Detection of extrascleral extension in uveal melanoma with histopathological correlation

Burris, Christopher K.H.; Papastefanou, Vasilios P.; Restori, Marie; Arora, Amit; Sagoo, Mandeep S.; Cohen, Victoria M L

doi:10.1080/01676830.2017.1423083

Cited by 12 publications

(17 citation statements)

References 21 publications

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“…Extraocular growth is associated with an increased rate of orbital recurrence and worse survival [ 29 , 30 ]. It should be diagnosed in order to be taken into account in the treatment plan.…”

Section: Discussionmentioning

confidence: 99%

MR imaging characteristics of uveal melanoma with histopathological validation

et al. 2021

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Purpose To evaluate the magnetic resonance imaging (MRI) characteristics of uveal melanoma (UM), to compare them with fundoscopy and ultrasound (US), and to validate them with histopathology. Methods MR images from 42 UM were compared with US and fundoscopy, and on 14 enucleated cases with histopathology. Results A significant relationship between the signal intensity on T1 and pigmentation on histopathology was found (p=0.024). T1 hyperintense UM were always moderately or strongly pigmented on histopathology, while T1-hypointense UM were either pigmented or non-pigmented. Mean apparent diffusion coefficient (ADC) of the UM was 1.16 ± 0.26 × 10−3 mm2/s. Two-thirds of the UM had a wash-out and the remaining a plateau perfusion time-intensity curve (TIC). MRI was limited in evaluating the basal diameter of flat tumors. US tends to show larger tumor prominence (0.5mm larger, p=0.008) and largest basal diameter (1.4mm larger, p<0.001). MRI was good in diagnosing ciliary body involvement, extrascleral extension, and optic nerve invasion, but limited on identifying scleral invasion. An increase of tumor prominence was associated with lower ADC values (p=0.030) and favored a wash-out TIC (p=0.028). An increase of tumor ADC correlated with a plateau TIC (p=0.011). Conclusions The anatomical and functional MRI characteristics of UM were comprehensively assessed. Knowing the MRI characteristics of UM is important in order to confirm the diagnosis and to differentiate UM from other intra-ocular lesions and because it has implications for treatment planning. MRI is a good technique to evaluate UM, being only limited in case of flat tumors or on identifying scleral invasion.

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Section: Discussionmentioning

confidence: 99%

MR imaging characteristics of uveal melanoma with histopathological validation

et al. 2021

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“…The literature reporting outcomes of adjuvant radiotherapy for EOE following enucleation for uveal melanoma is sparse [12][13][14][15] and little has been published in the past three decades with respect to the incidence of orbital recurrence following enucleation. Our findings suggest that cases with relatively small EOE of less than 5mm in thickness, with complete excision from the orbital contents can be safely observed without the need for adjuvant radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Those undergoing EBRT received 50 Gy in 20 fractions with 6MV x-rays, typically administered over 4 weeks, as this was the protocol reported by Hykin et al from our institution in 1990. 15 Patients who did not have a date of death listed in the electronic medical record, and who had not been seen in clinic within six months of the study close were contacted via telephone to determine their vital status and exclude orbital recurrence.…”

Section: Methodsmentioning

confidence: 99%

Adjuvant External Beam Radiotherapy Following Enucleation of Eyes With Extraocular Extension From Uveal Melanoma

Roelofs

Cohen

Sagoo

et al. 2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To report local disease control and all-cause mortality in patients with extraocular extension (EOE) of uveal melanoma (UM) undergoing enucleation followed by observation or external beam radiotherapy (EBRT).Methods: Charts of patients enucleated between January 1 st , 1997 and December 31 st , 2019, with histopathological evidence of EOE of UM were reviewed. Results:The cohort comprised 51 patients with a mean age of 67 ± 15 years, 22 (43%) of whom underwent adjuvant post-enucleation EBRT. Risk factors for metastasis included presence of epithelioid cells (29/45; 88%), closed loops (20/43; 47%), monosomy 3 (16/25; 64%) and gain of 8q (20/22; 91%). Patients undergoing EBRT had more extensive EOE (median: 5.1 mm vs 2.6 mm, p = 0.008) and surgical excision was less likely to be histologically complete (2/20; 10% vs 14/25; 56%, p = 0.002). Local side effects following EBRT were seen in 64% (14/22). At latest follow up, 59% of patients (30/51) were alive, with a median follow-up of 1.8 years [IQR 2.9, range 0.1 -6.5]. By Kaplan Meier survival analysis, the 5-and 10-year overall survival rates were 56% and 12% respectively. There was no difference in all-cause mortality between those receiving adjuvant EBRT and those who were observed (log rank, p = 0.273). No cases of orbital recurrence were documented. Conclusions:Orbital EBRT causes significant morbidity. Cases with relatively small EOE undergoing enucleation can be safely observed, without adjuvant EBRT. Multi-center studies are required to better assess the role of EBRT when EOE is more extensive.

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“…Extrascleral extension is also rare in CM. Routes of extrascleral extension previously described include via aqueous outflow vessels or emissary canals carrying posterior ciliary nerves, arteries, and vortex veins[11,12]. However, it may be difficult for pathologists to precisely cut the eyeball specimen at the point where tumor cells exit the eye, especially when the extrascleral extension is large.…”

Section: Discussionmentioning

confidence: 99%

Distant metastasis in choroidal melanoma with spontaneous corneal perforation and intratumoral calcification: A case report

Wang

Liu

Bee

2019

WJCC

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BACKGROUNDUveal melanoma is the most common primary intraocular malignancy in adults, but its incidence is low in Asian populations. Spontaneous corneal perforation and intratumoral calcification are rare presentations of choroidal melanoma (CM) , and reports regarding these presentations have been limited. Even after complete surgical treatment, the prognosis of CM patients is usually poor if distant metastasis is present. We here present a case of CM with unique presentations and early distant metastasis to the liver.CASE SUMMARYA 63-year-old Asian woman presented to our hospital with complaint of pain and brownish discharge from her left eye for 3 d. Imaging studies revealed intratumoral calcification within the left eye with eyeball rupture. Enucleation of the left eye was performed and pathological examination confirmed the diagnosis of CM. Systemic surveillance revealed no metastatic diseases. However, the patient was lost to follow-up 3 mo after surgery. At 1.5 years after the operation, she presented to our emergency department with complaint of dull epigastric pain that radiated to the back for 1 d. Imaging studies revealed a large mass at the upper abdomen abutting the pancreatic neck and body as well as several nodular lesions in the liver. Fine needle biopsy was performed and findings confirmed liver and pancreatic metastases.CONCLUSIONThis case highlights the importance of continued follow-up of patients with CM.

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Detection of extrascleral extension in uveal melanoma with histopathological correlation

Cited by 12 publications

References 21 publications

MR imaging characteristics of uveal melanoma with histopathological validation

MR imaging characteristics of uveal melanoma with histopathological validation

Adjuvant External Beam Radiotherapy Following Enucleation of Eyes With Extraocular Extension From Uveal Melanoma

Distant metastasis in choroidal melanoma with spontaneous corneal perforation and intratumoral calcification: A case report

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