Mean Tumor Thickness Research Articles

Evaluation of peritumoral inflammatory infiltration and its relationship with different prognostic factors in cutaneous squamous cell carcinoma.

Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin cancers. Prognostic factors, such as tumor thickness, play a crucial role in the management of these patients. Peritumoral inflammatory infiltration has been shown to influence the prognosis of malignancies. This study aimed to determine different prognostic factors and investigate peritumoral inflammatory infiltration in patients with cSCC. The study population consisted of 272 patients with a diagnosis of cSCC. Clinical data, such as age and tumor location, were extracted from pathology reports, and other information was gathered by contacting the patients via phone calls. All pathology slides were reviewed by an expert dermatopathologist, and the histopathological features and prognostic factors were evaluated. The highest number of tumors was found in the scalp and forehead (21.3%), while the lowest number was found in the trunk and thighs (3.31%). The highest mean tumor thickness was observed in the group with no inflammatory cells; on the other hand, the lowest tumor thickness was found in the group of lymphocytes and plasma cells. The group with severe eosinophilic infiltration had the highest mean tumor thickness, while the group with no eosinophilic infiltration had the lowest mean tumor thickness. Depending on the type of peritumoral inflammatory cells, the prognosis of cSCC may be predictable.

Choroidal Melanoma Masquerading as Central Serous Chorioretinopathy

To determine the clinical features and outcomes of choroidal melanoma initially masquerading as central serous chorioretinopathy (CSCR). Retrospective case series. All patients with choroidal melanoma, initially misdiagnosed as CSCR elsewhere and evaluated by the Ocular Oncology Service at Wills Eye Hospital from 2004 to 2022, were included. A retrospective detailed review of patient charts and imaging was performed for all patients included in the study. Paired t tests and chi-squared tests were performed for data analysis. The primary outcome measures included clinical characteristics, ultrasonography, OCT, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. The secondaryoutcome measures included treatment results, such as the final visual acuity, tumor control, radiation-related complications, and melanoma-related metastasis and death. There were 22 patients (mean age, 48 years; 16 men) in this cohort. The mean interval between initial CSCR diagnosis and suspicion of choroidal melanoma was 50 months (median, 50 months; range, 0-242 months). At tumor diagnosis, the melanoma was submacular in 16 (73%) patients and extramacular in 6 (27%) patients. The mean tumor thickness was 3.4 mm (median, 2.5 mm; range, 1.4-10.7 mm), and the mean basal diameter was 9.2 mm (median, 8.0 mm, range, 4.5-22.0 mm). Features enabling differentiation of choroidal melanoma from CSCR (affected versus unaffected eye) included choroidal thickness asymmetry (100% > 300 μm versus 21% > 300 μm; P= 0.005), ipsilateral choroidal surface irregularity (100% versus 0%; P < 0.001), loss of choroidal vascular detail on OCT (100% versus 0%; P < 0.001), presence of multiple pinpoint leaks on angiography (100% versus 0%; P < 0.001), and contralateral lack of autofluoresence abnormalities (75% versus 6%; P= 0.001). Management of the choroidal melanoma included plaque radiotherapy (19, 86%), enucleation (2, 9%), or treatment elsewhere (1, 5%). On follow-up (mean, 6 years), vision loss of ≥ 3 Snellen lines (9 patients, 47%), metastasis (3 patients, 14%), and death (1 patient, 5%) were noted. Patients with presumed CSCR, especially if chronic, should be evaluated for a possible thin underlying choroidal melanoma with a dilated fundus examination and multimodal imaging.

RetinoblastomainAdults: Clinical Features, Gene Mutations and Treatment Outcomes: A Study of Six Cases.

PurposeTo report six Asian adult patients with retinoblastoma (RB).DesignRetrospective and observational small case series.ParticipantsSix patients with a white dome-shaped tumor of the retina were evaluated from May 10, 1995, to September 10, 2021.Main Outcome MeasuresInitial tumor and associated fundus features, pathology, gene mutation, treatment, tumor course on follow-up, and salvage globe outcome.ResultsThe six affected Asian patients consisted of three men and three women. The mean age at the time of diagnosis was 36.5 years (median: 31 years, range: 20-55 years). All patients were unilateral. In all cases, the tumors were white, dome-shaped, with full-thickness retinal involvement, and mushroom-like protrusions into the vitreous cavity. The mean tumor thickness measured by ultrasonography was 4.5 mm (median: 3.2 mm, range: 3.2-6.8 mm). Associated characteristic symptoms included dilated retinal feeding artery and draining vein (100%), surrounding subretinal infiltration (83%), exudative retinal detachment (83%), and vitreous seeds (67%). Local tumor resection was performed in three patients, I-125 plaque brachytherapy combined with transpupillary thermotherapy (TTT) and intravitreous injection of melphalan (combination treatment) in one patient, I-125 plaque brachytherapy in two patients, and enucleation in one (20%) patient. RB1 gene testing was carried out on four patients and pathological diagnosis on five patients. Genetic analysis revealed that the RB1 mutation was a mosaic c.709dupG (p.Glu237GlyfsTer4) duplication in one patient, a mosaic c.763C>T(p.Arg255Ter) mutation in another patient, while the remaining two patients were RB1 negative. At the end of the follow-up, none of the patients had developed tumor-related metastasis or died. The findings were consistent in all patients who had an adequate follow-up. This study focused on this rare lesion to distinguish it from other intraocular white lesions in adults, including choroidal osteoma, vitreoretinal lymphoma, and retinal capillary hemangioma, all of which are different clinical entities.ConclusionIn adults, RB is typically a white, full-thickness retinal mass that is unilateral, often combining with retinal feeding vessels, subretinal infiltration, and vitreous seeds. Genetic studies on adult-onset RB are essential and still require elucidation. Despite RB being a malignant tumor, patient survival was minimally affected.

Long-term results of wide local excision with concurrent venous free flap reconstruction in subungual melanoma

Purpose: Wide local excision (WLE) has been used as an alternative to amputation for preserving the length of the digit in subungual melanoma (SUM). For reconstruction, a free flap could be a more suitable option than a skin graft or a local flap. We investigated the clinical value of WLE with concurrent venous free flap reconstruction in SUM located on the finger and toe.Methods: Seventeen patients underwent WLE with a concurrent arterialized venous free flap between January 2011 and December 2015. Venous flaps were harvested from the forearm or foot dorsum and inset using a through- or against-valve type.Results: The mean tumor area was 1.3±0.9 cm2, and the mean resection margin was 5.6±2.3 mm. In histologic analyses, the mean tumor thickness was 1.2±1.1 mm. The mean duration of the follow-up period was 75.5 months. Three patients had local recurrence and one patient had distant metastasis. Reconstruction of the fingers and toes using a venous flap was effective and could be performed without major complications. Patients were satisfied with the functional and aesthetic results.Conclusion: WLE provides an acceptable local control rate and offers a safe and conservative alternative for the treatment of SUM of the fingers and toes. Concurrent venous free flaps could be a desirable option for aesthetic and functional reconstruction.

PHOTODYNAMIC THERAPY FOR THE TREATMENT OF CHOROIDAL METASTASES: A Case Series and Meta-analysis.

To investigate the efficacy and safety of photodynamic therapy (PDT) in the treatment of choroidal metastasis. We conducted a systematic review of all reported cases of choroidal metastases treated with PDT in literature, and included the cases from our institution, for a comprehensive meta-analysis. We identified 52 tumors in 40 eyes of 34 patients. The mean age was 60 years (range 28-77). The mean tumor thickness was 1.9 mm (range 0-4.8 mm), whereas the mean largest basal diameter was 8.2 mm (range 1.5-30 mm) on presentation. After an average of 1.4 treatment visit, PDT resulted in decreased tumor thickness (mean 1.9 mm before vs. 1.0 mm after PDT, P < 0.0001) and decreased central macular thickness (mean 454 µm before vs. 289 µm after PDT, P = 0.03). After PDT, 82% of tumors had reduced thickness, and subretinal fluid resolved in 75% of eyes. Photodynamic therapy also resulted in stable or improved vision in 78% of treated eyes (logMAR 0.50 before vs. 0.56 after PDT, P = 0.54). No adverse events were reported, and PDT was effective in treating the most common choroidal metastases (tumor control rate of 94% in 16 lung adenocarcinoma and 92% in 26 breast carcinoma metastasis cases). Photodynamic therapy is effective at controlling tumors and preserving vision in patients with some choroidal metastases. Because of its minimal time commitment and good safety profile, PDT should be considered as a potential first-line treatment for small choroidal metastases.

DOUBLE FLUENCE PHOTODYNAMIC THERAPY FOR THE TREATMENT OF CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

To evaluate the efficacy and safety of double-fluence photodynamic therapy for the treatment of circumscribed choroidal hemangioma. Retrospective observational study including patients affected by circumscribed choroidal hemangioma and treated with double-fluence photodynamic therapy. The photodynamic therapy was performed with verteporfin infusion intravenously (dose of 6 mg/m2 body surface area over 10 minutes), followed by the application of two consecutive spots of 50 J/cm2 light at 689 nm for 83 seconds. Twenty-three eyes of 23 patients were included. The mean best-corrected visual acuity increased from 20/45 to 20/28, the mean tumor thickness decreased from 2,758 ± 530 µm to 722 ± 314 µm (P < 0.05), and the mean central retinal thickness decreased from 404 ± 209 µm to 188 ± 56 µm (P < 0.05) in 12 months, respectively. A total reabsorption of macular subretinal fluid, cystoid macular edema, and SRF associated with the tumor was obtained within 6 months in all cases, with persistence of tumor-associated intraretinal fluid up to 12 months only in two patients. No cases of side effects or need for retreatment were reported during the follow-up (average time of 25 months). Double-fluence photodynamic therapy is a safe and effective treatment for circumscribed choroidal hemangiomas and should be considered as the first line of treatment for these lesions.

Digital melanoma in Caucasians: a descriptive and survival study according to sublocation.

Digital melanoma is an uncommon form of acral melanoma that is anatomically restricted to the finger. The aim of this study is to provide specific epidemiological and clinical information about this subtype of melanoma, as well as to identify differences in recurrence and survival depending on the anatomical sublocation. We describe a group of 45 Caucasian patients with digital melanoma divided into three groups: nail unit melanoma (group A), finger skin melanoma (group B), and those melanomas that involve both nail and adjacent skin (group C). The mean tumor thickness was 4.66 mm, and the most common histological subtype is acral lentiginous melanoma. Group C was more frequent in older men and was thicker and more frequently ulcerated (P < 0.05). In addition, patients in group C developed distant metastases more frequently and had a significantly lower median disease-free survival (26.60 months) compared with group A (69.47 months) and group B (89.81 months) (P < 0.05). According to our results, digital melanoma limited to nail apparatus or finger skin was associated with a better prognosis, while those affecting both nail apparatus and skin showed lower melanoma-specific survival.

Metastatic tumours to the eye. Review of metastasis to the iris, ciliary body, choroid, retina, optic disc, vitreous, and/or lens capsule.

Metastasis to the eye can involve the choroid (90%), ciliary body (2%), iris (8%), and retina, optic disc, vitreous, and/or lens capsule (<1-4%). The mean number of uveal metastasis per eye (1.7), mean tumour base (11.6 mm) and thickness (3.2 mm), tumour colour (86% yellow), and presence of subretinal fluid (72%), are all clinical features suggestive of the diagnosis. Imaging with ultrasonography demonstrates an echodense mass (80%) and optical coherence tomography shows a "lumpy bumpy" choroidal surface (64%), both important diagnostic features. Uveal metastases typically emanate from primary cancer of the breast (37%), lung (27%), kidney (4%), gastrointestinal tract (4%), cutaneous melanoma (2%), lung carcinoid (2%), prostate (2%), thyroid (1%), pancreas (1%), and other sites (3%). Occasionally, fine needle aspiration biopsy is employed if the primary site is not known. In 16% of cases, the primary site remains unknown. Rarely, metastases affect the retina, vitreous, and lens capsule, most often originating from cutaneous melanoma and in patients previously treated with checkpoint inhibitor therapy. Kaplan-Meier analysis in a series of 1111 patients with uveal metastasis revealed 32% survival at 3 years and 24% at 5 years. Patients with uveal metastasis from carcinoid tumour showed most favourable survival at 5-years (92%), whereas pancreatic and kidney cancer demonstrated least favourable survival (0%). The 5-year survival was better for females (versus (vs.) males) (31% vs. 21%) and older adults (vs. children) (40% vs. 0%). In this review, we examine several large-cohort publications on the topic of ocular metastasis.

Secondary endoresection for previously treated choroidal melanomas with a non-responsive course and persistent exudative retinal detachment

To evaluate the results and complications of secondary endoresection via pars plana vitrectomy for choroidal melanoma and review the previously reported endoresection studies on the treatment of choroidal melanoma. The medical records of 6 patients with choroidal melanoma who underwent secondary endoresection between March 2012 and March 2020 were retrospectively reviewed. The indications for secondary endoresection were progressive or recurrent tumor and severe exudative retinal detachment after previous treatment with plaque radiotherapy/Cyberknife radiosurgery/transpupillary thermotherapy (TTT). Before endoresection, 2 eyes had Iodine-125 plaque radiotherapy and TTT, 1 eye had Ruthenium-106 plaque radiotherapy and TTT, 1 eye had Cyberknife radiosurgery and TTT, 1 eye had Cyberknife radiosurgery, and 1 eye had TTT only. Preoperative visual acuity ranged from 20/63 to 20/1600 (Snellen) and from 0.5 to 1.9 (mean: 1.1) on the logMAR scale. The mean tumor base diameters were 9.5×8.7 mm and the mean tumor thickness was 5.4 mm. After secondary endoresection, transient vitreous hemorrhage developed in 2 (33.3%) eyes and retinal detachment in 1 (16.7%) eye. Cytopathological examination revealed epithelioid cell melanoma in 4 (66.7%) eyes and mixed cell melanoma in 1 (16.7%). Melanoma cell type was not specified in 1 (16.7%) eye. At a mean follow-up of 49.6mo (range: 16-90mo), mean visual acuity did not improve and 1 eye was enucleated due to tumor recurrence. Final visual acuity ranged from 20/63 to 20/1600 (Snellen) and from 0.5 to 1.9 (mean: 1.2) on the logMAR scale. Two patients with choroidal melanoma developed metastasis and eventually expired. Secondary endoresection seems to be an effective treatment option for globe salvage in choroidal melanoma not responsive to conventional treatment and displaying persistent exudative retinal detachment. There was no visual acuity increase among the treated eyes but globe salvage was possible in most cases in this study.

Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy.

Uveal melanoma is the most common primary intraocular malignancy. The aim of this retrospective study was to report the results after ruthenium-106 (Ru-106) plaque brachytherapy for uveal melanoma in terms of tumor control, visual acuity, radiation-related complications, tumor recurrence, metastases, and patients’ survival rate during 4 years’ follow-up. A total of 355 eyes from 355 patients have been treated with Ru-106 plaque brachytherapy for uveal melanoma between February 2011 and March 2020. Five patients were lost to follow-up, and then 350 eyes of 350 patients (mean age 58 ± 11 years) were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination including echography and spectral domain–optical coherence tomography. The mean follow-up was 4 years (3 months to 9 years). After treatment, the mean tumor thickness was reduced to 1.75 ± 0.21 mm. Radiation complications were found in 63% of patients: 38% showed radiation maculopathy, 11% had optic neuropathy, and 14% developed cataracts. Cancer-free survival was 99%, 97%, and 85%, respectively, at 5, 7, and 9 years. Ru-106 plaque brachytherapy represents a reliable treatment of uveal melanoma. This technique is valid and safe with a low rate of ocular complications during a long-term follow-up.

BRAF, NRAS, KIT, TERT, GNAQ/GNA11 Mutation Profile and Histomorphological Analysis of Anorectal Melanomas: A Clinicopathologic Study.

Primary anorectal melanomas (AMs) are uncommon neoplasms with aggressive behavior. Molecular profile and clinicopathologic features of AMs are still not well established. In this study, we aimed to investigate BRAF, NRAS, KIT, TERT, and GNAQ/GNA11 mutation status and clinicopathologic features of AMs. All diagnostic slides of 15 AMs were reviewed. Histopathological and follow-up information were documented. Mutations in exon 15 of the BRAF gene; exons 2 and 3 of the NRAS gene; exons 9, 11, 13, 17, and 18 of the KIT gene; and exons 4 and 5 of the GNAQ/GNA11 genes and mutations in the promoter region of the TERT gene (chr.5, 1,295,228C > T and 1,295,250C > T) were analyzed. BRAF(V600E) and KIT(V555I and K642E) mutations were observed in one (7%) and two cases (14%), respectively. NRAS, TERT and GNAQ/GNA11 mutations were not detected. The mean age was 65. Patients presented with rectal mass, rectal bleeding, pain, and weight loss. 73% of the lesions were macroscopically polypoid. The most common tumor cell type was epithelioid. Mean tumor thickness was 10.4 mm. One third of the cases lacked pigmentation. In situ melanoma was present in one third of the cases. Among 14 patients with follow-up data, 12 succumbed to disease. The mean overall survival was 36 months. AMs are uncommon tumors with dismal survival, usually occurring in the elderly in various gross and microscopic appearances. In terms of molecular profile, BRAF and KIT mutations are rarely detected. Profiling of larger cohorts is required to elucidate the pathogenesis and to identify potential molecular indicators that may contribute to the development of individualized targeted therapies.

Preoperative determination of tumor thickness in oral squamous cell carcinoma by computed tomography

Introduction. Evaluation of the prognostic factors and the survival rate in oral squamous cell carcinoma is extremely important, because patients in the same tumor-node-metastasis stage may have a different survival rate. Numerous studies have been conducted on various clinical and pathological prognostic factors in order to develop a prognostic model for the survival rate of patients with oral cancer. Material and Methods. The study was designed as a prospective study including 65 consecutive patients (n = 65) of both sexes who underwent surgical treatment of oral cancer. The diagnosis of oral cancer was based on the medical history, physical examination, and biopsy. The clinical tumor-node-metastasis staging was determined based on clinical examination. The radiological tumor-node-metastasis staging was done by computed tomography of the head, neck, and chest. The tumor thickness was determined by computed tomography and histopathological analysis of surgical specimens. Results. The histopathological analysis showed a mean tumor thickness of 13.446 mm, while the mean computed tomography tumor thickness was 15.2707 mm. The correlation between computed tomography tumor thickness and histopathological tumor thickness was moderately significant (Spearman?s rho = .581, p = 0.000). Conclusion. This study supports the use of computed tomography in the determination of tumor thickness in patients with oral squamous cell carcinoma. We want to emphasize the importance of preoperative, detailed imaging evaluation of patients in order to avoid multiple surgical procedures, significant morbidity, and unnecessary costs.

Frameless Multisession Radiosurgery for Symptomatic Circumscribed Choroidal Hemangioma

<h3>Purpose/Objective(s)</h3> Choroidal hemangioma (CH) is a benign vascular tumor that induces exudative retinal detachment and consequent visual symptoms. Current standard treatments for CH include cryotherapy, diathermy, photocoagulation, PDT, transpupillary thermotherapy, and Radiation. SRS is preferred in the treatment of CH because of its characteristic stiff dose-fall-off and accuracy. Current retrospective study evaluated tumor volume reductions and improvements to visual acuity following multisession Radiosurgery in the treatment of symptomatic circumscribed choroidal hemangioma. <h3>Materials/Methods</h3> Study comprised of Thirteen patients with symptomatic circumscribed CHs diagnosed between August 2012 to December 2019 (8 Male & 5 female). 3 pts. had Sturge-Weber syndrome. All patients underwent frameless SRS following retrobulbar block, Thermoplastic immobilization & Imaging (CT & MRI). A total of 15-18gy / 3 frcs was planned using a 5mm collimator, prescribed to 90% isodose and treatment delivered on a frameless robotic radiosurgery system with skull tracking or C arm Linac equipped with hexapod robotics. Best corrected visual acuity, funduscopic findings, basal tumor diameter and tumor thickness were recorded at baseline and at follow-up visits every 6 -month intervals. <h3>Results</h3> The mean age of patients was 33 years (range: 12-61 years) and the mean duration of clinical or radiological follow-up was 33 months (range: 16-80 months). The mean volume, Basal diameter, tumor height & tumor thickness at baseline were 533.5 mm³ (range: 124-1150 mm³); 8 mm (range: 5-12mm, ± 2.3); 2.8mm (range, 2.0 - 4.5mm); tumor thickness was 5.1 (range: 3.0-11.0, ± 2.7) mm respectively. 6 tumors were subfoveolar, 4 were juxtafoveolar, and 3 were extrafoveolar. Exudative retinal detachment resolved within a median of 5.5 months (response rate, 100%; 95% CI, 48%-100%). Median best-corrected visual acuity was 20/50 (range, 20/22-20/90) at diagnosis and 20/25 (range, 20/20-20/60) 18 months after treatment. The visual acuity of the affected eye had improved at the latest follow-up examination (<i>P</i> = .018) in all patients. Tumor height had decreased a median of 32% (range, 10-40%) by 6 months and 41% (range, 17%-59%) by 20 months. No recurrence of exudative RD occurred. Thinning of the CHs was observed in most patients; however, symptomatic radiation toxicity had not developed in any of the patients. <h3>Conclusion</h3> Multisession radiosurgery could be an acceptable alternative treatment for symptomatic circumscribed CH with resolution of exudative RD being achieved within 5-6mo.

Transpupillary laser thermotherapy of retinoblastoma

Introduction. Despite the fact that transpupillary thermotherapy (TTT) is one of the main local methods of small retinoblastoma (RB) destruction, only a few studies have been published on the use of this method, and they are devoted only to certain aspects of the application of TTT.Purpose of the study – to evaluate the effectiveness of TTT in the treatment of children with RB.Material and methods. In the period from 2011 to 2020, 177 children (224 eyes, 1156 tumors) with RB were treated by TTT. Of these, 99 (56 %) patients were boys, 78 (44 %) – girls. The mean age at the time of treatment was 16.8 months (from 0 to 86 months). Bilateral RB was observed in 128 (72.3 %) patients, monolateral – in 49 (27.7 %). In 51 (28.8 %) cases, TTT was performed on an only eye. TTT was performed on eyes that had RB of groups A (n = 43; 19 %), B (n = 81; 36 %), C (n = 31; 14 %), D (n = 63; 28 %), E (n = 6; 3 %). In total, 1156 tumors were treated by TTT. 488 (42 %) tumors were localized post-equatorially (of which 27 were located juxtapapillary, 23 – in the macular zone, 22 – paramacular). 668 (58 %) foci had pre-equatorial localization (on the middle and far periphery of the fundus). The number of foci in one eye varied from 1 to 48 (mean – 5). The mean tumor thickness was 1.1 mm (from 0.2 to 4.5), the mean base diameter was 2.2 mm (from 0.3 to 13.4). TTT was performed using a diode laser with the following parameters: wavelength – 810 nm, spot diameter – 1200 microns, power from 200 to 800 mW (mean – 350 mW), exposure-from 3 to 15 s in the application mode, and continuous in the scanning mode.Results. Complete tumor regression after TTT was achieved in 92 % of cases (1064 tumors). Incomplete regression of the tumor with stabilization was achieved in 0.7 % (8 tumors). The average number of TTT sessions to achieve full regression was 1.7 (from 1 to 10). Complete tumor regression after 1 TTT session was achieved in 54 % of cases (622 tumors), after 2 sessions – in 11 % (132 tumors), after 3 sessions – in 7 % (85 tumors), after 4 or more sessions– in 19 % (225 tumors). In 7 % of cases (82 tumors), due to the progression of the tumor, other treatment methods (brachytherapy, cryotherapy, stereotactic radiosurgery) were applied. 209 (93 %) eyes were preserved. 15 (7 %) eyes were enucleated due to continued tumor growth, total retinal detachment, vitreous hemorrhage, or subatrophy of the eyeball. The mean follow-up after TTT was 35.5 months (from 3 to 112 months).Conclusion. TTT is a highly effective method of RB treatment and can be used for destruction of small primary foci of both post-equatorial and pre-equatorial localization, residual tumors after inefficiency of other local methods. TTT is also effective in the treatment of large cavitary tumors located in functionally significant areas of the retina.

Effect of photodynamic therapy with verteporfin on tumor thickness and best corrected visual acuity in patients with circumscribed choroidal hemangioma: a single-center experience.

The management of circumscribed choroidal hemangioma (CCH) with photodynamic therapy (PDT) using verteporfin has resulted in significant functional and clinical improvement compared with the pre-PDT era. Literature data on factors influencing clinical outcomes and predictors of response to PDT in symptomatic CCH are inconsistent. The aim of this study was to investigate the efficacy of PDT with verteporfin in patients with CCH depending on symptom duration and tumor thickness at baseline. We analyzed the medical records of 37 patients with symptomatic CCH divided into 3 groups according to symptom duration (≤ 50 weeks, 51 - 100 weeks, and > 100 weeks) and into 2 groups according to tumor thickness (≤ 2.3 mm and > 2.3 mm). Patients were subjected to PDT with verteporfin at a concentration of 6 mg/m2 body surface area and a light dose of 50 J/cm2 at a wavelength of 689 nm. The mean number of treatment sessions was 1.57 (range, 1 - 3). Tumor thickness, the transverse and longitudinal diameters of the tumor base, and best corrected visual acuity (BCVA) were evaluated at baseline and at 12 - 15 months after treatment. After PDT, the mean tumor thickness in the whole study group decreased by 1.19 ± 0.66 mm (from 3.14 mm to 1.95 mm). Subgroup analyses revealed no significant differences between the 2 groups divided according to tumor thickness (p = 0.49). However, tumor thickness differed significantly between the 3 groups divided according to symptom duration (p < 0.05). BCVA increased in 22 patients (59.5%), remained unchanged in 12 patients (16.2%), and decreased in 3 patients (10.1%). Our study provides evidence for the efficacy of PDT with verteporfin in terms of improving or stabilizing visual function as well as reducing tumor thickness in patients with CCH, including those with long-lasting disease.

The correlation between tumor thickness and aggressive histopathological pattern in Basal cell carcinoma

The significance of tumor thickness is not clear in the prognosis of basal cell carcinoma. We aimed to identify the relationship between the tumor thickness and aggressive histopathological growth pattern in BCC. We retrospectively reviewed 85 primary BCCs of 82 patients. A total of 78 (91.7%) tumor slides were available for review, 7 (8.2%) missing slides in archive could not to be re-evaluated. We recorded the histological subtype, ulceration, perineural invasion, and the tumor thickness. Tumors with infiltrative, micronodular, morpheaform and basosquamous features were classified as having an aggressive growth pattern. The aggressive growth pattern was determined in 21 (26.9%) tumors with a mean tumor thickness of 2.19±0.71mm (range, 0.9-3.40). The non-aggressive growth pattern was detected in 57 (73%) tumors and the mean tumor thickness was 1.76±0.87mm (range 0.50-4.40mm). There was a statistically significant difference in the mean tumor thickness between the tumors with aggressive growth pattern and non-aggressive growth pattern (p=0.033). Tumor thickness might have positive correlation with aggressive histological pattern. Measuring and reporting tumor thickness may be a more practical way to determine the pathological risk for BCC.

Novel Guarded Needle Trans-Scleral Biopsy for Uveal Melanoma: A Pilot Study

Introduction: Trans-scleral biopsy of uveal melanoma (UM) poses an inherent risk of tumor and possibly retinal perforation. We describe a novel technique for trans-scleral biopsy of UM and evaluate its safety and efficacy in an initial cohort of patients. Methods: A retrospective, consecutive observational case series was conducted from October 14, 2019, to April 15, 2020, at Kaiser Permanente, San Francisco, CA among patients with UM of the ciliary body or anterior choroid undergoing trans-scleral fine-needle aspiration biopsy using a novel guarded needle technique. Results: A total of 6 patients were included in the study, with a mean age of 64.3 (range 35–77) years (5 women 83%). Mean (±SD) tumor thickness and maximal basal diameter were 6.4 (±2.66) and 11.9 (±2.13) mm, respectively. Five out of 6 patients achieved a successful biopsy with reliable gene expression profiling (GEP) results. The only failure to obtain specimen occurred in the first attempted patient and, after a minor technique modification, all subsequent biopsies were successful. No intraoperative or short-term postoperative complications were observed in any patient. Conclusion: This novel trans-scleral biopsy technique appears to be safe and effective when obtaining UM tissue for GEP. This method may provide a more controlled biopsy depth thereby minimizing the risk of tumor perforation and its associated complications while still obtaining adequate biopsy yield.

Partial lamellar sclerouvectomy surgery for anteriorly located uveal tumour resection: a 20-year experience.

To investigate the results of partial lamellar sclerouvectomy (PLSU) for anteriorly located uveal tumours. We reviewed the tumour features, histopathologic findings, complications, visual acuity outcomes, eye preservation, metastasis, and mortality data of 56 cases with uveal tumours who underwent PLSU between February 1999 and February 2019. The mean largest tumour base diameters were 5.8 × 3.4 mm and the mean tumour thickness was 3.3 mm. Histopathologically, 30 (53.6%) eyes had malignant melanoma, 13 (23.2%) had nevus, 5 (8.9%) had iris stromal cyst, 4 (7.1%) had melanocytoma, 2 (3.6%) had Fuchs' adenoma, 1 (1.8%) had iris pigment epithelial cyst, and 1 (1.8%) had invasive breast cancer metastasis. The most common postoperative complications included cataract in 21 (37.5%) eyes, vitreous haemorrhage in 15 (26.8%), scleral thinning in 10 (17.9%), and hyphema in 6 (10.7%). At a mean follow-up of 40.4 (range: 10-201) months, tumour recurrence was observed in 2/30 (6.7%) eyes with melanoma and 1/5 (20.0%) eye with iris stromal cyst. Eyes with recurrent melanoma were treated with enucleation. Liver metastasis developed in only 1 (3.3%) melanoma case. All patients were alive at the end of follow-up. PLSU is a successful treatment method for many anteriorly located uveal tumours. In our series, the overall tumour recurrence and globe salvage rates were 5.4% and 96.4% respectively. Among melanoma cases, the metastasis rate was 3.3% and survival rate was 100%.

Relationship between Thickness of Early Oral Tongue Carcinoma (T1, T2) with Cervical Lymph Node Metastasis

Background: Carcinoma of oral tongue is the most common oral cancer and because of its structure and function is prone for early local and regional spread of cancer. The final outcome of a primary tongue carcinoma patient depends upon various prognostic factors like thickness of tumor, depth of invasion, size of lesion and neck node 67metastasis. Risk of metastasis and spread to neck nodes increases with increase in tumor thickness&#x0D; Methods: This prospective observational study was carried out in the Department of Otolayngology- Head &amp; Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months. Thirty patients with early oral tongue carcinoma i.e.T1 &amp; T2 as per UICC and AJC criteria were included in this study by purposive non-randomized sampling technique. Result of the study were expressed as mean, standard deviation (+SD), frequency and percentages. Unpaired Student’s t-test and Pearson’s correlation co-efficient (r) test were performed.&#x0D; Results: Result of the study showed the mean (+SD) thickness of the tumor was 3.62 (+1.46) mm. Minimum thickness 1.1mm and maximum thickness 7.8mm. Only 21 (70%) subjects neck node were metastasized from tongue and mean (+SD) tumor thickness of the positive neck node metastasis was 5.54 (+1.07) mm and negative neck node metastasis was 2.87 (+0.75) mm. This indicated a significant difference between the groups. Pearson’s correlation co-efficient r (+0.981) which indicated tumor thickness was positively correlated with neck node metastasis.&#x0D; Conclusion: Tumor thickness of the early oral carcinoma positively correlated with neck node metastasis. Correlation between thickness and metastatic lymph node can help planning the treatment regimen and indicate the disease prognosis.&#x0D; Bangladesh J Otorhinolaryngol; April 2021; 27(1): 25-35

Transretinal biopsy via 23-gauge pars plana vitrectomy for retinal and choroidal tumors: cytopathological results, surgical complications, and patient outcomes.

To evaluate the cytopathological results, surgical complications, and patient outcomes after transretinal biopsy (TRB) for diagnosis of retinal/choroidal tumors METHODS: Records of40cases who underwent TRB via 23-gauge (23 G) pars plana vitrectomy between March 2011 and March 2020 were reviewed. Retrospective. Twenty-six (65.0%) cases were women and 14 (35.0%) were men. The mean age at diagnosis was 57.2 (range: 18-83) years. The mean tumor base diameter was 12.0×9.8mm and the mean tumor thickness was 4.9mm. According to cytopathological examination, 29 (72.5%) cases had choroidal melanoma, 2 (5.0%) had non-small cell lung cancer metastasis, 1 (2.5%) had adenoma of retinal pigment epithelium, 1 (2.5%) had small cell lung cancer metastasis, 1 (2.5%) had invasive breast cancer metastasis, 1 (2.5%) had retinal astrocytic hamartoma, and 1 (2.5%) had pseudoneoplastic gliosis. Cytopathological examination of 4 (10.0%) cases revealed findings consistent with macular and extramacular degeneration. Postoperative complications were mild vitreous hemorrhage in 16 (40.0%) cases,gradually worsening cataract in 4 (11.8%), retinal detachment in 1 (2.5%), hyphema in 1 (2.5%), glaucoma in 1 (2.5%), and macular hole in 1 (2.5%). During the mean 11.1 (range: 1-55) months follow-up, 1 (3.4%) patient with choroidal melanoma developed liver metastasis. All patients were alive at the end of follow-up. TRB using 23 G pars plana vitrectomycan be used to make the cytopathologic diagnosis of retinal/choroidal tumors whenever the clinicaldiagnosis is not certain or in cases with known diagnosis to obtain information on cell type/cytogenetics. In our series, the most common diagnosis after cytopathologic examination was choroidal melanoma.