Biomedical subjects
Publications and source records attributed to F Bacin.
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Two eyes with a complicated retinal detachment were operated using intraocular silicone oil injection. They were enucleated 33 and 12 months after the operation because of painful secondary glaucoma and corneal dystrophy. Using light and electron microscopy, silicone oil vacuoles were observed in the corneal depth, the iris stroma, the trabecular meshwork and in lens remnants. There was an angle closure due to iridocorneal synechia. The same vacuoles were recognized in epiretinal membranes, in the internal and external layers of the retina and in the pigment epithelium. When the retina was detached, silicone oil vacuoles were present in the choroidal vessels.
PURPOSE: The purposes of this study were to evaluate the incidence of uveal melanoma in France in 1992, to describe the characteristics of the tumors and their treatments. METHODS: This was a retrospective and multicentric study. First a questionnaire was sent to 4575 French ophthalmologists asking whether they had established a diagnosis of uveal melanoma during 1992, and if so, to describe the tumor and its management. Then the patients files were reviewed in the specialized treatment centers (Paris, Lyon, Nice, Strasbourg, Bordeaux, Clermont-Ferrand). All the data were statistically analysed. RESULTS: 412 new cases of uveal melanomas were registered (incidence 0.7/100000) affecting 234 females and 178 males. The cases ranged in age from 7 to 93 years (mean 61.5 years). There were 5 (1%) isolated tumors of the iris, 75 (18%) of the ciliary body, either isolated (10%) either associated to iris and/or to choroïdal tumors and 332 (81%) choroïdal melanomas. 201 (53%) tumors were posterior to the equator and 153 (40%) had a margin at less than 3 mm of the optic disc; 87 (21%) melanomas were detected in asymptomatic patients. In 29 (7%) other cases, the diagnosis was established after enlargement of the tumor. In all other eyes, symptoms were present. 17% of the melanomas were T1, 34% were T2, et 48% were T3. 353 (86%) melanomas were pigmented, 30 (7%) were achromic and 29 (7%) of the mixed color type. 156 (38%) tumors were associated with a retinal detachment. In 12 cases (3%), at presentation there was an extrascleral extension. 9 patients (2%) had metastases (7 to the liver, 1 to the lungs and 1 to the lungs and bones). The study of the patients residence and work did not show any environmental risk factor. The initial treatment was protontherapy in 251 patients (63%), plaque therapy in 91 (23%), enucleation in 40 (10%), and other methods in 18. CONCLUSION: This was the first epidemiologic study conducted in France on this subject. It describes the clinical features of the disease, its geographical display and its management in this country.
A sixteen-year-old white girl with peripheral neurofibromatosis (NF1), who had been treated for a glioma of the optic nerves and chiasma developed a choroidal mass in her only functional eye. After a transchoroïdal biopsy, the pathologic examination disclosed a choroïdal melanoma of epithelioid cell type, using morphological criteria as well as an immunohistochemical study. After treatment with a ruthenium plaque, the tumor completely regressed over 4 months. According to the data of the literature, neurofibromatosis seems to predispose to the development of uveal melanomas.
We describe a case of cutaneous malignant melanoma metastatic to the iris and the angle 31 months after excision of the primary tumor in a 37-year-old caucasian female patient. The patient who had numerous metastases (lung, liver, cerebrum, skin) suffered from secondary glaucoma and died 5 months after the discovery of the intraocular metastases. The glaucoma was treated with medications and cyclocryotherapy. There was no response of the iris metastases to cyclical combined chemotherapy.
Twenty months after cobalt 60 plaque therapy of a choroidal malignant melanoma, a patient developed an intraocular recurrence at a site distant from and non contiguous to the original lesion that seemed controlled. The characteristics and the possible explanations of this unusual recurrence are discussed.
The authors present a case of gigantic tear of the retinal pigmented epithelium. This tear was situated in the middle periphery and seems to have appeared spontaneously together with a carotid-cavernous fistula. The functional outcome was favorable. The authors deal with the various possible patho-physiological mechanisms.
Fifty-seven uveal malignant melanomas (T2: 36.8%; T3: 49.1%) were treated between 1983 and 1989 with Cobalt 60 or/and Ruthenium 106 Rhodium 106 plaques. The mean follow-up was 32 months (from 6 to 69 months). A diminution of tumor size was observed in 88% of the cases, either rapid and marked (57%), or slower and more moderate (31%). A multivariate study showed the radiation dose administered to the tumor edge to be the most significant parameter associated with the tumor control. Seven patients developed metastases, and the probability of survival at 60 months was 83.3%. This probability was identical to that of 59 comparable patients treated, some years before, by enucleation. The most frequent complications were radiation retinopathy (28.1%) and retinal detachment (15.8%). The treated eye was retained in 86% of cases. In 57% of treated eyes, vision remained better or equal to 0.1. The predictive parameters of vision impairment after treatment seemed to be tumor size, tumor site near the macula and the optic nerve, and the radiation dose to the tumor base. The use of Ruthenium 106 Rhodium 106 appeared to be advantageous in controlling the disease as well as in reducing the incidence of complications.
The modulation of interference fringes reflected by the peripheral fundus is always lowered by passage through the outer segments of the photoreceptors. In addition, it also may be degraded by passage through a diseased inner retina or through the choroid (in cases where there is only light pigmentation of the fundus). The contributions of the inner retina and choroid can be differentiated by varying the spatial frequency of fringes, or by studying the directionality of the fundus reflection. Reflecto-modulometry seems to be an appropriate method for analysing pathological changes in the optical quality of the inner retina.
Fibrous histiocytomas are commonly found on the skin, whereas the appear to affect the conjunctiva only very rarely.
We report a case of Spitz nevus of the bulbar conjunctiva in a 15-year-old boy. Clinically, the lesion was juxtalimbic, nodular, red, and 6mm in diameter. Only histologic examination provided the diagnosis. Perusal of the literature revealed seven cases of Spitz nevus of the conjunctiva, but for some of them the histology was incompletely described. We compare the clinical and histologic features in cutaneous and conjunctival nevi and stress the similarity between the two. The histologic criteria which permit differentiation of melanomas and Spitz nevi in conjunctival locations are identified.
The case of a 49-year old woman who developed fibrous histiocytoma of the conjunctiva is reported. Clinically, the lesion was tumoral, unpigmented and located in the corneo-scleral limbus. The lesion was excised, and the patient remained cured throughout the 4-year follow-up. Five other cases have been published, and in all of them cure without recurrence was obtained by excision.
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In order to evaluate the clinical and histopathologic prognosis indicators of uveal melanomas treated with enucleation, 59 patients, followed up during 1 to 18 years were included in a retrospective study. Kaplan Meier survival curves were constructed and compared using the log rank test. The overall 5 and 10 years probabilities of survival were 74.9% and 48.5% respectively. Metastases were, or might have been, responsible for death in 83.3% of the cases. The median survival was 4 years 9 months (range less than 1 to 11 years). Fifty five per cent of the metastases occurred within 4 years of the enucleation and 90% within 8 years. For the patients with spindle cell melanomas, the 5 year probability of survival was 90% against 38% for the patients with epithelioid cell tumors. The median time to tumor related death was 5 years for the first group against 3 years 8 months for the second. The analysis of our data demonstrated the tumor volume to be a statistically significant clinical prognosis indicator. The following histopathologic parameters were also statistically significant prognosis indicators: the cell type (p less than or equal to 0.001), the mitotic activity, the state of the sclera, the presence of blood lakes. Statistical adjustments and determination of the instantaneous relative risk of death showed the histopathologic factors, specially the cell type, to be the most important indicators.
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