Abstract
Simple SummaryUveal melanomas may undergo necrosis, both spontaneously or following radiotherapy. Nowadays radiotherapy is the preferred treatment, whereas enucleation of the eye is used in selected cases. In order to differentiate the effects of radiotherapy from spontaneous degenerative changes in uveal melanomas, we compared the appearance of necrosis, both from a histopathological point of view and from the perspective of MR imaging, in two groups of patients with uveal melanoma: a group who had undergone previous proton beam radiotherapy (secondary enucleation); a control group who had undergone enucleation without any previous radiotherapy treatment (primary enucleation). Irradiated and nonirradiated uveal melanomas differ on the basis of the histological appearance, the MR imaging appearance and the distribution of necrosis. We hope that the findings we observed could be extended to all patients with uveal melanomas treated with radiotherapy, and may enhance the accuracy of radiologists in evaluating MR examinations after radiotherapy.Necrosis in uveal melanomas can be spontaneous or induced by radiotherapy. The purpose of our study was to compare the histopathologic and MRI findings of radiation-induced necrosis of a group of proton beam-irradiated uveal melanomas with those of spontaneous necrosis of a control group of patients undergoing primary enucleation. 11 uveal melanomas who had undergone proton beam radiotherapy, MRI and secondary enucleation, and a control group of 15 untreated uveal melanomas who had undergone MRI and primary enucleation were retrospectively identified. Within the irradiated and nonirradiated group, 7 and 6 eyes with histological evidence of necrosis respectively, were furtherly selected for the final analysis; the appearance of necrosis was assessed at histopathologic examination and MRI. Irradiated melanomas showed a higher degree of necrosis as compared with nonirradiated tumors. Irradiated and nonirradiated lesions differed based on the appearance and distribution of necrosis. Irradiated tumors showed large necrotic foci, sharply demarcated from the viable neoplastic tissue; nonirradiated tumors demonstrated small, distinct foci of necrosis. Radiation-induced necrosis, more pigmented than surrounding viable tumor, displayed high signal intensity on T1-weighted and low signal intensity on T2-weighted images. The hemorrhagic/coagulative necrosis, more prevalent in nonirradiated tumors (4 out of 6 vs. 1 out of 7 cases), appeared hyperintense on T2-weighted and hypointense on T1-weighted images. Our study boosts the capability to recognize radiation-induced alterations in uveal melanomas at MRI and may improve the accuracy of radiologists in the evaluation of follow-up MR examination after radiotherapy.
Highlights
Uveal tract melanoma is considered a rare neoplasm, it represents the most prevalent type of ocular melanoma and the most widespread primary intraocular malignancy among the adult population [1,2,3,4]
In the mid-80s, in one of the first reports dealing with pathologic features of uveal melanomas treated with proton beam radiotherapy, Ferry et al postulated that it was not possible histopathologically to distinguish radiation-induced necrosis from spontaneous necrosis, since many untreated melanomas exhibit areas of spontaneous necrosis [45]; on the other hand, during the following years, various authors have demonstrated that eyes with secondary enucleation after radiotherapy displayed different histological features from eyes undergoing primary enucleation [38,39]
We focused our attention on pathologic findings, MR imaging findings, and MR imaging-pathologic correlation of treated uveal melanomas in order to understand how radiations modify tumor appearance at imaging, in particular with regard to radiationinduced necrosis
Summary
Uveal tract melanoma is considered a rare neoplasm, it represents the most prevalent type of ocular melanoma and the most widespread primary intraocular malignancy among the adult population [1,2,3,4]. A variety of risk factors related to the onset of uveal melanoma have been identified: fair skin phototype, light iris, ultraviolet-B radiation exposure, melanocytic lesions both ocular or cutaneous, occupational cooking, welding [5,6,7]. From a histologic point of view, uveal melanoma can be pigmented, amelanotic or mixed [8,9]; the lesion is generally solid, though necrotic or hemorrhagic areas may occur as well. In case of tumor necrosis, pain, increased intraocular pressure and inflammatory changes of the sclera, episclera, and uvea may occur [5,11]
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