INTRODUCTION: Uveal melanoma is the most common primary intraocular tumour in adults in Caucasians and in 75% is arising from choroid. It threatens not only the patients loss of vision and eye, but also 50% of patients after 5-year interval after therapy die due to distant metastases. The treatment of small and medium-sized melanoma are methods preserving eye globe. Almost half of the total number of patients is still unavoidable enucleation. Considerably rarer is indicated exenteration of an orbit. These tumors metastasize only hematogenous, while the most frequent place of localization of distant metastases is the liver. Generalized disease prognosis is poor, and our current treatment options in this stage are ineffective. MATERIAL AND METHODS: Case report of 59 years old patient with choroidal melanoma stage T4 N1 M1 massively infiltrating the orbit. At the time of diagnosis of the primary tumor distant metastases were present. The patient underwent exenteration of the orbit and systemic chemotherapy. DISCUSSION: Although choroidal melanomas with extrascleral extension and infiltration into the orbit have no better prognosis after exenteration of the orbit, surgery is providing us local tumour control. Good cosmetic effect after this mutilating procedure is offered by individually made prosthesis (epithesis). All patients with uveal melanoma require lifelong dispensation, distant metastases may occur even after many years. In the treatment of generalized disease is available systemic chemotherapy and immunotherapy only palliative. The best effect on survival has complete surgical resection of single metastasis. Uveal melanoma has a different genetic profile as cutaneous melanoma. The biological nature of uveal melanoma seems to be the key to determining risk patients, as well as the development of targeted systemic therapy. CONCLUSION: Treatment of patients with generalized large uveal melanoma with extrascleral extension is difficult. A better understanding of biological interest may be the key to the detection of patients at higher risk of distant metastases formation, and to an effective systemic treatment. KEY WORDS: large uveal melanoma, extrascleral extension, orbital exenteration, the treatment of generalized disease.
- MeSH
- eviscerace orbity * MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanom sekundární chirurgie MeSH
- nádory choroidey patologie chirurgie MeSH
- nádory orbity sekundární chirurgie MeSH
- orbita chirurgie MeSH
- protézy a implantáty MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
AIM: Diagnosis and treatment of tumors of the eye is extremely difficul; surgical treatment in advanced stages, when the tumor grows in the orbit, leads to extensive radical surgery of the face. The extent and nature of surgical procedures depends on the nature of the tumor process, in advanced stages is indicated mutilating surgery--exenteration of the orbit. Exenteration of the orbit due to the extrascleral extension of malignant melanoma of the uvea is very rare, unfortunately, even today in certain cases it is necessary to make such a mutilating surgery. MATERIALS AND METHODS: Case report--65 year old female patient, sent to our Departement in 2008 with the finding of the pigment deposits on the posterior pole of the left eye. Ultrasound study found elevations of up to 3 mm, she was asked to come for further control in three months interval. She did not coma, furthermore she sporadically attended another eye clinic. In 2011 she was treated for secondary glaucoma--cyclocryopexia. Due to pain another surgery--tarzoraphia was indicated. In 2012 she underwent surgery at St. Elisabeth Cancer Institute in Bratislava--Nefrectomia transperitoneally l. dx., excision hepatis. Histological examination in addition to the primary papillary renal carcinoma--mucinous tubular T1 Nx Mx type, found the metastasis of malignant melanoma to the liver and right kidney. She underwent the diagnostic procedure to find the origo of the melanoma. The patient was subsequently admitted to our clinic with blind painfull eye for enucleation. During the surgery the was found retrobulbar tumor ingrowth. Histopatholigical findings confirmed malignant melanoma. Indicated was exenteration of the orbit due to malignant melanoma T4 N0 M2 stage in June 2012. After healing of the cavity she was recommended to design an individual prosthesis. After completing several courses of palliative chemotherapy during a recent review in January 2015 the patient is without recurrence of the melanoma in the orbit RESULTS: Histological examination confirmed malignant melanoma in stage G2, predominantly epithelioid type, spindle cell type in part B of pips, tumor fills the entire back and part of the anterior chamber, grows through the sclera and optic nerve is completely overgrown by tumor mass and spreads into orbit. The immunophenotype is suggesting a better prognosis (S100+, melanoma+, +HMB45, cyklin D1 3%, 10% of p53, Ki67 3%). Tissue eyelashes were infiltrated by numerous micrometastases. The patient after exenteration of the orbit after 3 months got an individual epithesis. Local orbit cavity is more than 24 months after exenteration without recurrence of melanoma. The patient is still undergoing outpatient chemotherapy and feels good. CONCLUSION: The treatment of malignant tumors of the orbit and the eye is difficult, in most cases surgical treatment is indicated, with the additional radiation therapy and chemotherapy. Malignant tumors at an advanced stage should to be solved radically. Exenteration of the orbit leads to produce a large defect in the orbit and this part of the face. Patients in the active age after surgery followed by facial defects after such procedures have disadvantage in work and thie defect leads to serious socio-economic challenges. Patients with individually made prosthesis comprising a refund of the eyeball and the surrounding soft tissues allow active life and full application of the private as well as professional life.
- MeSH
- eviscerace oka metody MeSH
- lidé MeSH
- melanom patologie chirurgie MeSH
- nádory choroidey patologie chirurgie MeSH
- orbita chirurgie MeSH
- protézy a implantáty * MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVE: Comparison of two methods of irradiation of patients with malignant choroidal melanoma - stereotactic radiosurgery and proton beam irradiation. External (non-contact) applied irradiation is used as a source of accelerated protons, respectively helium ions. This method allows applications of ionizing irradiation also despite the low radiosensitivity of cells of malignant melanoma of the uvea (MMU). External source of ionizing radiation is modulated current energy electrons, protons or neutrons, accelerated in linear accelerators. From the external medium voltages resources (4-16 MeV) are irradiated tissues with target dose of 5.0-24.0 Gy. Volume protons permeate straight the structures of the eye to a certain distance. The use of proton radiation density of ionized protons increases in the vicinity of the impact due to energy losses for electrons interacting with the environment. At the end of the track there is a huge increase in the ionization dose ("Bragg spike"). Therefore, the structures surrounding the eye at the point of entry and little affected and increasing the dose at the end of the proton beam is ideal for the desired therapeutic effect. Fractionated application is also possible. CASE REPORT: In December 2011 we performed stereotactic radiosurgery to treat female patient (born 1939) with malignant melanoma of the choroid stage T1 N0 M0. Plan has been drawn up for stereotactic irradiation - model for linear accelerator Clinac, Corvus planning system ver. 6.2, verification and OmniPro IMRT planning system Liebinger ver. 4.3. Patient characteristics were compared with the virtual plan for proton radiation therapy, and we used the scheme in Physical parameters FIAN-technical center in the Russian Federation. We compared both planning protocols and assess in particular the extent of radiation surrounding non-tumor tissue. RESULTS: When comparing the two planning schemes irradiation levels of surrounding tissues and risk structures (lens, optic nerve, chiasm) in both methods were corresponding to the required standard. CONCLUSION: Treatment of uveal melanoma through proton beam irradiation in Slovakia is not available yet, although it has several advantages, such as fractionation and the possibility of achieving a higher dose of irradiation to deposit (more than 50.0 Gy). The fundamental difference between the two methods for an eye is particularly the possibility of proton beam irradiation exposure of tumor of iris and ciliary body, which can not be solved through stereotactic radiosurgery. The dose to the tumor during irradiation can be optimized. The model device allowed us to make OPTMI - Therapy (Proton Treatment with Optimized Modulated Intensity).
- MeSH
- lidé MeSH
- melanom radioterapie chirurgie MeSH
- nádory choroidey patologie radioterapie chirurgie MeSH
- plánování radioterapie pomocí počítače * MeSH
- protonová terapie * MeSH
- radiochirurgie * MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- srovnávací studie MeSH
OBJECTIVE: Course of progression of the malignant choroidal melanoma diagnosed in T2 stage up to stage T4 with infiltration of the orbit. Case report 41 year old patient identified with intraocular malignant melanoma in the year 2005, documentation of disease progression and disease. Access to treatment of intraocular malignant melanoma in stage T1 - T2 in the last decade has changed from a radical approach (enucleation) towards conservative treatment (brachytherapy, radiosurgical methods) or combined procedures (pars plana vitrectomy and endoresection followed by irradiation or addition of laser treatment). Currently, more than 60% of uveal melanoma is treated by brachytherapy or radiosurgical techniques and combined procedures. CASE REPORT: A 41 years old female patient with malignant melanoma in the choroid stage T2 since 2005. The volume of the tumor was 0.9 cm³, maximal elevation was over 12 mm. The patient refused a radical treatment (primary enucleation). Due to the stage of the melanoma she was recommended to stereotactic radiosurgery and combined therapy. She underwent stereotactic radiosurgery (TDmax - total dose of 35.0 Gy) in 2005. In 2006 pars plana vitrectomy with incomplete endoresection of the tumor and silicon oil instillation was done. In 2006-2007 appeared bleeding into the anterior chamber and she underwent three times an anterior chamber lavage in another department with subsequent development of secondary glaucoma. In January 2010 patient came to our department with the local finding of malignant melanoma in stage T4 with epibulbar growth process and the infiltration of the orbit. In the period have been found two solid liver metastases. Indicated exenteration of the orbit, histopathologically confirmed mixed cell type malignant melanoma. CONCLUSION: Progression of malignant melanoma after incomplete endoresection despite previous radiosurgical treatment can be very rapid in the course of the disease documented by ultrasound, computed tomography and magnetic resonance. The patient subsequently passed to another workplace and underwent repeated lavage of the vitreous cavity. During endoresection is opened the package fibrous mesh gateway for the infiltration process in the cavity of the orbit and epibulbar space. In the case of residual melanoma after endoresection even though the tumor was irradiated before the procedure the melanoma might progress very fast into the surrounding tissues.
- MeSH
- dospělí MeSH
- kombinovaná terapie MeSH
- lidé MeSH
- melanom farmakoterapie patologie chirurgie MeSH
- nádory choroidey farmakoterapie patologie chirurgie MeSH
- radiochirurgie * MeSH
- skléra patologie MeSH
- vitrektomie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: To correlate between the echographic and histopathological findings, and to search for important criteria for the prognosis in vivo using standardised echography. METHODS: The study included 51 consecutive patients treated by primary enucleation for choroidal or ciliary body melanoma and 30 patients who underwent secondary enucleation after failing radiotherapy treatment. All patients were treated during the period of 1998--2008 at the Eye Clinic of the 3rd Faculty of Medicine in Prague, Czech Republic. Standardised echography based on the Ossoinig method was used in this study. Histopathological processing and evaluation was performed by the Laboratory of Ocular Pathology at the same clinic. Professional statistical software (Statistica 7.1 by Statsoft, Inc.) was used for all statistical analysis. RESULTS: Statistically significant results were found in these correlations in the group of primary enucleation: US prominence vs. HP prominence (R = 0.8943, p = 0.0000), US base vs. HP base (R = 0.8060, p = 0.0000), US tumor shape vs. HP tumor shape (R = -0.7576, p = 0.0000), posterior choroidal spike condition vs. scleral invasion (R = -0.5341, p = 0.0005), TNM vs. pTNM (R = 0.7242, p = 0.0000). In the group of secondary enucleation: US prominence vs. HP prominence (R = 0.8132, p = 0.0000), US base vs. HP base (R = 0.7959, p = 0.0000). Other correlations were statistically insignificant. CONCLUSIONS: Tumor dimensions, shape of the tumor and scleral invasion are important predictors that can be in vivo reliably determined using standardised echography.
- MeSH
- corpus ciliare patologie chirurgie MeSH
- dospělí MeSH
- echoplanární zobrazování MeSH
- enukleace oka MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory choroidey patologie chirurgie MeSH
- nádory uvey patologie chirurgie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statistika jako téma MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: To determine if optical coherence tomography (OCT) measurements of retinal thickness at the fixation point (RTFP) can be used to confirm the effectiveness of photodynamic therapy (PDT) with verteporfin in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). METHODS: Nine eyes of nine patients with subretinal fluid under foveal centre were treated by PDT with a dose of 6 mg/m2 of intravenous verteporfin administered 5 minutes before a laser irradiation at 689 nm. Visual outcomes, initial, and final findings were evaluated using biomicroscopy, OCT, ultrasound, fluorescein angiography, and indocyanine green angiography. RESULTS: After a mean follow-up of 8 months (range, 3-18 months) OCT showed absorption of subretinal fluid in all cases (100%). Maximal decrease of RTFP was seen within first month after treatment. Average RTFP decreased from 378 microm (range, 221 microm-849 microm) preoperatively to 190 microm (range, 118 microm-321 microm) postoperatively (p=0.017, paired t-test). Mean best corrected visual acuity (BCVA) improved from 4/16 (range, 4/5-1/20) preoperatively to 4/8 (range, 4/3-1/15) postoperatively (p=0.0046, paired t-test). An improvement in BCVA was observed in all cases (100%, one to seven lines on Early Treatment Diabetic Retinopathy Study charts). BCVA returned to 4/5 or better in six patients (67%). Mean tumor height decreased from 3.2 mm (range, 1.5 mm-4.0 mm) preoperatively to 0.9 mm (range, 0 mm-2.4 mm) postoperatively (p=0.00003, paired t-test). There was no measurable tumor height in four cases (44%), there were marked reduction in the other five cases (56%) on ultrasound. CONCLUSIONS: OCT appears to be useful method for evaluation of subretinal fluid absorption after the treatment of CCH by PDT with verteporfin. RTFP value can be used for quantification of subretinal fluid under the foveal centre. Functional results of PDT with verteporfin in CCH are limited in pre-existing retinal alterations. Randomised trial with single versus repeated sessions of PDT with verteporfin is needed.
- MeSH
- dospělí MeSH
- fotochemoterapie škodlivé účinky metody MeSH
- fotosenzibilizující látky škodlivé účinky terapeutické užití MeSH
- fovea centralis účinky léků patologie MeSH
- hemangiom farmakoterapie metabolismus patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory choroidey farmakoterapie metabolismus patologie MeSH
- optická koherentní tomografie metody MeSH
- porfyriny škodlivé účinky terapeutické užití MeSH
- retina účinky léků metabolismus patologie MeSH
- senioři MeSH
- tělesné tekutiny metabolismus MeSH
- verteporfin MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- Názvy látek
- fotosenzibilizující látky MeSH
- porfyriny MeSH
- verteporfin MeSH
UNLABELLED: 19 patients with choroidal melanomas were included in a prospective study with iodine-125 plaque treatment from 1984 to 1989. The mean tumor height was 5.8 mm, the base diameter 11.6 mm, the tumor volume-calculated for the spherically shaped melanomas-80 to 510 mm3. None of the tumors had invaded the pars plana, 10 melanomas were localized < 3 mm from the fovea or disc. 1 eye had diabetic background retinopathy. Mean radiation dose to the apex was 57 to 90 Gy with a mean of 75 Gy, sclera contact dose was 350 Gy, the plague was in place 71/2 days. Follow-up 2 1/4 to 7 years, mean 5 years: in 11 patients follow-up is longer than 5 1/2 years. Half-time reduction of tumor volume was 6.7 months, of tumor height 13 1/2 months. During the first 5 years no tumor regrowth, late tumor regrowth in 2 eyes at 65 and 69 months. COMPLICATIONS: radiation retinopathy in 17 eyes after 1 1/2 years with development of vitreous hemorrhage in 3 eyes, rubeosis iridis stage I in 3 eyes after 37 months, a cataract in 17 eyes after 28 months and an anterior ischemic optic neuropathy in 7 eyes after 15 months. Life expectancy: 2 patients died from metastases after 28 and 71 months, 1 patient alive with metastases after 17 months. Preoperative visual acuity: primarily it recovered postoperatively or it even improved due to disappearance of the accompanying exudative detachment or vitreous hemorrhage. However, after a follow-up of more than 2 years a deterioration of visual acuity occurred in all of the patients due to late radiogenic complications.
- MeSH
- brachyterapie škodlivé účinky přístrojové vybavení MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanom patologie radioterapie MeSH
- nádory choroidey patologie radioterapie MeSH
- následné studie MeSH
- radioizotopy jodu terapeutické užití MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- radioizotopy jodu MeSH
The authors give an account of 12 patients where the original ophthalmological finding corresponded to central serous retinitis. In the course of check-up examinations the picture changed and finally the complex of applied examinations revealed that a malignant melanoma of the choroid was involved. The authors mention the time needed for the clinical decision on the final diagnosis of the disease which was confirmed histologically after enucleation of the eye. In the conclusion the authors draw attention to the necessity of frequent check-up examinations after the initial establishment of the diagnosis of central serous retinitis with regard to the differential diagnostic possibilities of the above disease.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanom komplikace diagnóza patologie MeSH
- nádory choroidey komplikace diagnóza patologie MeSH
- nemoci retiny komplikace diagnóza MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- buněčné jádro ultrastruktura MeSH
- časové faktory MeSH
- choroidea ultrastruktura MeSH
- chromatin MeSH
- endoplazmatické retikulum ultrastruktura MeSH
- histologické techniky MeSH
- kultivované buňky MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanom patologie MeSH
- mitóza * MeSH
- nádory choroidey patologie MeSH
- počet buněk MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- chromatin MeSH
- MeSH
- časové faktory MeSH
- germinální a embryonální nádory patologie MeSH
- kultivační média MeSH
- lidé středního věku MeSH
- lidé MeSH
- metody MeSH
- nádory choroidey patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- kultivační média MeSH
