundus studied: small choroidal melanoma, choroidal nevus, circumscribed choroidal hemangioma, melanocytoma, choroidal metastatic carcinoma, congenital hypertrophy of the retinal pigment epithelium, late-stage age-related macular degeneration, focal retinochoroiditis of the posterior pole, organized subretinal hemorrhage, retinal hemangioma. The attention was focused on the similarity of angiographic and autofluorescence symptoms of the diseases under study. The need for new differential diagnostic criteria was emphasized.
Цель работы-описать клинический случай глазных осложнений лечения стромальной опухоли желудка иматиниба мезилатом. Материал и методы. Пациентка 78 лет обследована с помощью общеофтальмологических и инструментальных методов, включая ультразвуковое исследование и спектральную оптическую когерентную томографию (СОКТ). Результаты. С помощью офтальмоскопии диагностированы стушеванность макулярного рефлекса правого глаза. В левом глазу также выявлена нечеткость границ диска зрительного нерва (ДЗН) и макулярного рефлекса, наличие в парамакулярной зоне белесоватых фокусов серо-желтого цвета, неправильной формы, с ровными четкими границами, в нижнем отделе глазного дна-слабопигментированного серо-желтого фокуса с неровными нечеткими границами, неровной поверхностью. CОКТ показала в правом глазу в макуле и парамакулярных зонах ретинальный отек, эпиретинальную мембрану. По краям ДЗН левого глаза-витреоретинальные тракции, отек сетчатки; в парамакулярной зоне и во внутренних отделах глазного дна-витреоретинальные тракции, эпиретинальный фиброз, ретинальный отек; в нижних отделах-полная деструкция всех слоев сетчатки из-за гиперрефлективного фокуса с мелкобугристым внутренним контуром, ровный хориоидальный профиль с истончением хориоидеи, витреоретинальные тракции, эпиретинальная мембрана. Заключение. Клинический случай глазных осложнений применения иматиниба мезилата в лечении стромальной опухоли желудка свидетельствует о необходимости междисциплинарного комплексного подхода (онколога и офтальмоонколога) к диагностике и лечению опухолевых заболеваний. Комплекс инструментальных методов диагностики заболеваний глазного дна с включением дополнительных уточняющих методов (СОКТ) дает возможность провести дифференциальную диагностику ретинопатии на фоне химиотерапии, вторичного метастатического поражения и витреоретинальной патологии другого этиопатогенеза. Ранняя диагностика позволяет провести адекватное лечение для сохранения зрения, глаза и жизни больного. Ключевые слова: иматиниба мезилат; глазные осложнения; спектральная оптическая когерентная томография Конфликт интересов: отсутствует. Прозрачность финансовой деятельности: никто из авторов не имеет финансовой заинтересованности в представленных материалах или методах.
The immune response to any antigen includes the induction of effector and regulatory T lymphocytes. In tumors, an imbalance in the subpopulation of lymphocytes is noted. Ophthalmotropic pathogens of herpes virus infections play a role in the etiopathogenesis of some oncological processes in the tissues of the eye. Their “cancer modulating” role is to regulate the functions of immunocompetent cells by viruses and reprogram it in the direction of greater progression of tumor growth. The aim of our study was a comparative analysis of the content of effector subpopulations of blood lymphocytes in patients with uveal melanoma during activation and the chronic course of herpes virus infection. The study involved 141 people: with uveal melanoma 70 patients, with corneal ulcers and involvement of the uveal tract - 38 patients and 33 healthy donors. Immunophenotyping was performed by flow laser cytofluorimetry using a monoclonal antibody system to differentiate lymphocyte subpopulations. IgM and IgG antibodies to herpes virus infections were determined in an enzyme-linked immunosorbent assay (ELISA) on an automatic ELISA analyzer "Lazurite" (USA) with diagnostic kits of CJSC Vector-Best (Koltsovo). The results of the study showed that the absolute number of blood lymphocytes (CD45 +) in patients with uveal melanoma, regardless of the presence of active or chronic herpes virus infection, did not differ from the values in healthy donors. In patients with corneal ulcers involving the uveal tract, an increase was noted. A decrease in the relative and absolute content of T cells (CD3+) was revealed in patients with uveal melanoma during activation and the chronic course of herpes virus infection. An increase in the absolute content of CD3 + was noted in patients with active and chronic herpesvirus infection in patients with inflammatory lesions of the eye. There was no difference in the relative and absolute contents of the subpopulation of CD3 + CD4 + helpers / inducers upon activation of herpes virus infections in tumor. With corneal ulcers - a significant increase in the absolute content of CD3 + CD4 + helpers / inducers with active and chronic infection. In chronic herpes virus infection, an increase in the relative and absolute number of cytotoxic T-lymphocytes (CD3 + CD8 +) with uveal melanoma was revealed. With active infection, a decrease in the relative number of T-lymphocytes (CD3 + CD8 +) in the tumor was noted. With corneal ulcers involving the uveal tract, an increase in the absolute content during activation and chronic infection and a decrease in the relative content compared to the norm were determined. When analyzing the “double positive” T cells in a tumor, an increase in relative and absolute indices was observed in chronic and active infection with herpes viruses. The same trends were observed with inflammatory eye diseases. Analysis of the content of B-lymphocytes (CD19 +) in blood with melanoma showed an increase in the absolute number during activation and the chronic course of herpes virus infection. When analyzing the indicators of the absolute and relative content of B-lymphocytes (CD19 +) with inflammation of the membranes of the eyes, their increase was revealed regardless of activation or chronic infection. The relative number of natural killers (CD16 + CD56 +) of blood with uveal melanoma increased with infection activation. In inflammatory eye diseases, a decrease in the relative content of natural killers (CD16 + CD56 +) was found in chronic infection and active herpes virus infection. With melanoma, no changes in the index of the ratio CD4 + / CD8 + were detected, with ulcerative lesions of the cornea involving the uveal tract, its increase was noted in acute and chronic infections with herpes virus infections. (p <0.05). Thus, our own studies suggest a deep suppression of the immune system of the body of patients with uveal melanoma, which does not allow the activation of antiviral protection. Tumor causes multidirectional shifts in the relative and absolute content of lymphocytes during activation and chronic infection with herpes virus infections. The results obtained are important for the development of personalized approaches to the prognosis and treatment of patients with uveal melanoma.
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