*Monza Eye Bank Unit, San Gerardo Hospital, Monza, Italy; †Department of Pathology, San Gerardo Hospital, Monza, Italy; and ‡Research and Development, AL.CHI.MI.A. S.r.l., Ponte San Nicolò, Italy.
Cornea. 2013 Dec;32(12):1613-6. doi: 10.1097/ICO.0b013e31829de477.
To describe the case of a donor cornea that showed hematogenous metastatic spread of cutaneous melanoma to the sclerocorneal limbus.
Corneal tissue obtained from a donor with cutaneous malignant melanoma was evaluated for endothelial cell density, corneal transparency, and epithelial morphology. Subsequently, hematoxylin and eosin staining and immunohistochemical characterization using S100, HMB45, Melan-A, and CD34 antibodies were performed on the corneal sections.
The corneal tissue was transparent with high endothelial cell density; it was graded as being suitable for transplantation according to the current eye bank criteria. However, the aggressiveness of the donor's cancer and the diffuse melanosis of the sclera led to the suspicion of malignant melanoma metastasis to the cornea. Histochemical analysis of the corneoscleral rim showed small aggregates rich in pigmented cells that were localized in cleft-like structures in the sclera, at the sclerocorneal interface and in the peripheral avascular portion of the cornea. The aggregates were positive for the melanocytic tumor markers S100, HMB45, and Melan-A; the rims of the clefts expressed the panvascular CD34 antigen, which was suggestive of neovascularization.
Corneal tissue from a donor with malignant cutaneous melanoma displayed neoplastic lesions of melanocytic origin that had spread from a primitive melanoma through hematogenous routes to the sclerocorneal limbus. On the basis of this finding, we believe that having a metastatic cutaneous malignant melanoma could in some cases be reviewed as an exclusionary criterion for undergoing cornea transplantation.
描述一例供体角膜出现皮肤黑色素瘤血行转移至角巩膜缘的病例。
对来自患有皮肤恶性黑色素瘤供体的角膜组织进行评估，包括内皮细胞密度、角膜透明度和上皮形态。随后，对角膜切片进行苏木精和伊红染色以及 S100、HMB45、Melan-A 和 CD34 抗体的免疫组织化学特征分析。
角膜组织透明，内皮细胞密度高；根据现行眼库标准，其被评为适合移植。然而，供体癌症的侵袭性和巩膜的弥漫性黑色素沉着导致怀疑角膜发生恶性黑色素瘤转移。角巩膜缘的组织化学分析显示，小的富含色素细胞的聚集物位于巩膜的裂隙样结构中，在角巩膜交界处和角膜的周边无血管部分。这些聚集物对黑色素细胞肿瘤标志物 S100、HMB45 和 Melan-A 呈阳性；裂隙的边缘表达泛血管 CD34 抗原，提示存在新生血管。
来自患有皮肤恶性黑色素瘤的供体的角膜组织显示出源自黑色素瘤的肿瘤病变，这些病变通过血行途径从原始黑色素瘤扩散至角巩膜缘。基于这一发现，我们认为患有转移性皮肤恶性黑色素瘤的患者在某些情况下可能会被审查为角膜移植的排除标准。
