Histopathologic characteristics of uveal melanomas in eyes enucleated from the collaborative ocular melanoma study COMS report no. 6☆
Accepted 13 October 1997.
Abstract
Purpose: To describe the principal histopathologic findings in a series of 1,527 globes with uveal melanoma and the relationship of these findings to each other.
Methods: All eyes enucleated in the Collaborative Ocular Melanoma Study (COMS) were examined independently by three ophthalmic pathologists and the findings recorded on a data form. A composite of findings was obtained after adjudication.
Results: The diagnosis was choroidal melanoma in 1,527 (99.7%) of 1,532 cases examined. Misdiagnoses were metastatic adenocarcinoma (four) and hemangioma (one). Spindle cell (9.0%), mixed cell (86.0%), and epithelioid cell (5.0%) types were observed. Medium tumors were located more posteriorly than large tumors. Considerable local invasion was seen: rupture of Bruch’s membrane (87.7%), invasion of the retina (49.1%), tumor cells in the vitreous (25.2%), vortex vein invasion (8.9%), invasion of tumor vessels by tumor cells (13.8%), and invasion into emissary canals (55.0%). Overall, 81.1% demonstrated local invasion, excluding rupture of Bruch’s membrane. Scleral invasion was present in 55.7% of eyes, and extrascleral extension was present in 8.2%. Mitotic activity was significantly reduced in eyes that had received preenucleation radiation treatment (P < .001). The number of macrophages in the tumor increased with increased pigmentation (P < .001) and increased necrosis (P < .01).
Conclusion: The accuracy of diagnosis in the COMS is high, with histopathologic confirmation of the diagnosis at 99.7%. Extensive local invasion of the tumor was seen. Preenucleation irradiation significantly reduced the number of mitotic figures. An association was found regarding the presence of macrophages, the level of pigmentation, and degree of necrosis.
aDepartment of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin, USA (Dr Albert and Ms Robinson)
bDepartment of Biostatistics (Dr Diener-West), Johns Hopkins University, Baltimore, Maryland, USA
cDepartment of Ophthalmology, Emory University, Atlanta, Georgia, USA (Dr Grossniklaus)
dDepartment of Ophthalmology (Drs Diener-West and Green), Johns Hopkins University, Baltimore, Maryland, USA
Correspondence to Daniel M. Albert, MD, Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, F4/338 CSC, 600 Highland Ave, Madison, WI 53792-3220; fax: (608) 263-1466
☆ This work was supported under cooperative agreements EY06260, EY06284, and EY06887 with the National Eye Institute, which includes support from the National Cancer Institute, National Institutes of Health, Bethesda, Maryland; an unrestricted gift from Research to Prevent Blindness, Inc, New York, New York; and the Wisconsin Lions Eye Research Fund, Madison, Wisconsin.
∗ A complete listing of the COMS Group as of August 31, 1997, begins on page 757.
2 Prepared by Daniel M. Albert, MD, Marie Diener-West, PhD, Nancy L. Robinson, AB, Hans E. Grossniklaus, MD, and W. Richard Green, MD.
3 Reprint requests to Barbara S. Hawkins, PhD, COMS Coordinating Center, 550 N Broadway, 9th Fl, Baltimore, MD 21205-2010; fax: (410) 955-0569.
ABSTRACT