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Intraocular tumours.Magy
Onkol. 2005;49(1):9-13. Epub 2005 May
18.
Intraocular
tumours may be benign or malignant. The latter are more numerous,
and endanger not only vision but life as well. Two of them deserve
special attention: melanoma malignum oculi in adults and
retinoblastoma in children. Melanoma malignum may arise from all
three areas of the uvea: the iris, the ciliary body and the choroid.
The more malignant growths are those which are situated closer to
the posterior pole. Histologically the epitheloid cell-type of
melanoma is more malignant than those containing only spindle cells.
Their treatment depends on the size: in the case of large tumours
enucleation is required, while for the smaller ones, radiation
therapy can be applied. Retinoblastoma is most common in children of
1-2 years of age. It has familial and sporadic forms. Sixty-seven
percent of the inherited-type cases are bilateral. An early symptom
in small children is strabismus. A white tissue mass growing into
the vitreous is seen on the fundus. A diagnostic feature that can be
detected by ultrasound examination is calcification. The tumour may
also present intracranially, therefore CT of the skull should be
performed in each case. Histologically the tumour contains malignant
neuroepithelial cells, which may form a rosette. In the case of
large tumours the treatment is enucleation; in bilateral processes
the bulbus with the larger mass is removed and the other eye is
treated with radiation therapy. In both cases chemotherapy is used
according to a prescribed schedule. Metastases to the eye occur most
frequently from carcinomas of the breast, lungs or gastrointestinal
tract. These are treated with radiotherapy, chemotherapy and hormone
therapy. Primary intraocular lymphoma often occurs bilaterally, and
may be accompanied by primary lymphoma of the central nervous system
(CNS). Some benign tumours are found by chance on routine eye
examinations, others due to subjective and objective symptoms.
Posterior
pole tumor update.Ophthalmol
Clin North Am. 2002 Dec;15(4): 489-501.
This chapter
focuses on the diagnosis and management of choroidal melanoma in
light of recent findings from the COMS. Retinoblastoma is emphasized
to describe recent trends in primary treatment away from EBRT and
toward chemoreduction with local therapy. In addition, vascular and
glial tumors of the retina and tumors of the retinal pigment
epithelium are described because of the association between these
lesions and systemic disease. Recent advances in treatment and
genetic testing for these diseases are discussed. Finally, ocular
metastasis, intraocular lymphoid tumors, and intraocular leukemia
are included because of their importance in determining systemic
treatment and prognosis. The chapter gives an overview of important
posterior pole tumors and highlights recent developments in the
management of each intraocular disease process.
Ocular
manifestations of cancer.J
Fr Ophtalmol. 2002 Feb;25(2):194-202.
Cancer may
affect the eye and orbit as a direct result of metastatic neoplastic
infiltration, compression, or circulating antibodies involving
paraneoplastic retinal degeneration. A metastatic tumor to the uvea
is the most common form of an intraocular metastatic process. The
choroid is the most common site for uveal metastasis; metastases to
the ciliary body, iris, retina, optic disk, and vitreous are rare.
Approximately one-third of patients have no history of primary
cancer at the time of ocular diagnosis. Breast and lung carcinomas
for women and lung and gastrointestinal carcinomas for men most
commonly metastasize to the eye and orbit. The short-term prognosis
for vision is usually good after an individualized therapeutic
approach (chemotherapy, hormonal therapy, external beam
radiotherapy, or plaque radiotherapy), but the systemic prognosis is
poor. The visual paraneoplastic syndromes encompass several distinct
clinical and pathological entities including carcinoma-associated
retinopathy (CAR), melanoma-associated retinopathy (MAR), and
bilateral diffuse melanocytic uveal proliferation (BDUMP). The CAR
syndrome affects photoreceptors, MAR is thought to affect bipolar
cell function, and BDUMP targets the uveal tract. Identification of
circulating antibodies against retinal proteins (recovering, 23-kDa
retinal protein; 46-kDa and 60-kDa retinal proteins) serves to
recognize the paraneoplastic nature of the patient's symptoms, which
frequently develop before the cancer is diagnosed. Anecdotal
therapeutic responses are described after systemic steroids,
immunoglobulin injection, and plasmapheresis. Recognition of their
visual symptoms and ocular findings should alert the ophthalmologist
to the possibility of cancer and systemic evaluation should be
pursued.
Diagnosis
and treatment of intraocular tumors in the child.Klin
Monatsbl Augenheilkd. 2001
May;218(5):292-7.
PURPOSE: To
remind of the absolute necessity for early diagnosis in the presence
of ocular signs in children giving rise to possible intraocular
tumours. METHOD: Based on our own experience of intraocular tumours
in children, together with findings from the literature, diagnostic
criteria and methods of treatment are presented. RESULTS:
Retinoblastoma is the predominant cause of intraocular tumours in
children, representing over 80% of cases under the age of 15 years.
Other diseases may give rise to the same initial signs, usually
leukocoria, sometimes strabismus, more rarely other atypical signs.
Elements taken into account for diagnosis include age, sex,
laterality, heredity, size of the globe, clinical aspect of the
tumours, presence of calcifications and vitreous seeding. Full
fundus examination under general anaesthetic is usually necessary.
Biological examination, ultrasonography, computerized tomography and
MRI enable an accurate diagnosis to be made in the majority of
doubtful cases. The management of retinoblastoma is adapted for each
individual case from the wide range of treatments available.
Enucleation, radioactive applicators (...), brachytherapy (...),
cryo- and photocoagulation represent classical measures. Primary
chemotherapy, combined with other treatments such as thermotherapy,
has become the treatment of choice in those cases where external
beam radiotherapy has been used up to now, or in some instances
before enucleation. Enucleation is usually carried out for
medullo-epitheliomas, but brachytherapy may offer an alternative.
CONCLUSION: Any unexplained ocular sign in children should be
considered as a possible retinoblastoma, making an accurate and
certain diagnosis imperative. Early treatment may save not only the
life but also the vision of patients carrying this highly malignant
lesion.
Intraocular
metastasis from cutaneous malignant melanoma.Acta
Ophthalmol (Copenh). 1990
Feb;68(1):102-6.
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.
Malignant
intraocular tumors.Cancer.
1982 Feb 1;49(3):578-85.
The role of
the radiation therapist in the management of malignant intraocular
tumors is changing. With more active identification of malignant
intraocular tumors, and a better recognization of the manner in
which one can deal with problems of radiation sensitivity, radiation
techniques of all sorts will be more actively employed in the
treatment of these tumors. Special techniques must be selected for
appropriate circumstances of management in order to diminish to an
absolute minimum the impact upon the lens, the impact upon visual
acuity and the impact upon the cornea. Cobalt-60 plaques are being
used more commonly in the treatment of melanomas of the choroid, and
the role for radiation therapy in the management of retinoblastoma
is changing markably to where it may be used as the primary
treatment program rather than enucleation. In metastatic disease
involving the uveal tract, radiation therapy has assumed the most
important role for management. Chemotherapy should be considered as
an active adjuvant in the management of not only those individuals
with retinoblastoma but also in those identified circumstances where
metastases to the uveal tract are being treated. The role for
chemotherapy or immunotherapy in malignant melanoma is unclear.
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