Histomorphological changes in choroidal melanoma after transpupillary thermotherapy according to the developed method (unsuccessful cases)

Authors

  • V.V. Vit State Institution “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”, Odesa, Ukraine
  • S.I. Polyakova State Institution “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”, Odesa, Ukraine
  • I.V. Tsukanova State Institution “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”, Odesa, Ukraine

DOI:

https://doi.org/10.22141/2309-8147.8.2.2020.209915

Keywords:

choroidal melanoma, transpupillary thermotherapy, histomorphological examination

Abstract

Background. The most modern and promising method of treating small choroidal melanoma (CM) is transpupillary thermotherapy (TTT). A modified technique for conducting a diode laser (810 nm) TTT on CM, which consisted of one TTT session a day for four consecutive days and, if necessary, was repeated after 2.5–3 months. The purpose was to study histomorphological features of therapeutic pathomorphosis in CM after TTT by the developed method on enucleated eyes (unsuccessful cases). Material and methods. Еnucleation was performed in 7 patients with small stage T1 CM due to prolonged tumor growth or complications after 1 to 8 TTT courses. Histomorphological studies were performed on a Jenamed 2 microscope after fixing the objects and pouring them into paraffin. Histological preparations were stained with hematoxylin and eosin. Results. Histologically, most melanomas were mixed (57.1 %) and epithelioid (28.6 %), with one patient having spindle cell AB type melanoma (14.3 %). Tumor pigmentation, which was determined using ophthalmoscopy, does not always coincide with the pigmentation determined by histomorphological examination (in 71.4 % of cases, CM was without pigmentation). Despite the initial stage of the disease, tumor invasion into the inner (28.6 %) and middle la­yers (14.3 %) of the sclera and retrobulbar invasion (14.3 %) were detected. Histomorphologically, therapeutic pathomorphosis after TTT according to the developed method is manifested itself by dry necrosis with focal accumulation of intensely pigmented melanophages, fibroblasts, areas of fibrillogenesis, inflammatory infiltration of the tumor parenchyma, which appears in the first days and persists during the entire treatment period. Conclusions. Most of the small stage T1 CM (prominence into the vitreous body up to 3 mm, tumor base length up to 12 mm) studied, with negative treatment results, were pigment-free (71.4 %) and had scleral invasion to the inner (28.6 %), middle (14.3 %) layers and retrobulbar growth (14.3 %). Histomorphologically, therapeutic pathomorphosis after TTT according to the developed method is manifested itself in CM tissue by dry necrosis with focal accumulation of intensely pigmented melanophages, fibroblasts, areas of fibrillogenesis, inflammatory infiltration of the tumor parenchyma, which appears in the first days and persists during the entire treatment period. More significant destructive changes after TTT are found with intense melanoma pigmentation.

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Published

2020-03-01

Issue

Section

Clinical Ophthalmology