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Histomorphological changes of uveal melanoma (UM) following proton beam therapy (PBR)
Author(s) -
Qureshi S.,
Hussain R.,
Kalirai H.,
Heimann H.,
Coupland S.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0602
Subject(s) - enucleation , medicine , pathology , ciliary body , sclera , eye enucleation , ophthalmology , surgery
Purpose PBR is used for the treatment of UM. Little is known about histomorphological alterations in UM following PBR. Our aim was to document these changes. Methods Data was obtained for 25 UM enucleation samples following PBR between Jan 2005–Dec 2015. Histological sections were examined for morphological changes affecting tumour cells, its microenvironment and adjacent sclera. Data was analysed using SPSS Software. Results 730 patients underwent enucleation at the Liverpool Ocular Oncology Centre (646 primary, 84 secondary); 41 underwent enucleation following PBR, of which 25 samples were analysed. Histological examination of tumour type classified 5 UM as epitheloid, 9 spindle, and 11 as mixed. Focal necrosis was seen in 10 cases (41.7%); bizarre mitoses in 5 (20.8%); tumour cell‐ ballooning in 17 (70.8%) and mummification in 12 (50%); and vessel wall‐ thickening in 13 (54.2%) and hyalinization in 15 (62.5%). Prominent tumour infiltrating lymphocytes (TIL's) were noted in 17 UM (70.9%), and tumour‐associated‐macrophages (TAM's) in 15 (62.5%); 19 UM (79.2%) had noticeable degenerative scleral changes. Median time elapsed between PBR and enucleation was 14.5 months (range 7–26). Bivariate analyses demonstrated statistically significant correlations between interval from PBR to enucleation and histological changes (bizarre mitoses (p = 0.035); tumour cell mummification (p = 0.025), nuclear inclusions (p = 0.002); TILs/TAMs (p = 0.022); plasma cells (p = 0.021); and hyalinisation (p = 0.031). UMs enucleated >20 months following PBR were 1.73 times more likely to have inflammation and bizarre mitoses than eyes enucleated within 10 months following PBR (p = 0.041). Conclusions The histopathological alterations of UM following PBR are complex, and evolve over time, with increasing degenerative and inflammatory changes. Immunohistochemical and genetic studies are underway.