Epidemiologie, Invasion und Wachstum nicht-iridaler Aderhautmelanome und assoziierte intraokulare Veränderungen: Histologische Untersuchung von 223 Augen

Abstract

223 complete eyes enucleated because of a malignant uveal melanoma were studied histologically to evaluate patterns of growth and invasion and secondary intraocular changes. Eyes with primary iris melanomas or with a previous operation were excluded. The most important secondary changes are the retinal detachment usually responsible for the loss of visual function as well as the direct tumor invasion of the chamber angle and the rubeosis iridis, both able to cause a secondary glaucoma, which is often difficult to treat. The rubeosis iridis increased in frequency with increasing tumor prominence and was in no case combined with preretinal neovascularisations. The growth of malignant uveal melanomas may occur in three directions, i.e. outwards (through the outer envelope of the eye), inwards (towards the vitreous) or in the uveal plane. In any case intraocular borders manifesting different resistance against tumor invasion and thereby influencing prognosis of the disease have to be penetrated. Changes at the front of tumor invasion like loosening of the cellular union and transformation to a higher malignant cell type seem plausible but could not be demonstrated light-microscopically.

Retinoinvasive malignant melanoma of the uvea

“…3 5-7 It is most frequent close to the optic disc and ora serrata, where the retina is relatively fixed 13 5 These uveal melanomas may also seed the subretinal space,8 the vitreous,5 9 10 and the surface of the retina 15 8 11-17 The inner retina resists infiltration, however 1…”

“…3 5 These uveal melanomas may also seed the subretinal space,8 the vitreous,5 9 10 and the surface of the retina 15 8 11-17 The inner retina resists infiltration, however 15 Uveal melanomas also show little if any tendency to horizontally invade non-adjacent retina 1…”

“…5 8 11-17 The inner retina resists infiltration, however 15 Uveal melanomas also show little if any tendency to horizontally invade non-adjacent retina 15 6 8 12 13 15-17 …”

“…5 18-20 When they extend outside the eye, they generally do so along ciliary vessels and nerves 511 21Infiltration of the optic nerve proper is not, however, entirely exceptional 2…”

“…3 5 10-12 18-38 It is reportedly seen in 2% to 5% of all enucleated eyes with a uveal melanoma,2 3 5 18 19 25 31-33 and in 5% to 62% of eyes in which the tumour is located adjacent to the optic disc 35 18 27 36 In rare instances, the neoplastic cells may even extend to the optic chiasm and cause a visual field defect in the fellow eye 2023 29 38 Optic nerve invasion is enhanced by concomitant glaucoma 3…”