Diaz C E, Capone A, Grossniklaus H E
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Ophthalmology. 1998 Aug;105(8):1419-24. doi: 10.1016/S0161-6420(98)98022-8.
This study aimed to report the clinicopathologic findings of recurrent choroidal melanoma after transpupillary thermotherapy (TTT).
Two case reports.
The clinical histories and ophthalmologic findings of two patients with recurrent choroidal melanomas who did not respond to TTT were reviewed. Both patients had their eyes with the melanoma enucleated and processed routinely for light and electron microscopic examination.
The eyes were examined for histopathologic and ultrastructural findings.
Histopathologic examination showed choroidal melanomas with extensive tumor necrosis and hemorrhage. In areas, tumor cells appeared histologically intact and presumably viable, with ultrastructural evidence of melanogenesis. The eye from one patient was treated only with TTT and showed hemorrhagic necrosis with cytolysis and no changes to tissues surrounding the melanoma. The eye from the other patient, treated with TTT and a radioactive isotope of iodine (I125) plaque, exhibited areas of intact tumor, tumor necrosis, fibrosis, and radiation retinopathy.
These two cases among a total treated series of 14 patients represent examples of uveal melanoma regrowth after TTT. Opaque media precluded adequate treatment in the first case that showed some TTT effect. The second case showed a combination of TTT and I125 effect and failed because of the aggressive nature of tumor.
本研究旨在报告经瞳孔温热疗法（TTT）治疗后复发性脉络膜黑色素瘤的临床病理特征。
两例病例报告。
回顾了2例对TTT治疗无反应的复发性脉络膜黑色素瘤患者的临床病史和眼科检查结果。两名患者均摘除了患黑色素瘤的眼睛，并进行常规的光镜和电镜检查。
对眼睛进行组织病理学和超微结构检查。
组织病理学检查显示脉络膜黑色素瘤伴有广泛的肿瘤坏死和出血。在某些区域，肿瘤细胞在组织学上看似完整且可能存活，并有黑色素生成的超微结构证据。一名患者的眼睛仅接受了TTT治疗，表现为出血性坏死伴细胞溶解，黑色素瘤周围组织无变化。另一名患者的眼睛接受了TTT和碘（I125）放射性同位素敷贴治疗，表现为肿瘤完整区域、肿瘤坏死、纤维化和放射性视网膜病变。
在总共14例接受治疗的患者中，这两例代表了TTT治疗后葡萄膜黑色素瘤复发的病例。在第一例显示出一定TTT治疗效果的病例中，不透明介质妨碍了充分治疗。第二例显示了TTT和I125治疗效果的联合，但由于肿瘤的侵袭性而治疗失败。
