RESUMO
BACKGROUND: Choroid, ciliary body, and iris melanomas are often grouped as uveal melanoma, the most common intraocular primary malignancy. The purpose of the current study was to analyze the tumor profile of newly diagnosed cases of choroidal melanoma at a reference center in Sao Paulo, Brazil, and to investigate the frequency of eyes treated by enucleation that could have been treated with brachytherapy if available in the service. METHODS: Medical records of patients referred to our service with initial diagnostic hypothesis of choroidal melanoma from July 2014 to June 2020 were analysed on demographics, diagnosis confirmation, tumor measurement by ultrasonography and established treatment. Data were evaluated on clinical and demographic characteristics as age, sex, affected eye, ultrasound parameters, and treatment management of patients with clinically diagnosed choroidal melanoma. Among the patients submitted to enucleation, we investigated how many could have been selected to receive brachytherapy. RESULTS: From the 102 patients referred with the choroidal melanoma diagnosis hypothesis, 70 (68.62%) were confirmed. Mean measurements from the tumors in millimetres were: 9.19 ± 3.69 at height and 12.97 ± 3.09 by 13.30 ± 3.30 at basal. A total of 48 cases (68.57%) were enucleated, 8 (11.43%) were treated by brachytherapy in a different service, and 14 patients (20.00%) returned for enucleation at their original referral center. Out of the 48 patients enucleated, 26 (54.17%) could have been selected to brachytherapy treatment. CONCLUSIONS: The results indicate a late diagnosis of choroidal melanoma cases referred to our service. Most enucleated cases could have been treated with brachytherapy if it was broadly available at the national public health insurance. Further public health political efforts should focus on early diagnosis and better quality of life post-treatment for oncologic patients.
Assuntos
Neoplasias da Coroide , Melanoma , Neoplasias Uveais , Humanos , Brasil/epidemiologia , Qualidade de Vida , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/terapia , Neoplasias da Coroide/diagnóstico , Neoplasias da Coroide/terapia , Neoplasias da Coroide/patologia , Melanoma/diagnóstico , Melanoma/terapia , Melanoma/patologia , Corpo Ciliar/patologia , Enucleação OcularRESUMO
RESUMO O hemangioma de coroide é um tumor vascular benigno, de coloração vermelho-alaranjada, bem delimitado, caracterizado por uma placa elevada. É um tumor raro, com prevalência de um caso a cada 40 tumores de coroide. O diagnóstico pode ser feito por meio da clínica associada à avaliação biomicroscópica e a exames complementares para diferenciação de outros tumores. O tratamento pode ser expectante nos casos assintomáticos. Para os casos sintomáticos ou com presença de fluido sub-retiniano, existem diversas terapias. O objetivo deste estudo foi relatar um caso de hemangioma circunscrito de coroide submetido a tratamento combinado de terapia fotodinâmica com verteporfina e injeção intravítrea de antiangiogênico (bevacizumabe). A decisão de tratar um hemangioma de coroide deve ser individualizada com base nos sintomas, na perda visual e em qualquer potencial de sua recuperação. O exame oftalmológico completo é necessário, mesmo em casos assintomáticos, para rastreamento precoce de doenças oculares.
ABSTRACT Choroid hemangioma is a benign, well-delimited orange-red, vascular tumor characterized by an elevated plaque. It is a rare tumor with a prevalence of one case in every 40 choroidal tumors. It can be diagnosed by the clinic associated with biomicroscopic evaluation and complementary tests to differentiate from other tumors. Treatment can be expectant in asymptomatic cases. For symptomatic cases or those with the presence of subretinal fluid, there are several therapies. The objective of this study was to report a case of circumscribed choroidal hemangioma submitted to combined treatment of photodynamic therapy with verteporfin and intravitreal injection of an antiangiogenic agent (bevacizumab). The decision to treat choroidal hemangioma must be individualized based on symptoms, visual loss, and any potential for recovery. A complete eye examination is necessary, even in asymptomatic cases, for early screening for eye diseases.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/métodos , Neoplasias da Coroide/diagnóstico , Neoplasias da Coroide/terapia , Tomografia de Coerência Óptica , Bevacizumab/uso terapêutico , Verteporfina/uso terapêutico , Hemangioma/diagnóstico , Hemangioma/terapia , Angiofluoresceinografia , Neoplasias da Coroide/patologia , Ultrassonografia , Inibidores da Angiogênese/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Quimioterapia Combinada , Hemangioma/patologiaRESUMO
A 68-year-old man diagnosed with choroidal melanoma (CM) in the right eye underwent treatment with episcleral brachytherapy (I125) and transpupillary thermotherapy. Ultrasound, computed tomography, and magnetic resonance imaging were performed and revealed ocular recurrence of CM. Treatment with extended enucleation was performed. Macroscopic and microscopic examinations revealed extraocular extension and malignant cells, respectively. Immunohistochemistry demonstrated tumoral Melan-A and HMB-45 expression. No cytogenic abnormalities were detected with fluorescence in situhybridization of tumor cells using probes against chromosomes 3q27 and 8q24. The patient underwent adjuvant external beam radiotherapy for treatment of residual tumor tissue. This case represents the first reported case of recurrent CM with no cytogenetic abnormalities and the absence of metastatic disease, despite a number of the poorest prognostic factors.
Assuntos
Neoplasias da Coroide/patologia , Neoplasias da Coroide/terapia , Melanoma/patologia , Melanoma/terapia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Idoso , Braquiterapia/métodos , Humanos , Hipertermia Induzida/métodos , Imageamento por Ressonância Magnética , Masculino , Esclera/patologia , Tomografia Computadorizada por Raios XRESUMO
ABSTRACT A 68-year-old man diagnosed with choroidal melanoma (CM) in the right eye underwent treatment with episcleral brachytherapy (I125) and transpupillary thermotherapy. Ultrasound, computed tomography, and magnetic resonance imaging were performed and revealed ocular recurrence of CM. Treatment with extended enucleation was performed. Macroscopic and microscopic examinations revealed extraocular extension and malignant cells, respectively. Immunohistochemistry demonstrated tumoral Melan-A and HMB-45 expression. No cytogenic abnormalities were detected with fluorescence in situhybridization of tumor cells using probes against chromosomes 3q27 and 8q24. The patient underwent adjuvant external beam radiotherapy for treatment of residual tumor tissue. This case represents the first reported case of recurrent CM with no cytogenetic abnormalities and the absence of metastatic disease, despite a number of the poorest prognostic factors.
RESUMO Um homem de 68 anos de idade com diagnóstico de melanoma de coroide no olho direito foi submetido a tratamento com braquiterapia episcleral (I125) e termoterapia transpupilar. Ultrassonografia, tomografia computadorizada e ressonância magnética foram realizadas para avaliar a presença de recorrência ocular ou doença sistêmica. Enucleação ampliada foi realizada para tratar a recorrência ocular. O exame macroscópico e microscópico revelou o tipo de célula tumoral e a extensão extraocular. Colorações por Melan-A e HMB-45 foram realizadas. A fluorescência por hibridização in situ com sondas para os cromossomos 3q27 e 8q24 não mostraram anormalidades citogenéticas. O paciente foi submetido a radioterapia externa adjuvante para o tratamento de tumor residual orbitário. Este caso representa a o primeiro relato de paciente sem anomalias citogenéticas e sem doença metastática, apesar de demonstrar alguns dos mais pobres fatores prognósticos.
Assuntos
Idoso , Humanos , Masculino , Neoplasias da Coroide/patologia , Neoplasias da Coroide/terapia , Melanoma/patologia , Melanoma/terapia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Braquiterapia/métodos , Hipertermia Induzida/métodos , Imageamento por Ressonância Magnética , Esclera/patologia , Tomografia Computadorizada por Raios XRESUMO
Objetivo: Avaliar, retrospectivamente, num longo intervalo de tempo, os resultados da termoterapia transpupilar em casos selecionados do melanoma de coróide. Métodos: Foram identificados todos os casos com melanoma de coróide tratados com termoterapia transpupilar, como terapia única ou suplementar. Foram excluídos os casos com seguimento inferior a 60 meses, prontuários incompletos ou com o abandono do acompanhamento. Resultados: De um total de 18 olhos, 7 (38.9%) foram incluídos no estudo. Cinco (71,4%) pacientes foram tratados exclusivamente com termoterapia transpupilar, em 1 (14,2%) olho a crioterapia foi simultânea, 1 (14,2%) suplementou braquiterapia - placa episcleral. Três (42.8%) sofreram recorrência, 2 (28.5%) apresentaram metástases (um óbito), 2 foram enucleados. Complicações foram encontradas em 3 olhos: dobras maculares em 2, hemorragia vítrea em 1. Nos olhos enucleados, não havia extensão extraescleral, porém células interesclerais foram identificadas. Conclusão: Termoterapia transpupilar mostra um declínio em sua eficácia e conserva os riscos de metástases em períodos mais longos de acompanhamento, sendo necessária uma definição mais exata de seu papel nos melanomas de coróide.
Objective: To evaluate, retrospectively, in a long time interval, the results of transpupillary thermotherapy in selected cases of choroidal melanoma (CM). Methods: All patients with melanoma treated with transpupillary thermotherapy as sole therapy or supplement were identified. Cases with less than 60 months follow-up, incomplete records or abandonment of monitoring were excluded. Results: A total of 18 eyes, seven (38.9%) were included. Five (71,4%) patients were treated exclusively with transpupillary thermotherapy, in one (14,2%) eye criotherapy was used simultaneously, one (14,2%) was supplemented with brachytherapy - episcleral plate. Three (42.8%) had recurrence, two (28.5%) had metastases (one death), two eyes were enucleated. Complications were found in three eyes: two with macular folds, one with vitreous hemorrhage. In the enucleated eyes, extraescleral did not occur, however intrascleral tumoral cells were identified. Conclusion: Transpupillary thermotherapy shows a decline in its effectiveness and retains the risk of metastases in longer periods of follow-up, requiring a more exact definition of its role in choroidal melanoma.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Braquiterapia/métodos , Crioterapia/métodos , Hipertermia Induzida/métodos , Melanoma/terapia , Neoplasias da Coroide/terapia , Estudos RetrospectivosRESUMO
OBJECTIVES: To evaluate the outcome of children with different degrees of choroidal invasion, to compare different systems for grading the extent of choroidal invasion, and to assess the role of concomitant prelaminar optic nerve and anterior segment invasion as predictors of extraocular relapse. DESIGN: Retrospective analysis of children included in 4 prospective protocols (January 1, 1989, through June 31, 2010). Children with postlaminar optic nerve or scleral involvement and overt extraocular disease were excluded. Adjuvant chemotherapy was not scheduled. All slides were reviewed, and massive involvement was classified according to 3 definitions: (1) extending at least 3 mm in any dimension, (2) through the choroid's whole thickness, and (3) more than 50% of the thickness and/or more than 1 cluster. RESULTS: One hundred sixty-seven children (35 with massive invasion) were studied (136 did not receive adjuvant therapy). The probability of 5-year event-free survival was 98.1% and the probability of overall survival was 98.7% because 1 patient relapsed. Children with massive invasion had a significantly lower event-free survival probability (94.2%) compared with those with focal invasion (99.2%) (P = .04). However, no significant difference was found in overall survival probability (98.7% vs 99.2%; P = .29). No significant effect of other risk factors was found. CONCLUSIONS: Survival was excellent without adjuvant therapy, and no other factors correlated with survival. Children with massive invasion have a higher relapse rate but comparable survival to those with focal invasion provided that aggressive therapy for extraocular relapse is available with adequate safety conditions.
Assuntos
Neoplasias da Coroide/patologia , Neoplasias da Retina/patologia , Retinoblastoma/patologia , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Neoplasias da Coroide/mortalidade , Neoplasias da Coroide/terapia , Intervalo Livre de Doença , Enucleação Ocular , Feminino , Seguimentos , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Gradação de Tumores , Invasividade Neoplásica , Neoplasias da Retina/mortalidade , Neoplasias da Retina/terapia , Retinoblastoma/mortalidade , Retinoblastoma/terapia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The treatment of small choroidal melanoma is controversial. Thermal laser-induced treatment is utilized by some centers but there is still sparse literature about the subject, mainly with short-term follow-up time. The efficacy of transpupillary thermotherapy (TTT) for the treatment of small choroidal melanomas was evaluated. METHODS: A prospective nonrandomized study of transpupillary thermotherapy for small (thickness ≤ 4.0 mm and basal diameter ≤ 12 mm) pigmented choroidal melanomas presenting either growth or risk factors for growth and metastasis. Ophthalmoscopic aspect, tumor control, visual acuity and complications were evaluated. RESULTS: Twenty-seven patients were treated; mean age 61 years; mean tumor thickness before treatment was 2.7 mm and base was 8.52 mm. After a mean of three treatment sessions and 45-month follow-up, mean tumor thickness decreased significantly to 1.34 mm (p < 0.001) and mean tumor base to 5.48 mm (p < 0.001). Complications were observed in 12 patients (44%) and included retinal vascular occlusion, optic disc atrophy, retinal traction, vitreous hemorrhage, rhegmatogenous retinal detachment, and maculopathy. Lesions touching the optic disc were associated with a significantly higher rate of disc atrophy after treatment (60% vs. 40%, p=0.030). Visual acuity remained the same in nine eyes (33%), improved in five (19%) and decreased during the first 6 months after treatment in 13 eyes (48%). Complete tumor control without recurrence was observed in 25 patients (93%). Recurrence at tumor margin was detected in two (7%). All eyes were preserved. One patient had tumor-related death. CONCLUSIONS: TTT is an effective treatment in the management of selected small choroidal melanoma. Decrease in visual acuity occurred early after treatment mainly associated with subfoveal and perifoveal tumors treatment and complications. Long-term randomized studies are still needed in order to better situate this treatment.
Assuntos
Neoplasias da Coroide/terapia , Hipertermia Induzida , Melanoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Coroide/patologia , Feminino , Angiofluoresceinografia , Humanos , Verde de Indocianina , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Pupila , Fatores de Risco , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
El manejo del hemangioma coroideo circunscrito se relaciona con la presencia de síntomas; en casos asintomáticos es suficiente la simple observación. El objetivo del tratamiento es la conservación o mejora de la agudeza visual, produciendo la reabsorción del líquido subretiniano y la resolución del edema macular. El hemangioma coroideo es una tumoración vascular de coroides que se puede presentar como forma circunscrita y sin conexión sistémica o bien de forma difusa generalmente asociada a enfermedades sistémicas. A pesar de su probable origen congénito, se suele diagnosticar de forma tardía entre la 2-5 décadas de la vida, si el tumor se asocia a desprendimiento de retina exudativo, apareciendo así los primeros síntomas. La incidencia del hemangioma circunscrito es difícil de establecer, pues muchos presentan un curso asintomático y no son diagnosticados; en relación con el melanoma de coroides su frecuencia es de 1/15. El manejo del hemangioma coroideo circunscrito se relaciona con la presencia de síntomas; en casos asintomáticos es suficiente la simple observación. El objetivo del tratamiento es la conservación mejora de la agudeza visual, produciendo la reabsorción del líquido subretiniano y la resolución del edema macular. Actualmente no existe un tratamiento específico por lo que hemos realizado una revisión de las diversas modalidades terapéuticas, sus ventajas y desventajas
The circumscribed choroidal hemangioma is a vascular tumor of the choroid that can be seen either in its circumscribed form without systemic connection or in its diffuse form, generally associated with systemic diseases. In spite of their likely congenital origin, it is usually diagnosed late when the patient is 20 to 50 years-old and if the tumor relates to exudative retinal detachment, thus emerging the first symptoms. The incidence of the circumscribed hemangioma is difficult to establish, because many patients are asymptomatic and then they are not diagnosed; with respect to the choroidal melanoma, the frequency is 1 out of 15. The management of the circumscribed choroidal hemangioma depends on the presence of symptoms; but simple observation is enough for asymptomatic individuals. The objective of the treatment is the preservation or the improvement of the visual acuity, leading the reabsorption of the subretinal fluid and the resolution of the macular edema. There is no specific treatment at present for this disease; hence, a literature review of the therapeutic modalities with their advantages and disadvantages was presented in this paper
Assuntos
Humanos , Masculino , Feminino , Corioide/patologia , Neoplasias da Coroide/terapia , Sinais e SintomasRESUMO
A raíz de un caso de osteoma de coroides que se diagnóstico en el Instituto Barraquer de Barcelona se hizo una revisión bibliográfica del tema y se revisaron las fichas con el diagnóstico de osteoma de coroides entre los años 1982 y 2004, encontrándose 29 casos diagnosticados como tal. La revisión de las fichas descartó a 13 pacientes que no cumplían con los parámetros para osteomas, ya sea por mala interpretación de la ecografía o de otros exámenes. Los 16 restantes, 9 habían concurrido a una segunda opinión ya con el diagnóstico de osteoma. Los exámenes hechos en nuestro centro corroboraron el diagnóstico. Cinco pacientes nos consultaron por primera vez por disminución de la agudeza visual y en nuestro examen se encontró el osteoma. Otro caso nos consultó por jaqueca y diagnóstico previo en otro centro de coroiditis posterior. Un caso fue un hallazgo casual en una ecografía practicada por nosotros.
Assuntos
Masculino , Adulto , Humanos , Feminino , Neoplasias da Coroide/diagnóstico , Neoplasias da Coroide/fisiopatologia , Neoplasias da Coroide/terapia , Osteoma/diagnóstico , Osteoma/fisiopatologia , Osteoma/terapia , Neoplasias da Coroide/patologia , Prognóstico , Sinais e SintomasRESUMO
PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) for the treatment of serous retinal detachment secondary to circumscribed choroidal hemangiomas (CCH). MATERIAL AND METHODS: Four eyes of four consecutive patients who presented decreased vision due to serous macular detachment secondary to CCH were enrolled in this study. After informed consent was obtained, the four eyes were treated with TTT. All the patients underwent pretreatment ocular examination, which included fluorescein angiography and ultrasonography. TTT was applied using a diode laser at 810 nm with a spot size of 4.3 mm. The diode laser was transmitted through a contact lens. The end-point of the treatment was a detectable light-gray appearance of the entire lesion. The patients were re-examined monthly during the first 6 months, and regularly thereafter. RESULTS: Within 3 months of treatment all eyes had already demonstrated decreased exudation on clinical examination and on fluorescein angiography. Reduction in tumor prominence was observed in all eyes by A-B ultrasonography. Three patients showed an improvement in visual acuity (VA) over a period of 6 months. Case 2 from 20/60 to 20/25; case 3 from 20/400 to 20/50 and case 4 from 20/80 to 20/20. The VA in case 1 remained unchanged (counting fingers). No recurrences were observed within a mean follow-up of 14.5 months. CONCLUSIONS: TTT showed no deleterious side effects in treating serous macular detachment secondary to CCH, and must be regarded as a therapeutic alternative to manage selected cases.