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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The histological sections of 74 retinoblastoma patients were reviewed. The extent of optic nerve invasion was correlated with choroidal/scleral extension. Choroidal invasion carries 100% survival provided that the sclera, iris, and whole optic nerve are not also involved. Invasion of the optic nerve beyond the lamina cribrosa also carries 100% survival provided that the resection line is free and that invasion does not involve the sclera or iris. Plentiful rosettes were usually found in those tumours that had not extended beyond the choroid or as far as the resection line of the optic nerve and were therefore associated with a good prognosis. The absence of rosettes did not necessarily indicate a poor prognosis. The site of metastases was related to optic nerve and scleral/extrascleral extension. The various systems of staging retinoblastoma are compared, and a new system is proposed to cover the whole spectrum of the disease and to offer a reliable guide to prognosis and treatment.
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PMID:Retinoblastoma: correlation of invasion of the optic nerve and choroid with prognosis and metastases. 47 32

After a classification in benign and malignant tumours and in pigmented and non-pigmented growth, attention is drawn to the fact that most of the tumours lie in the palpebral fissure and are benign. Leukoplakia is a clinical description but not a diagnosis. Both the benign and the malignant growths can be called Leukoplakia. The intra-epithelial epithelioma is often incorrectly diagnosed as Bowen's disease. This disease of the skin and the intraepithelial epithelioma of the limbus are histologically quite different, and therefore the term Bowen's disease is incorrect. Not all the various tumours occur with the same incidence, e. g. the squamous cell carcinoma occurs more often in some countries than in others. The malignant melanomas of the conjunctiva are not so malignant as in the caruncle or cornea. In the conjunctiva secundary melanomas can occur after penetration of an intraocular melanoma through the sclera; similary metastases can occur in the form of epibulbar tumours. In all cases the epibulbar tumour should be excised very carefully and a histological examination is necessary for the diagnosis.
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PMID:[Epibulbar tumours (author's transl)]. 48 Aug 13

A follow-up study and histologic reevaluation were made of 105 melanomas of the choroid and ciliary body that had originally been classified as Callender's spindle A type. There were 18 deaths attributable to tumor, with metastatic disease confirmed by autopsy or biopsy in eight cases. We were able to separate the 105 melanomas histopathologically into three groups. The first group consisted of 15 cases in which the spindle-shaped tumor cells were cytologically benign; no deaths were observed for this group. The 75 tumors in the second group were composed of spindle cells, but differed from those in the first group by their malignant features, namely, more atypicality of cells, mitotic activity, necrosis, invasion into sclera or through Bruch's membrane, larger size of the tumor, or any combination of the above. The prognosis for this group was good, comparable to that of spindle B melanomas. The 15 tumors in the third group contained epithelioid cells and had a poor prognosis, comparable to that of mixed-cell melanomas.
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PMID:Reappraisal of Callender's spindle a type of malignant melanoma of choroid and ciliary body. 70 4

The authors reviewed the postoperative course, visual results, histopathologic findings, and mortality data on 95 consecutive patients with tumors of the ciliary body and/or choroid who were managed by a partial lamellar sclerouvectomy. This surgical procedure is designed to remove the uveal tumor and leave intact the outer sclera and sensory retina. In this group of 95 patients, vitreous hemorrhage occurred in 79 (83%) cases, intraretinal or subretinal hemorrhage in 33 (35%), retinal detachment in 26 (28%), and cataract in 32 (34%). Most of the vitreous and retinal hemorrhages resolved spontaneously, sometimes leaving subretinal or preretinal fibrosis. A number of the postoperative retinal detachments resolved spontaneously, but retinal detachment surgery was necessary in 16 patients (17%), mostly in the earlier years of the survey. Most of the cataracts were mild and did not require surgery. The eventual postoperative visual acuity was equal to or better than the preoperative visual acuity in 23 cases (24%) over a mean follow-up period of 5 years. Enucleation was eventually necessary in 15 cases (16%), usually because of residual or recurrent tumor. Histopathologic diagnosis was uveal melanoma in 81 cases (85%) and other tumors in 14 cases (15%). There were no orbital recurrences, but distant metastases developed in five patients (5%), all of whom had undergone enucleation for recurrence of the intraocular melanoma. Although the surgical technique is difficult, partial lamellar sclerouvectomy appears to be a reasonable therapeutic option in selected cases of posterior uveal tumors.
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PMID:Partial lamellar sclerouvectomy for ciliary body and choroidal tumors. 186 53

Metastatic melanoma to the eye can show a number of unusual features. Two cases with intraocular metastases from primary cutaneous malignant melanoma, with a latency of 5 and 16 years, respectively, from excision to debut of ocular symptoms are reported. In the first case, tumour cell invasion of the chamber angle caused an advanced secondary glaucoma. This eye was enucleated some months later when the tumour extended through the sclera despite palliative external radiation therapy. In the other seeing eye, small melanoma metastases were treated with laser. The patient died of systemic involvement. In the second case, a probable melanoma metastasis was revealed by a vitrectomy of a thickened posterior vitreous membrane. Ophthalmoscopy and B-scan ultrasonography 8 months later showed growths projecting 2 mm into the vitreous cavity. Metastases from a malignant melanoma with infiltration of the retina forming nodules, but also affecting adjacent choroid and optic nerve, was disclosed by histology. The patient died of metastasis to the brain.
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PMID:Intraocular metastasis from cutaneous malignant melanoma. 233 25

The left eye of an otherwise healthy child was enucleated at the age of 2 months because of an enlarging mass involving the temporal iris, ciliary body, and anterior retina. The initial histopathologic diagnosis was malignant medulloepithelioma with orbital extension. Closer study revealed a superotemporal chorioretinal and ciliary body coloboma; dysplasia of the adjacent retina; a glioneuromatous mass replacing the temporal ciliary body, chamber angle structures, and iris and extending through the sclera to involve the insertion of the lateral rectus muscle; neuroepithelial elements resembling medulloepithelioma; and abnormally developed iris pigment epithelium, and dilator and sphincter muscles. Immunohistochemistry demonstrated that the main mass consisted of neurons positive for neuron-specific enolase (NSE), synaptophysin and neurofilaments, and glial cells expressing vimentin, glial fibrillary acidic protein, and S-100 protein. The neuroepithelial elements reacted positively for cytokeratins and S-100 protein, in addition to NSE and vimentin, suggesting ciliary epithelial rather than embryonic retinal origin. The tumor was rediagnosed as glioneuroma, which in this case was part of a widespread colobomatous dysplasia of the anterior uvea and retina. The patient is alive without metastases or local recurrence 2 years following enucleation and subtotal removal of the lesion.
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PMID:Glioneuroma associated with colobomatous dysplasia of the anterior uvea and retina. A case simulating medulloepithelioma. 262 23

In order to evaluate the clinical and histopathologic prognosis indicators of uveal melanomas treated with enucleation, 59 patients, followed up during 1 to 18 years were included in a retrospective study. Kaplan Meier survival curves were constructed and compared using the log rank test. The overall 5 and 10 years probabilities of survival were 74.9% and 48.5% respectively. Metastases were, or might have been, responsible for death in 83.3% of the cases. The median survival was 4 years 9 months (range less than 1 to 11 years). Fifty five per cent of the metastases occurred within 4 years of the enucleation and 90% within 8 years. For the patients with spindle cell melanomas, the 5 year probability of survival was 90% against 38% for the patients with epithelioid cell tumors. The median time to tumor related death was 5 years for the first group against 3 years 8 months for the second. The analysis of our data demonstrated the tumor volume to be a statistically significant clinical prognosis indicator. The following histopathologic parameters were also statistically significant prognosis indicators: the cell type (p less than or equal to 0.001), the mitotic activity, the state of the sclera, the presence of blood lakes. Statistical adjustments and determination of the instantaneous relative risk of death showed the histopathologic factors, specially the cell type, to be the most important indicators.
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PMID:[Prognostic study of malignant melanoma of the uvea treated by enucleation]. 307 63

On the basis of data collected over a period of 22 years from 376 patients enucleated at the Eye Clinic of Karl Marx University, Leipzig because of malignant choroidal melanoma, the prognostic significance and reliability of various histopathological characteristics was investigated. The most significant characteristic proved to be the cell type, followed by the degree of pigmentation, the nature and degree of infiltration of the sclera, and tumor size. The relationship of these parameters to the survival rate was shown to be statistically significant by the mortality tabulation method, contingency tabulation method and rank correlation (Spearman). Furthermore, various correlations between the observed variables were ascertained. This statistical analysis shows that the mitosis has no significant bearing on the prognosis. The five-year metastasis rate was 32.8% and the ten-year rate 40.3%. The metastasis peak of 10.4% occurs in the second postoperative year. After the fifth year the annual mortality rate falls to less than 2% and after the seventh year to less than 1%. The data also indicate that even small, Stage I melanomas metastasize if they are not composed purely of spindle cells. With such tumors the peak metastasis rate shifts to the fourth postoperative year.
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PMID:[Prognostic relevance of histopathologic parameters in malignant melanoma of the choroid using the pTNM classification]. 340 40

The predictive value of prognostic factors is of utmost importance for the treatment of patients with retinoblastoma. Functional results, that may be expected following sight saving therapy, can be deducted from ophthalmoscopic findings. Large tumors, tumors located centrally, the presence of extensive retinal detachment or diffuse vitreous seeding are poor prognostic signs. Histopathologic findings of the enucleated eye harbouring retinoblastoma correlate well with the incidence of metastatic disease. Patients in which the tumor has invaded the choroid, optic nerve or sclera have a high risk of developing metastases.
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PMID:[Value of ophthalmoscopy and histology for the prognosis of patients with retinoblastoma]. 362 21

Patients who are at risk for developing an orbital recurrence after enucleation of the eye for retinoblastoma are those with full thickness choroidal invasion or further extension into the sclera or extension into the optic nerve beyond the lamina cribrosa. The authors have treated these patients routinely with external irradiation to the orbit but this usually resulted in a dry contracted socket that often would not accept a prosthesis. An orbital implant was designed with 125I seeds in an attempt to improve the cosmetic result. It consisted of seven rows of 125I seeds, six of which were partially screened and implanted around the periphery of the orbit so that the contents were irradiated whilst reducing the dose to the bony orbit. The seventh central row was unscreened. A metal disc, with 125I seeds sealed to the posterior surface, was sutured beneath the eyelids thus protecting them and the accessory lacrimal glands. A TDF of 90-100 over two to three days was given. Thirteen patients have been treated, nine prophylactically and four therapeutically. Three of the latter patients have died of metastases but no local recurrences have been seen. All 13 patients were left with a moist socket that accepted a prosthesis.
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PMID:Improved cosmesis in retinoblastoma patients treated with iodine-125 orbital irradiation. 365 44


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