Uveal Melanoma Cell Seeding after Transretinal Tumor Biopsy

Koch, Konrad R.; Hishmi, Ahmed M.; Ortmann, Monika; Heindl, Ludwig M.

doi:10.1159/000453360

Cited by 10 publications

(13 citation statements)

References 13 publications

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“…Furthermore, the scleral ports likely reduce the risk of tumor seeding in the sclera [27]. However, the risk of scleral seeding is not entirely eliminated, as demonstrated by case reports of extraocular recurrence at the scleral port entry site following a transvitreal biopsy [47,48]. The vitrector system allows for sufficient biopsy material with a single pass compared to transscleral biopsies, which usually demand several passes, increasing the number of seeded tumor cells mainly if multiple needle tracts are performed [41].…”

Section: Resultsmentioning

confidence: 99%

Uveal Melanoma Biopsy: A Review

Frizziero

Midena

Trainiti

et al. 2019

Cancers

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Intraocular tumor diagnosis is based on clinical findings supported by additional imaging tools, such as ultrasound, optical coherence tomography and angiographic techniques, usually without the need for invasive procedures or tissue sampling. Despite improvements in the local treatment of uveal melanoma (UM), the prevention and treatment of the metastatic disease remain unsolved, and nearly 50% of patients develop liver metastasis. The current model suggests that tumor cells have already spread by the time of diagnosis, remaining dormant until there are favorable conditions. Tumor sampling procedures at the time of primary tumor diagnosis/treatment are therefore now commonly performed, usually not to confirm the diagnosis of UM, but to obtain a tissue sample for prognostication, to assess patient’s specific metastatic risk. Moreover, several studies are ongoing to identify genes specific to UM tumorigenesis, leading to several potential targeted therapeutic strategies. Genetic information can also influence the surveillance timing and metastatic screening type of patients affected by UM. In spite of the widespread use of biopsies in general surgical practice, in ophthalmic oncology the indications and contraindications for tumor biopsy continue to be under debate. The purpose of this review paper is to critically evaluate the role of uveal melanoma biopsy in ophthalmic oncology.

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Section: Resultsmentioning

confidence: 99%

Uveal Melanoma Biopsy: A Review

Frizziero

Midena

Trainiti

et al. 2019

Cancers

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“…[56] However, the risk of scleral spread is not completely eliminated, as demonstrated by case reports of extraocular recurrence at the scleral port entry site after transvitreous biopsy. [63,64] e vitrectomy system allows sufficient biopsy material to be obtained with a single pass compared to trans-scleral biopsies, which usually require several passes, increasing the number of tumor cells seeded mainly if multiple needle trajectories are performed. [16] Nevertheless, UM FNA is generally accepted as a safe procedure.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic algorithm in small pigmented choroid tumors (less than 3 mm thick)

Pelayes

Folgar

Chiaradia

et al. 2021

LAJO

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Objectives: The aim of this paper is to present a diagnostic algorithm for a controversial topic in ophthalmic oncology, small pigmented choroidal tumors (<3 mm thick). Material and Methods: Nineteen consecutive patients with a clinical diagnosis of small choroidal pigmented tumors were included in the study. The group of patients studied consisted of 9 patients (47.36%) female and 10 patients (52.64%) male, the age range was 14–68 years. All cases were ophthalmologically evaluated, including best-corrected visual acuity, anterior and posterior segment biomicroscopy, intraocular pressure, binocular indirect ophthalmoscopy, and as additional complementary examinations, ocular ultrasound was performed, which in 100% of the cases was inconclusive, optical coherence tomography, autofluorescence, and angiography in selected cases according to location and symptomatology. In 13 patients (68.50%), transvitreous puncture was performed with or without vitrectomy. Trans-scleral puncture was performed in 6 patients (31.50%), located at the equator (4 patients) and ciliary body (2 patients). Post-surgical follow-up was performed within the first 3 weeks after the procedure and then controlled every 3 months within the 1st year. The material obtained by fine-needle aspiration (FNA) was placed in non-hemolytic preservative liquid. Hematoxylin and eosin, Pas, Masson’s trichrome, and immunohistochemistry (HMB 45, MELAN A, PROT. S-100 base) were performed. Results: The yield of cytologic material was 100% in the sampled patients. The most frequent complication was subretinal hemorrhage in three patients with transvitreous access and two patients with trans-scleral access, in all cases, there was a favorable evolution without requiring further action. In three patients, there were mild vitreous hemorrhages that resolved spontaneously, all of them had undergone transvitreous access. Conclusion: In TPPC of less, we propose a diagnostic algorithm with FNA to obtain cytological sample which allows not only the diagnosis of certainty to indicate treatment but also to determine cytological and molecular prognostic factors that allow classifying melanoma of high or low grade and potentially in case of metastatic disease to indicate systemic treatments. We believe that it is essential to diagnose this type of lesions in which a diagnosis of certainty is required. The alternative is the observation that we consider potentially dangerous in these cases.

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“…Nonetheless, several studies proved the safety of FNAB for choroidal melanoma with the transscleral or pars plana transvitreal approach, [1][2][3] and cases of extraocular extension are rare. [4][5][6][7] Schefler et al [4] reported extraocular extension in four patients with uveal melanoma, but three of them had undergone vitrectomy and/or open biopsy in addition to FNAB. The interval between FNAB and the detection of extraocular extension in their series ranged from five months to approximately nine years.…”

Section: Discussionmentioning

confidence: 99%

“…Mashayekhi et al [6] reported one patient with extraocular extension of ciliochoroidal melanoma one and a half years after transscleral FNAB using a 25-gaugeneedle without infusion. Koch et al [7] reported pars plana seeding with localized extraocular extension 3.5 years after transretinal biopsy of choroidal melanoma using a 25-gauge vitrectomy probe followed by Ruthenium-106 plaque radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Ciliary Body Seeding after Pars Plana Transvitreal Fine-Needle Aspiration Biopsy of Choroidal Melanoma

Ndulue

Mashayekhi

Shields

2020

JOVR

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Purpose: To report ciliary body seeding 20 years after pars plana transvitreal fine needle aspiration biopsy (FNAB) of choroidal melanoma. Case Report: 67-year-old man with choroidal melanoma in left eye was previously managed with pars plana FNAB using a 25-gauge needle followed by plaque radiotherapy. Twenty years later, choroidal melanoma was regressed but there was a small flat focus of scleral pigment 3.0mm from the limbus at the FNAB site. Ultrasound biomicroscopy showed a contiguous ciliary body mass measuring 3.1mm in thickness. Tumor seeding in the anterior chamber angle was noted inferiorly. These findings suggested melanoma recurrence along the needle tract. Treatment was performed with Iodine-125 radioactive plaque covering entire anterior segment and ciliary body recurrence. The tumor regressed to 2.2mm over one year. Conclusion: Pars plana transvitreal FNAB of choroidal melanoma resulted in needle tract seeding in ciliary body and episcleral region 20 years later.

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Uveal Melanoma Cell Seeding after Transretinal Tumor Biopsy

Cited by 10 publications

References 13 publications

Uveal Melanoma Biopsy: A Review

Uveal Melanoma Biopsy: A Review

Diagnostic algorithm in small pigmented choroid tumors (less than 3 mm thick)

Ciliary Body Seeding after Pars Plana Transvitreal Fine-Needle Aspiration Biopsy of Choroidal Melanoma

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