Necrotic malignant melanomas of the choroid and ciliary body

Bujara, K.

doi:10.1007/bf02159979

Cited by 30 publications

(11 citation statements)

References 7 publications

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“…The 6 patients with spontaneously necrotic uveal melanomas in our study exhibited similar clinical presentations to those in previous studies [1,2,3,4,5,6]. All of them presented with pain as a common clinical finding in addition to acute changes in vision, inflammation of the sclera and episclera [7], and raised intraocular pressure.…”

Section: Discussionsupporting

confidence: 67%

“…Previous studies have shown a range of presentations associated with necrotic uveal melanomas. In a study of 474 malignant melanomas, patients with necrotic tumors were more likely to present with glaucoma, inflammatory exophthalmos, rubeosis iridis, secondary angle-closure glaucoma, and inflammation of the uvea, sclera, and episclera compared to those without tumor necrosis [2]. Another study of 334 ciliary body and choroidal tumors showed that patients with necrotic tumors were more likely to present with episcleritis or scleritis than those without tumor necrosis [3].…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Necrosis of Choroidal Melanoma

2014

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Background/Aims: The purpose of this study was to examine the clinical presentations and pathological features of spontaneously necrotic choroidal melanomas. Methods: The clinical and histological features of patients who underwent enucleation for uveal melanoma from 1989 to 2012 at Emory University and were found to have spontaneously necrotic choroidal melanomas were retrospectively analyzed. Results: A total of 6 cases were identified. All cases had 90-100% tumor necrosis and also exhibited marked ischemic necrosis of the iris and ciliary body; 5 of 6 cases exhibited marked ischemic necrosis of the retina. The tumor consisted of melanoma ghost cells often surrounded by a zone of pigmented macrophages. Thrombi were not found in any of the cases. All of the tumors in our cases were centered around the equatorial choroid and 2 extended into the ciliary body. One of the cases exhibited a wedge-shaped infarct in a lateral aspect of the tumor. In most of the cases, microscopic areas of intact tumor cells were present in the peripheries of the tumors. Conclusions: Spontaneous necrosis may occur in uveal melanoma. We believe that this occurs secondary to tumor hypoxia in the center of the tumor, followed by secondary inflammation, generalized ischemia and finally complete tumor necrosis.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Spontaneous Necrosis of Choroidal Melanoma

2014

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“…Two studies of melanocytic neoplasia in dogs have shown that necrosis within the neoplasm is associated with a malignant phenotype; however, neither study investigated the association between necrosis and metastatic risk . Furthermore, extraocular extension was detected more commonly in human uveal melanomas with necrosis than in those without necrosis . We also confirmed and further defined the risk associated with a high mitotic index.…”

Section: Discussionsupporting

confidence: 65%

Histologic and immunohistochemical predictors of clinical behavior for feline diffuse iris melanoma

Wiggans

Reilly

Kass

et al. 2016

Veterinary Ophthalmology

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Objective To determine histologic and immunohistochemical predictors of metastasis of feline diffuse iris melanoma (FDIM). Animals Globes from 47 client-owned cats enucleated for FDIM between January 1985 and December 2013. Procedures Hematoxylin and eosin-stained sections were evaluated for neoplastic invasiveness and cell morphology, necrosis within the neoplasm, inflammation, and glaucoma. Sections were immunolabeled with antibodies against melan-A, PNL2, E-cadherin, or B-Raf, and label intensity, percentage of labeled cells, and label homogeneity were semi-quantitatively graded. Medical records were evaluated, and referring veterinarians and clients were contacted to determine whether cats developed metastasis following enucleation. The log-rank test or Cox proportional hazards model was used to determine associations between histologic or immunohistochemical parameters and metastasis. Results Metastasis was suspected or confirmed in 9/47 (19%) cats. Extrascleral extension, necrosis within the neoplasm, a mitotic index of >7 mitoses in 10 high-power (9400) fields, choroidal invasion, and increased E-cadherin and melan-A label intensity were each associated with increased rate of metastasis. PNL2 label homogeneity was associated with decreased rate of metastasis. Decreased PNL2 label intensity and an increasing percentage of neoplastic cells labeled for melan-A each approached significance for increased rate of metastasis. Conclusions We report four histologic and three immunohistochemical parameters helpful in determining cats at risk of metastasis of FDIM. Further studies should determine if B-Raf mutations identified in human malignant melanomas are found in cats with FDIM and assess benefits of adjunctive therapy following enucleation of eyes with FDIM bearing poor prognostic indicators.

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“…Spontaneous necrosis of choroidal melanomas is very rare, varying between 0.5 and 1% of all UMs [4]. The incidence of totally necrotic UMs has been reported at 3.6% and that of partially necrotic UMs as 5.7% in previous studies [7]. These tumours are usually associated with significant haemorrhage and/or inflammation [4,8].…”

Section: Discussionmentioning

confidence: 97%

Spontaneous Necrosis of a Large Choroidal Melanoma: Unusual Presentation in a 49-Year-Old Male

et al. 2019

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Spontaneous intraocular haemorrhage can occur due to underlying malignancies, such as choroidal melanoma.• Choroidal melanomas usually demonstrate a solid dome-or mushroom-shaped low-to-medium reflective lesion with a regular internal acoustic structure on ultrasound (US), often with subretinal fluid at the margins. Colour Doppler US frequently shows pulsatile blood flow at the base of the melanoma. None of these features were observed in the case presented. • Rapid growth can occur in monosomy 3 and/or BAP1 mutant melanoma, leading to tumour necrosis, haemorrhage and secondary glaucoma. Novel Insights• A massive vitreous haemorrhage can obscure the underlying diagnosis of a large choroidal melanoma.• Atypical large choroidal melanomas can occur without any of the above-mentioned characteristics on US.• Rapid expansive growth of a choroidal melanoma does not necessarily equate a "high risk" uveal melanoma but can occur also in spindle cell melanomas with disomy 3 and in the absence of somatic BAP1 mutations. AbstractPurpose: To demonstrate a case of massive vitreous haemorrhage obscuring the underlying diagnosis of a large mixed-cell choroidal melanoma which had undergone spontaneous necrosis. Case Report: A 49-year-old man in good general health suddenly lost vision in his right eye due to an extensive vitreous haemorrhage 1 day after a workout at the gym. He reported good vision prior to that without any symptoms of flashes, floaters, or shadows. He was referred to the vitreoretinal department of a tertiary eye hospital, where he presented with a drop in vision to light perception Spontaneous Necrosis of a Large Choroidal Melanomaonly in the right phakic eye. Pars plana vitrectomy was performed in the right eye, which revealed intraoperatively massive retinal ischemia and choroidal haemorrhage, but no obvious tumour mass that could have been biopsied. The vitrectomy cassette specimen was sent for histopathology, where "ghost-like" melanoma cells were identified. The eye was subsequently enucleated, revealing an extensively necrotic and haemorrhagic choroidal melanoma of mixed cell type with only small viable tumour foci at the base and almost complete lysis of the detached retina. Conclusion: Some uveal melanomas (UMs) undergo spontaneous necrosis due to rapid growth, with the centre of the tumour outstripping its established blood supply in the "watershed area" of the eye, and becoming hypoxic with associated necrosis of intraocular structures. Such UMs are often associated with haemorrhage and/or inflammation and usually cause significant destruction of ocular tissues, resulting in enucleation as the only treatment option.

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Necrotic malignant melanomas of the choroid and ciliary body

Cited by 30 publications

References 7 publications

Spontaneous Necrosis of Choroidal Melanoma

Spontaneous Necrosis of Choroidal Melanoma

Histologic and immunohistochemical predictors of clinical behavior for feline diffuse iris melanoma

Spontaneous Necrosis of a Large Choroidal Melanoma: Unusual Presentation in a 49-Year-Old Male

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