Echegaray Jose J, Plesec Thomas, Bellerive Claudine, Singh Arun D
Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Ocul Oncol Pathol. 2020 Jan;6(1):50-57. doi: 10.1159/000500446. Epub 2019 Jun 18.
Histologic correlation of clinical patterns of recurrent choroidal melanoma following I-125 plaque brachytherapy was performed to identify pathologic mechanisms of recurrence.
We reviewed 7 cases of recurrent choroidal melanoma following I-125 plaque brachytherapy managed with enucleation. Clinical characteristics included tumor dimensions, radiation dose, time to local recurrence, and clinical pattern of recurrence. Histopathology (hematoxylin and eosin and periodic acid - Schiff) and immunohistochemistry (Ki-67, CD-163, HMB45, and SOX10) were performed.
Mean follow-up time and time to local recurrence were 42 and 21 months after brachytherapy, respectively. Tumor recurrences were described clinically as marginal in 43%, diffuse in 29%, and extraocular extension (EOE) in 29%. Eighty-six percent were classified as mixed cell type and 14% were epithelioid type. Tumor zonation (histologic demarcation between zones of recurrent and nonrecurrent tumor cells by immunohistochemistry) was present in marginal and EOE cases ( = 6) and absent in the diffuse cases ( = 2). Ki-67 proliferative index was higher in marginal and EOE recurrences, while diffuse cases showed uniform -Ki-67 staining. CD-163 staining was found to be greater in nonrecurrent tumor. HMB45 correlated with SOX10 with a greater staining in recurrent tumor.
Our observations provide a correlation between histopathologic and clinical patterns of local recurrence of choroidal melanoma after brachytherapy.
对碘-125敷贴近距离放射治疗后复发性脉络膜黑色素瘤的临床模式进行组织学相关性分析，以确定复发的病理机制。
我们回顾了7例接受眼球摘除术治疗的碘-125敷贴近距离放射治疗后复发性脉络膜黑色素瘤病例。临床特征包括肿瘤大小、放射剂量、局部复发时间和复发的临床模式。进行了组织病理学检查（苏木精和伊红染色以及过碘酸-希夫染色）和免疫组织化学检查（Ki-67、CD-163、HMB45和SOX10）。
近距离放射治疗后的平均随访时间和局部复发时间分别为42个月和21个月。临床上肿瘤复发表现为边缘性复发的占43%，弥漫性复发的占29%，眼外扩展（EOE）的占29%。86%为混合细胞型，14%为上皮样型。边缘性和眼外扩展病例（n = 6）存在肿瘤分区（通过免疫组织化学在复发和未复发肿瘤细胞区域之间进行组织学划分），弥漫性病例（n = 2）不存在。边缘性和眼外扩展复发的Ki-67增殖指数较高，而弥漫性病例显示Ki-67染色均匀。发现非复发肿瘤中的CD-163染色更强。HMB45与SOX10相关，在复发肿瘤中的染色更强。
我们的观察结果提供了近距离放射治疗后脉络膜黑色素瘤局部复发的组织病理学和临床模式之间的相关性。
