1/207. Radioactive phosphorus uptake testing of choroidal lesions. A report of two false-negative tests.Two false-negative results from 32P testing for histologically verified malignant melanomas of the choroid are reported. In the first case, a haemorrhagic choroidal detachment caused an increase in probe; additionally, the tumour was necrotic. Both factors are likely to have contributed to the false-negative result. A satisfactory explanation for the false-negative result in the second case was not determined, although it may have accurately reflected a period of minimal tumour activity, inasmuch as repeat 32P testing was strongly positive eight months later, when unequivocal evidence of tumour growth was present. An alternative explanation is that the orally administered 32P was incompletely absorbed. Since 32P testing is frequently accompanied by significant manipulation both in the manoeuvre associated with tumour localization and in that associated with the actual radioactive counting, it would seem desirable to perform indicated enucleation immediately after completion of the 32P testing. While the properly performed 32P test remains a valuable diagnostic test for helping to establish the presence or absence of malignancies of the posterior globe, it is important to guard against the tendency to underestimate careful clinical evaluation.- - - - - - - - - - ranking = 1keywords = detachment (Clic here for more details about this article) |
2/207. Clinical experience with presumed hemangioma of the choroid: radioactive phosphorus uptake studies as an aid in differential diagnosis.A total of 27 cases of choroidal hemangioma was evaluated with radioactive phosphorus uptake studies. In each case the diagnosis of malignant melanoma was initially entertained, but the 32P test was unequivocally negative in every instance. follow-up studies in every case have supported the clinical diagnosis. In 22 patients, the lesion was treated with photocoagulation, and in every treated case the serous macular detachment disappeared. The importance of early and correct clinical diagnosis is stressed, since these are salvageable and potentially useful seeing eyes.- - - - - - - - - - ranking = 1keywords = detachment (Clic here for more details about this article) |
3/207. Proton beam therapy for posterior pole circumscribed choroidal haemangioma.BACKGROUND: Macular and juxtapapillary circumscribed choroidal haemangiomas (CCH) have always posed a diagnostic and therapeutic challenge. Proton beam therapy has been advocated by Zografos and associates as optimal for treating these tumours in this critical region as charged particles have a highly localised and uniform dose distribution. patients: We present 3 cases of CCH treated with proton beam therapy. Two patients developed radiation optic neuropathy and maculopathy, and one had a persistent exudative macular detachment following treatment. CONCLUSION: Our experience with proton therapy of these tumours has been disappointing in preventing radiation optic neuropathy and maculopathy and offers little advantage over external irradiation. The majority of our patients with this condition are now treated with low-dose lens-sparing external beam radiotherapy or brachytherapy, which has encouraging visual results and is a far more cost-effective option.- - - - - - - - - - ranking = 1keywords = detachment (Clic here for more details about this article) |
4/207. Extraocular extension of unrecognized choroidal melanoma simulating a primary optic nerve tumor: report of two cases.BACKGROUND: Orbital extraocular extension of choroidal melanoma is well known and is usually detected in eyes with medium and large tumors, but it is very rare with small melanomas. It is particularly unusual for choroidal melanomas of any size to invade the optic nerve or its meninges. DESIGN: Two case reports. PARTICIPANTS: Two patients with small, relatively inconspicuous juxtapapillary pigmented choroidal lesions were referred with the diagnosis of primary optic nerve tumor. Both demonstrated a large nodular tumor in the meninges of the optic nerve, immediately posterior to the globe. methods: Retrospective review of clinical records and histopathology. RESULTS: In both cases, orbital magnetic resonance imaging confirmed the presence of a hyperintense enhancing nodular mass near the anterior portion of the optic nerve, prompting optic nerve biopsy in one case. Subsequent fundus examination disclosed a small juxtapapillary pigmented choroidal lesion measuring 1.0 mm or less in thickness. These observations suggested that the optic nerve tumor might be nodular extraocular extension of a small choroidal melanoma. Modified enucleation was performed in both cases, and histopathologic examination revealed a nodule of malignant melanoma within the meninges that compressed the optic nerve and extended extraocularly from a small, relatively inapparent juxtapapillary choroidal melanoma. In both cases, the extraocular component was large and symptomatic, whereas the intraocular component was inconspicuous. CONCLUSIONS: Small juxtapapillary choroidal melanomas can exhibit prominent extension into the orbit. All patients with orbital tumors should have careful ophthalmoscopy.- - - - - - - - - - ranking = 0.048752506756492keywords = pigment (Clic here for more details about this article) |
5/207. Transscleral choroidal biopsy in the diagnosis of choroidal lymphoma.A 57-year-old man with non-Hodgkin's B-cell lymphoma of the abdominal lymph nodes developed moderate cells in the anterior chamber and vitreous, choroidal infiltration, and total nonrhegmatogenous retinal detachment in both eyes while receiving chemotherapy. After a diagnostic vitrectomy in the left eye was nonrevealing, the patient was referred to the oncology service. Fine-needle aspiration biopsy of the choroidal infiltrate was not done because of poor visualization of the choroid through the turbid subretinal fluid. Transscleral choroidal biopsy was performed without complications and disclosed diffuse high-grade B-cell lymphoma and no signs of endogenous infection. Transscleral choroidal biopsy is a useful technique in eyes with choroidal infiltration, especially when hazy media prohibit fine needle biopsy.- - - - - - - - - - ranking = 1.8875369706651keywords = detachment, retinal detachment (Clic here for more details about this article) |
6/207. Transpupillary thermotherapy as primary treatment for small choroidal melanomas.OBJECTIVE: To report the short-term follow-up results of eyes containing small choroidal melanomas that were treated with transpupillary thermotherapy. methods: Twenty eyes with suspected small choroidal melanomas were treated with transpupillary thermotherapy using infrared light delivered from the diode laser. RESULTS: The age of the patients ranged from 26 to 82 years. In 14 patients, there was documented growth of the melanoma before transpupillary thermotherapy. The tumor thickness ranged from less than 1.0 to 3.2 mm. Seven tumors were treated more than once. Follow-up ranged from 6 months to more than 3 years. Following treatment, the tumor thickness decreased in all cases, usually within 2 months. Progressive atrophy of tumor mass and loss of pigmentation within the tumor continued beyond 1 year of follow-up in some eyes. Complications included field defects, vascular changes, and macular abnormalities. CONCLUSIONS: Transpupillary thermotherapy of small choroidal melanomas is usually followed by early tumor shrinkage but is complicated by dense scotomas, nerve fiber bundle defects, and, occasionally, macular abnormalities. The short-term follow-up results suggest that transpupillary thermotherapy may arrest the growth of selected small melanomas.- - - - - - - - - - ranking = 0.024376253378246keywords = pigment (Clic here for more details about this article) |
7/207. Transpupillary thermotherapy as primary treatment for small choroidal melanomas.PURPOSE: To report short-term follow-up of eyes containing small choroidal melanomas that were treated with transpupillary thermotherapy (TTT). methods: Twenty eyes with suspected small choroidal melanomas were treated with TTT using infrared light delivered from the diode laser. RESULTS: The age of patients ranged from 26 to 82 years. In 14, there was documented growth of the melanoma prior to TTT. Tumor thicknesses ranged from less than 1 to 3.2 mm. Seven tumors were treated more than once. Follow-up ranged from 6 months to more than 3 years. Following treatment, tumor thicknesses decreased in all cases, usually within 2 months. Progressive atrophy of tumor mass and loss of pigmentation within the tumor continued beyond 1 year of follow-up in some eyes. Complications included field defects, vascular changes, and macular abnormalities. CONCLUSIONS: Transpupillary thermotherapy of small choroidal melanomas is usually followed by early tumor shrinkage but is complicated by dense scotomas, nerve fiber bundle defects, and occasionally macular abnormalities. Short-term follow-up suggests that TTT may arrest growth of selected small melanomas.- - - - - - - - - - ranking = 0.024376253378246keywords = pigment (Clic here for more details about this article) |
8/207. Choroidal schwannoma: immunohistochemical and electron-microscopic study.Schwannoma (neurilemoma) arising from the ciliary body and choroid is a rare form of intraocular tumor and usually misdiagnosed clinically as amelanotic melanoma. This case report describes a 73-year-old woman who developed a large nonpigmented intraocular tumor of the choroid in the left eye and underwent enucleation with a clinical diagnosis of malignant melanoma. The tumor consisted of spindle-shaped cells with an indefinite cytoplasm and twisted nuclei, which had positive immunoreactivity for S-100 protein, vimentin, glial fibrillary acidic protein and neural cell adhesion molecule. A continuous basal lamina encompassing the tumor cells was demonstrated by immunostaining for laminin and type IV collagen. Ultrastructurally, tumor cells with scant organelles had delicate cytoplasmic processes apposing each other, all indicative of Schwann cell origin. In reexamination of fluorescein angiograms, ultrasonograms and magnetic resonance images, no findings were incompatible with a diagnosis of choroidal melanoma. Histopathological studies showed that the tumor was a schwannoma. At present, we do not have a benchmark for the clinical diagnosis of intraocular schwannoma.- - - - - - - - - - ranking = 0.024376253378246keywords = pigment (Clic here for more details about this article) |
9/207. Malignant melanoma arising in a choroidal magnacellular nevus (melanocytoma).A case is presented of a 55-year-old Caucasian male whose right eye was enucleated for a mixed spindle-A and spindle-B malignant melanoma in 1967. The ophthalmoscopic picture, fluorescein angiography, and overlying peculiar orange pigmentation were suggestive of a malignant lesion. Study of serial sections of the entire lesion made possible the histologic reconstruction of the lesion, clinicopathologic correlation of the yellow-orange pigment, and the location of the nevus and mixed spindle-cell melanoma components.- - - - - - - - - - ranking = 0.048752506756492keywords = pigment (Clic here for more details about this article) |
10/207. iris mammillations as the only sign of ocular melanocytosis in a child with choroidal melanoma.An 8-year-old girl had visual loss in her left eye over 2 months. Ocular examination showed that visual acuity was counting fingers in the left eye. The left iris was moderately pigmented and thickened with numerous confluent, dome-shaped elevations on its surface, consistent with iris mammillations arising from ocular melanocytosis. There was total retinal detachment and an inferiorly located large amelanotic choroidal mass compressing the optic nerve. A specimen from a fine-needle aspiration biopsy showed spindle and epithelioid melanoma cells. The eye was enucleated. Pathologic examination showed that the bland melanocytes comprising the anterior border layer of iris formed focal aggregates, corresponding to the iris mammillations observed clinically. The uvea was diffusely thickened. Arising from the posterior choroid and obscuring the optic nerve head was a moderately pigmented spindle and epithelioid cell choroidal melanoma with diffuse lymphocytic infiltration and high mitotic activity. This case demonstrates that iris mammillations can be the initial manifestation of ocular melanocytosis in the absence of scleral pigmentation.- - - - - - - - - - ranking = 1.9606657307998keywords = detachment, retinal detachment, pigment (Clic here for more details about this article) |
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