Melendez-Moreno Alexander, Singaravelu Janani, Brainard Jennifer, Davanzo Jacquelyn M, Singh Arun D
Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
Ocul Oncol Pathol. 2023 Feb;8(4-6):211-220. doi: 10.1159/000527596. Epub 2022 Oct 19.
Anterior uveal melanocytoma (AUM) pose a diagnostic challenge as they can mimic growing melanomas. Establishing a definitive diagnosis of melanocytoma necessitates cytologic or histopathologic confirmation. We describe the clinical presentation and characteristics of fifteen pathologically proven AUM cases and assess the role of fine needle aspiration biopsy (FNAB) as a safe and effective tool for diagnosis.
Retrospective review of pathologically confirmed AUM cases was performed. Demographic data, presenting symptoms, clinical features, diagnostic approach, cytological and histological features, and clinical outcomes were collected.
Fifteen patients with pathologically confirmed AUM were identified. The mean and median age of diagnosis were 50 and 53 years, respectively (range 3-77 years). The melanocytoma was localized to the iris (5, 33%) or ciliary body (7, 47%), and 3 patients had iridociliary involvement (20%). Presentation was due to concern for growth in 4 (29%), visual symptoms in 1 (7%), and was an incidental finding in 10 (64%) patients. Pigmentation of the tumor varied with 9 (60%) appearing brown and 3 (20%) black in color. The color of 3 (20%) ciliary body tumors could not be assessed. The diagnosis was confirmed with FNAB in 6 (40%), excisional biopsy in 7 (47%), and incisional biopsy in 2 (13%). Cytologic and histologic preparations demonstrated predominance of round to polygonal cells with heavily pigmented cytoplasm and small round nuclei. One patient who underwent excisional biopsy had prior FNAB that was interpreted as suspicious for melanoma (false-positive). Instances of false-negative cytology were not observed as demonstrated by the subsequent stable clinical course during the mean follow-up of 21.2 months (range = 1.0-63.0 months). FNAB-related complications were not observed in any case.
FNAB offers a minimally invasive and safe diagnostic approach for pathologic confirmation of AUM. However, limitations of FNAB including false-negative and false-positive biopsies must be considered when excluding underlying malignancy. Continued observation to document tumor stability should be considered.
前葡萄膜黑素细胞瘤（AUM）因其可模仿生长中的黑色素瘤而带来诊断挑战。确立黑素细胞瘤的明确诊断需要细胞学或组织病理学证实。我们描述了15例经病理证实的AUM病例的临床表现和特征，并评估了细针穿刺活检（FNAB）作为一种安全有效的诊断工具的作用。
对经病理证实的AUM病例进行回顾性研究。收集人口统计学数据、症状表现、临床特征、诊断方法、细胞学和组织学特征以及临床结果。
确定了15例经病理证实的AUM患者。诊断时的平均年龄和中位数年龄分别为50岁和53岁（范围3 - 77岁）。黑素细胞瘤位于虹膜（5例，33%）或睫状体（7例，47%），3例患者有虹膜睫状体受累（20%）。表现为因担心肿瘤生长而来就诊的有4例（29%），因视觉症状而来的有1例（7%），10例（64%）为偶然发现。肿瘤的色素沉着各不相同，9例（60%）呈棕色，3例（20%）呈黑色。3例（20%）睫状体肿瘤的颜色无法评估。6例（40%）通过FNAB确诊，7例（47%）通过切除活检确诊，2例（13%）通过切开活检确诊。细胞学和组织学标本显示，以圆形至多边形细胞为主，细胞质色素沉着明显，细胞核小而圆。1例接受切除活检的患者之前曾进行FNAB，结果被解释为怀疑黑色素瘤（假阳性）。在平均21.2个月（范围 = 1.0 - 63.0个月）的随访期间，未观察到假阴性细胞学情况，随后的临床病程稳定。在任何病例中均未观察到与FNAB相关的并发症。
FNAB为AUM的病理证实提供了一种微创且安全的诊断方法。然而，在排除潜在恶性肿瘤时，必须考虑FNAB的局限性，包括活检的假阴性和假阳性。应考虑持续观察以记录肿瘤的稳定性。
