Clélia Maria Erwenne

Tumour angiogenesis as a prognostic factor for disease dissemination in retinoblastoma.

Aim: To evaluate tumour angiogenesis as a predictor of prognosis in retinoblastoma. Methods: This was a retrospective, non-randomised comparative clinicopathological study. The histopathology from 24 cases of Reese-Ellsworth (RE) group V unilateral retinoblastoma treated by enucleation alone was reviewed. Group I consisted of five patients (four RE group Vb and one group Va) who developed disseminated disease at a mean of 10.4 months after enucleation. The remaining 19 patients constitute group II (18 RE group Vb and 1 group Va), none of whom had developed metastatic disease with a mean follow up of 54 months. None of the 24 patients had evidence of extraocular disease at enucleation. The surgical specimens from patients with unilateral retinoblastoma treated by enucleation at Hospital do Cancer AC Camargo between January 1992 and December 1995 were identified, reviewed and the clinical data recorded. Two subsequent histological sections were prepared. One stained with haematoxylin and eosin for assessment of choroidal and optic nerve invasion, and the other for immunoreaction with an endothelium specific marker (antibody anti-CD 34). The main outcome measures were choroidal and/or optic nerve invasion and quantification of the tumour’s relative vascular area (TRVA) obtained by Chalkley counting. Results: Choroidal invasion was present in three eyes of group I (all massive) and six eyes of group II (two focal and four massive). Optic nerve invasion was found in two eyes of group I (all post-laminar) and four eyes of group II (three prelaminar and one post-laminar). There was no statistical difference regarding choroidal or optic nerve between the two groups. The TRVA was the only independent variable found to predict disease dissemination (p = 0.008 by Cox analysis). A TRVA equal to or greater than 3.9% had 100% sensitivity and 79% specificity in predicting disease dissemination. Conclusions: Quantification of angiogenesis, through measurement of the TRVA, can help to identify patients with retinoblastoma at high risk for disease dissemination after enucleation.

Long-term results of topical mitomycin C 0.02% for primary and recurrent conjunctival-corneal intraepithelial neoplasia.

Purpose: To evaluate the efficacy, recurrence rate, and long-term complications of topical mitomycin C (MMC) 0.02% for conjunctival-corneal intraepithelial neoplasia (CCIN). Methods: A prospective, nonrandomized, noncontrolled study was conducted of patients with primary or recurrent CCIN treated with topical MMC 0.02%, four times per day, for 28 consecutive days. The main outcome measures were complete resolution of the neoplasia by slit-lamp examination and cytology 1 month after treatment, tumor recurrence, and long-term complications. Results: Between June 1999 and September 2005, 23 patients were included. Eighteen had primary CCIN (group 1) and 5 had recurrent CCIN (group 2). The mean follow-up was 46 months in group 1 and 54 months in group 2. All patients were treated with MMC 0.02% for 28 consecutive days. Complete resolution of the lesion was achieved in all patients after 1 month of treatment. Recurrence occurred in 1 patient (4.3%) after 24 months of treatment. Four patients developed corneal erosion (17.4%), 2 of them with primary CCIN and 2 with recurrent CCIN. Corneal erosion occurred 4 to 24 months after treatment and was treated successfully. The probability for corneal erosions by the log-rank test was equal for both groups (p = 0.1705). Conclusions: The use of topical MMC 0.02% for 28 consecutive days to treat primary or recurrent CCIN was effective and showed a low recurrence rate. Corneal erosion occurred in 17.4% of cases and can occur as late as 24 months after treatment.

Detection of human papillomavirus in epithelial lesions of the conjunctiva

CONTEXT Many factors like exposure to UV radiation, climatic conditions, genetic predisposition, immunological state and, more recently, the presence of HPV have been implicated in the genesis of some lesions of the conjunctiva, especially the carcinoma. OBJECTIVE To evaluate the presence of HPV DNA in acquired lesions of the conjunctiva and in normal mucosa. TYPE OF STUDY Cross-sectional study. SETTING A public university referral center (the Ophthalmology Service of the A.C. Camargo Hospital - A. Prudente Foundation, São Paulo). PARTICIPANTS Thirty patients with acquired lesions of the conjunctiva and 60 matched controls (by age and sex) were evaluated in this study, from June 1993 to March 1995. PROCEDURES The detection of HPV DNA in the normal conjunctiva and in acquired lesions was done by the PCR technique and dot blot hybridization. The material was collected by scraping the normal mucosa and the surface of the lesions. A fragment of fresh frozen tissue and paraffin embedded specimens of each lesion were also included. MAIN MEASUREMENTS The association between the HPV infection and the presence or absence of conjunctival lesions. RESULTS Sequences of HPV DNA were detected in 4 of the 31 lesions evaluated (12.9%) and in the healthy mucosa of one individual of the control group (1.6%). HPV type 16 was detected in 2 carcinomas and in the normal mucosa of one individual of the control group. HPV type 11 was demonstrated in 2 papillomas of one patient with lesions in both eyes. CONCLUSIONS The low frequency of HPV DNA found in the lesions of this sample and the detection of the viral genome in the normal mucosa indicate that there is a weak possibility of association between HPV infection and the carcinoma of the conjunctiva.

Ultrasound biomicroscopy features of iris and ciliary body melanomas before and after brachytherapy.

BACKGROUND AND OBJECTIVE To determine ultrasound biomicroscopy (UBM) features of iris and ciliary body melanomas before and after brachytherapy. PATIENTS AND METHODS Four uveal anterior melanoma cases undergoing brachytherapy were retrospectively studied. All cases were examined by UBM prior to treatment and repeatedly after treatment. RESULTS Before brachytherapy, UBM examination showed a solid mass in the iris, ciliary body, or both in all four cases and allowed its characterization, sizing, and positioning. Two cases had a pigmented scleral lesion corresponding to the tumor location, but UBM did not detect any scleral infiltration at those sites. After brachytherapy, all lesions showed progressive decrease in size and progressive attenuation of their limits. Internal reflectivity was variable. Complications related to brachytherapy were demonstrated, including cataract, peripheral anterior synechiae at tumor location, and secondary scleral thinning. CONCLUSION UBM played an important role as a complementary diagnostic method for anterior uveal melanomas, particularly ciliary body melanomas, but also allowed therapeutic planning (brachytherapy or surgery) and follow-up after treatment.

Depression and quality of life during treatment of ocular bulb removal in individuals with uveal melanoma.

The objective of this study is to asses the emotional repercussions in individuals with uveal melanoma referred for surgery, during the diagnosis and preoperative, post-surgery and late post-surgery phases. The clinical qualitative assessment used the Beck Depression Inventory and the Medical Outcomes Study 36-Item Short-Form Health Survey. Twenty patients were individually assessed, 13 men and 7 women, with an average age of 52. Before surgery, patients appeared fragile and impacted by the diagnosis and treatment, showing a minimum to mild state of depression and a quality of life affected by emotional and physical concepts. Three months after surgery, the patients showed a mild to severe state of depression. This depression had an effect on the physical, vitality, emotional, mental health and social life concepts, the emotional concept being the most affected. One year after the surgery, patients presented a minimum state of depression and quality of life had most health concepts in balance. It was concluded that the worst moment for the patient is 3 months after the surgery, when they appear more fragile with difficulties of adaptation, anxiety and depression. One year after the surgery, they appear more structured and with a more balanced quality of life.AMARO T.A.C., YAZIGI L. & ERWENNE C. (2010) European Journal of Cancer Care Depression and quality of life during treatment of ocular bulb removal in individuals with uveal melanoma The objective of this study is to asses the emotional repercussions in individuals with uveal melanoma referred for surgery, during the diagnosis and preoperative, post-surgery and late post-surgery phases. The clinical qualitative assessment used the Beck Depression Inventory and the Medical Outcomes Study 36-Item Short-Form Health Survey. Twenty patients were individually assessed, 13 men and 7 women, with an average age of 52. Before surgery, patients appeared fragile and impacted by the diagnosis and treatment, showing a minimum to mild state of depression and a quality of life affected by emotional and physical concepts. Three months after surgery, the patients showed a mild to severe state of depression. This depression had an effect on the physical, vitality, emotional, mental health and social life concepts, the emotional concept being the most affected. One year after the surgery, patients presented a minimum state of depression and quality of life had most health concepts in balance. It was concluded that the worst moment for the patient is 3 months after the surgery, when they appear more fragile with difficulties of adaptation, anxiety and depression. One year after the surgery, they appear more structured and with a more balanced quality of life.

Aspectos psicológicos e qualidade de vida em pacientes com melanoma uveal durante o processo de tratamento por remoção do bulbo ocular

PURPOSE: To evaluate prospectively the emotional repercussions in the individual with uveal melanoma and surgical indication in three phases: diagnosis and preoperative, postsurgery and late postsurgery. METHODS: Clinical qualitative study based on the following instruments: STAI - State, Trait Anxiety Inventory; BDI - Beck Depression Inventory; Quality of Life Questionaire SF-36. RESULTS: The sample of this study consisted of 20 patients, 13 males and seven females, with average age of 52 years. Before surgery: the patients appear fragile and impacted by diagnosis and treatment. The state of depression indicates a minimum to light state. Anxiety has the state increased in relationship to Trait. Quality of Life has the emotional and physical aspects affected. Three months after surgery: the Depression shows to light to serious state. Anxiety has the state considerably increased. Quality of Life has most aspects affected: the physical, vitality, social, mental health and emotional aspects being the most affected. One year after surgery: the State of Anxiety decreases considerable. The Trait of Anxiety is maintained in most patients when compared to the first evaluation. Depression shows a minimum state. Quality of Life has most of its aspects balanced. CONCLUSION: After three months of surgery the patients appear more fragile with adaptation difficulty, Anxiety and Depression increasing. This period revealed to be the worst moment. One year after surgery, they appear more structured and with a more balanced Quality of Life.

Artificial eye amplitudes and characteristics in enucleated socket with porous polyethylene spherical and quad-motility implant

PURPOSE To compare artificial eye amplitudes in enucleated socket with porous polyethylene either spherical or quad-motility implant and study the characteristics of artificial eyes fit with the two orbital implants. METHODS A total of 21 patients were prospectively studied who underwent enucleation because of an intraocular melanoma and the randomization defined a porous polyethylene either spherical or quad-motility orbital implant. Measurements of the amplitude of the artificial eye were obtained with prism and digital photos. The software Scion Image analyzed the digital photos (www.scioncorp.com) and the quantitative data were allocated to groups. The measurements (height, length, thickness) and weight of the 21 artificial eyes were analyzed. Students t-test was performed to determine the significance of difference between groups (p<0.05). RESULTS There was no statistically significant difference of the artificial eye amplitude analyzed by means of prisms between both orbital implants (p>0.05 for all directions). On analyzing the digital photos, the artificial eye with spherical implant showed higher artificial eye amplitude downward (p=0.009) among patients older than 55 years old, rightward (p=0.036) and downward (p=0.008) among the 9 patients with enucleated right eye. Height and length were similar in the 21 artificial eyes but those artificial eyes fit with quad-motility orbital implants were statistically significant thicker (p<0.001) and heavier (p=0.001). CONCLUSIONS The similar amplitude of movement of artificial eyes was observed with both spherical and quad-motility orbital implants. Artificial eyes fit with quad-motility orbital implant are significantly thicker and heavier than those fit with spherical orbital implant.

Evolução da terapêutica do retinoblastoma

OBJETIVO: Mostrar a evolucao do tratamento do retinoblastoma ao longo de uma decada e suas implicacoes na sobrevida global e na preservacao da visao. METODOS: Trezentos e dezenove pacientes foram avaliados no estudo. Analisamos 257 pacientes portadores de retinoblastoma admitidos no Hospital do Câncer, entre janeiro de 1986 a dezembro de 1996, divididos em dois grupos de acordo com tratamento a que foram submetidos (1986 a 1990 e 1991 a 1996). Analisamos ainda 62 pacientes portadores de retinoblastoma intra-ocular entre janeiro de 1996 e maio de 2000 que foram submetidos a quimiorreducao, aliada a medidas oftalmologicas, sem enucleacao ou radioterapia externa. RESULTADOS: Em pacientes com doenca intra-ocular, nos dois periodos, nao houve significância estatistica com relacao a sobrevida. Analisamos 59 pacientes com retinoblastoma extra-ocular, de acordo com a classificacao do CCG (Children´s Cancer Group), e a sobrevida global em 5 anos foi maior no 2o periodo, (63,7% vs. 41%; p= 0,059). Entre 1996 e 2000 analisamos 62 pacientes com retinoblastoma intra-ocular com visao preservada, sendo 47 (75,8%) com doenca bilateral e 15 (24,2%) com tumor unilateral. Os portadores de tumor bilateral tiveram uma taxa de preservacao de visao de 49,8%, versus 26,7% para os pacientes com tumor unilateral. CONCLUSOES: Tumores intra-oculares mantem altas taxas de cura e preservacao da visao. Novas combinacoes de drogas poderao melhorar a sobrevida dos extra-oculares. Quanto as perspectivas futuras, ha pesquisas envolvendo terapia genica/molecular e terapeutica anti-angiogenese. Apesar de toda a evolucao, o diagnostico precoce e a arma mais poderosa, na cura dos portadores deste tumor.

Relationship between histopathological features of chemotherapy treated retinoblastoma and P-glycoprotein expression.

Background: P‐glycoprotein (P‐gp) has been identifiedas a possible mediator of chemoresistance in retinoblastoma. Theaim of this study was to determine the expression of P‐gp in retinoblastomatreated with chemotherapy prior to enucleation.

Achados histopatológicos em retinoblastoma

OBJETIVO: Descrever e analisar os principais achados histopatologicos no retinoblastoma com enfase na invasao de nervo optico e tunicas oculares, correlacionando-os ao tratamento realizado. METODOS: Vinte e oito olhos com diagnostico de retinoblastoma tratados por enucleacao na Universidade Federal de Sao Paulo entre dezembro de 2000 e outubro de 2002 foram submetidos a revisao histopatologica. Os dados clinicos incluiram idade, sexo, raca, lateralidade e tratamento realizado. Na revisao histopatologica foram avaliados neovascularizacao da iris e seio camerular, grau de diferenciacao do tumor e invasao do nervo optico e coroide de acordo com a classificacao de Khelfaoui. RESULTADOS: De 27 pacientes, 13 (48,1%) eram do sexo masculino e 14 (51,9%) eram do sexo feminino, 16 (59,3%) eram da raca branca, 5 (18,5%) eram da raca amarela, 4 (14,8%) eram pardos e 2 (7,4%) eram negros. A media da idade dos pacientes foi de 22,7 meses, sendo 13 casos bilaterais e 14 casos unilaterais. Com relacao ao tratamento utilizado, 13 (46,4%) olhos foram submetidos a enucleacao primaria e 15 (53,6%) tiveram tratamento previo. Na avaliacao histopatologica, 15 (53,6%) tumores eram bem diferenciados. Neovascularizacao da iris e/ou seio camerular foram observados em 60,6% e necrose e calcificacao em 89,2% dos casos. O envolvimento da coroide foi observado em 18 (64,2%) dos casos (grau II e III) e a invasao de nervo optico em 8 (28,5%) (graus II, III e IV). Dos casos submetidos ao tratamento previo 40% tinham algum grau de invasao das tunicas oculares e apenas 6,67% apresentavam simultaneamente invasao do nervo optico e das tunicas oculares. Entretanto nos olhos que foram submetidos a enucleacao primaria 30,7% apresentavam invasao das tunicas oculares e 53,8% apresentavam simultaneamente invasao do nervo optico e das tunicas oculares. CONCLUSAO: Neovascularizacao, necrose e calcificacao foram achados mais comumente observados. A invasao do nervo optico e coroide foram os dois fatores prognosticos mais importantes, encontrados em 28,5% e 64,2% dos casos respectivamente. Os casos tratados com enucleacao primaria apresentavam maior comprometimento ocular.