Intraocular pigmented proliferations in the context of cytologic evaluation

Abstract

This article is written to give an overview of the various intraocular pigmented proliferations as it pertains to cytologic evaluation and interpretation. It reviews the various epithelial and melanocytic lesions, their location and the various clinical approaches the ophthalmologist uses to aspirate the lesion. It also reviews the current thinking in the differentiation between Class I and Class II melanomas and how molecular profiling may be necessary in its differentiation which could help stratify those patients whose tumors are refractory to treatment and may benefit from adjuvant chemotherapy and eye-sparing surgery.

Uveal melanoma: An analysis of cellular features and comparison to monosomy 3 status

“…Thus the AFIP classification, which modified the previously used Callender classification system, classifies uveal melanomas as spindle cell type (pure), epithelioid cell type, or mixed cell type . Cytologic samples seem to be well suited to a cell type classification, and cell type in cytologic specimens has been linked to prognosis …”

Retinal pigment epithelium adenoma in vitreous fluid cytology

“…Additionally, choroidal nevi, even larger ones, lack the coarse chromatin distribution and prominent nucleoli that are characteristic of melanomas . Nevi of the iris can be particularly difficult to distinguish from melanomas on morphology alone as they can also display large, round nuclei, coarse chromatin distribution, and prominent nucleoli . However, in both choroidal and iris locations, the clinical picture of a slow‐growing lesion is more in keeping with a nevus, which differs from the prototypical rapid progression and growth of melanomas.…”

Cytopathology of Vitreous Humor Samples in Routine Practice

“…The cytological features of benign uveal melanocytes are typically dendritic or spindled. Clinicopathological correlation is necessary in this situation [29,31]. Differential diagnoses include other pigmented, nonmelanocytic lesions, such as uveal inflammation with numerous melanophages and pleomorphic adenoma of the ciliary body [32].…”

“…Others may have nuclear inclusions. These cells may be pigmented or not [31]. The cells of spindle cell melanoma have features similar to those of benign melanocytes, so the differential diagnosis between melanoma and uveal nevus can be challenging.…”