Vasoproliferative Tumor Research Articles

Dramatic Regression of Amelanotic Choroidal Melanoma With PDT Following Poor Response to Brachytherapy

Photodynamic therapy (PDT) has been used for treatment of choroidal neovascular membrane from exudative macular degeneration. Other applications include treatment of some intraocular tumors, such as choroidal hemangioma, vasoproliferative tumor, and choroidal osteoma. The authors report the effect of PDT for amelanotic choroidal melanoma. A 40-year-old woman with an amelanotic choroidal melanoma of 6.5 mm thickness showed poor response to iodine brachytherapy (80 Gy apical dose) with no reduction in thickness at 16 months of follow-up. There was prominent residual tumor. The amelanotic tumor was treated with verteporfin PDT using three overlapping spots (8,600 microns), with avoidance of the optic disc using standard treatment parameters. Dramatic tumor regression over 2 months to a completely flat scar (1.3 mm thickness) was documented and remained stable at 50 months of follow-up. Amelanotic choroidal melanoma with incomplete response following conventional plaque radiotherapy can be treated with verteporfin PDT for consolidation.

Vascular Endothelium and Vector Borne Pathogen Interactions

The endothelium is the thin layer of cells that lines the lumen of blood and lymphatic vessels. Endothelial cells (ECs) from different locations have distinct and characteristic expression patterns that persist during in vitro culture. Although gene expression patterns in cultured cells clearly reveal the molecular heterogeneity of these ECs, their corelation with their in vivo counterparts remains to be defined. Situated at the interface between blood and tissues, the endothelium plays a central role for critical functions and represents a physical barrier for both blood-borne pathogens and immune cells, which must cross this barrier for trafficking between the bloodstream and tissues. Endothelial cells are target cells for several infectious agents, including Anaplasma, Bartonella, Orientia and Rickettsia. The lack of appropriate spontaneous or experimentally-induced animal models is a serious limitation for the study of pathogen-ECs interactions and is the major justification for the use of ECs cultures. Bartonella adherence to ECs is mediated by type-IV like pili and some outer membrane proteins. Some differences exist among Bartonella species adherence mechanisms. ECs are invaded either by an endocytic uptake or by engulfment of Bartonella. The activation of ECs by chronic inflammation and direct or indirect action of some Bartonella species leads to proliferation, angiogenesis and vasoproliferative tumor growth. Interactions between Anaplasma, Orientia, Rickettsia and ECs are less documented than Bartonella but differ significantly from the mechanisms described for Bartonella. At the least, they do not induce vasoproliferation. This review summarizes our understanding of the diversity of ECs, the vector borne bacterium-ECs interactions and the mechanisms of bacterial virulence and persistence.

Bartonella vinsonii subsp. berkhoffii and Bartonella henselae as potential causes of proliferative vascular diseases in animals

Bartonella species are highly fastidious, vector borne, zoonotic bacteria that cause persistent intraerythrocytic bacteremia and endotheliotropic infection in reservoir and incidental hosts. Based upon prior in vitro research, three Bartonella sp., B. bacilliformis, B. henselae, and B. quintana can induce proliferation of endothelial cells, and each species has been associated with in vivo formation of vasoproliferative tumors in human patients. In this study, we report the molecular detection of B. vinsonii subsp. berkhoffii, B. henselae, B. koehlerae, or DNA of two of these Bartonella species simultaneously in vasoproliferative hemangiopericytomas from a dog, a horse, and a red wolf and in systemic reactive angioendotheliomatosis lesions from cats and a steer. In addition, we provide documentation that B. vinsonii subsp. berkhoffii infections induce activation of hypoxia inducible factor-1 and production of vascular endothelial growth factor, thereby providing mechanistic evidence as to how these bacteria could contribute to the development of vasoproliferative lesions. Based upon these results, we suggest that a fourth species, B. vinsonii subsp. berkhoffii, should be added to the list of bartonellae that can induce vasoproliferative lesions and that infection with one or more Bartonella sp. may contribute to the pathogenesis of systemic reactive angioendotheliomatosis and hemangiopericytomas in animals.

Retinal vasoproliferative tumors in ocular conditions of childhood

Retinal vasoproliferative tumor (RVPT) is a vascular mass with exudative retinopathy and minimally dilated feeder vessels. This type of tumor can occur as a primary or secondary condition. Our purpose was to describe secondary vasoproliferative tumors from ocular conditions in childhood. The clinical records and fundus photographs of patients with secondary RVPTs were reviewed and a detailed literature search was conducted to identify reported cases of secondary RVPTs. This information was used to compile a list of ocular and nonocular childhood conditions associated with development of RVPTs. The ocular conditions related to vasoproliferative tumors in children include intermediate uveitis, retinitis pigmentosa, ocular toxocariasis, Coats disease, neurofibromatosis, retinal toxoplasmosis, retinopathy of prematurity, familial exudative vitreoretinopathy, and other rare conditions. Several pediatric ocular conditions can ultimately lead to retinal vasoproliferative tumor.

Episcleral plaque brachytherapy using ′BARC I-125 Ocu-Prosta seeds′ in the treatment of intraocular tumors: A single-institution experience in India

Context:To analyze the results of episcleral plaque brachytherapy using indigenous Bhabha Atomic Research Centre (BARC) Iodine-125 Ocu-Prosta seeds for the management of intraocular tumors from a single institute.AIM:To report our initial experience and learning curve on the use of ‘BARC I-125 Ocu-Prosta seeds’ for the management of intraocular tumors such as choroidal melanomas, retinoblastomas and vasoproliferative tumors (VPT).Materials and Methods:We retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between May 2008 to March 2012. Nine cases had choroidal melanomas; three had retinoblastomas while one case had VPT.Results:For choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm, respectively, which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow-up of 24 months (range 10-43 months). Retinoblastoma and VPT also showed good regression after brachytherapy.Conclusion:Plaque radiotherapy using 125I seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. Patients in our studies experienced excellent local tumor control. With the availability of indigenous ‘BARC I-125 Ocu-Prosta seeds’ locally, cost effective ophthalmic brachytherapy can be performed in India.

Retinal vasoproliferative tumor with total retinal detachment managed with plaque radiotherapy

Retinal vasoproliferative tumor with total retinal detachment managed with plaque radiotherapy

Bartonella Species Bacteremia in Two Patients with Epithelioid Hemangioendothelioma

Bartonella henselae and B. koehlerae bacteremia was documented in two epithelioid hemangioendothelioma patients and B. koehlerae bacteremia in an asymptomatic partner of one of the patients. Considering the biology and clinically variable natural history of epithelioid hemangioendothelioma, these results suggest that chronic Bartonella infection could have a role in the development of this vascular neoplasm. Bartonella spp. are known to induce vasoproliferative tumors in immunocompromised patients and may play a role in the development of epithelioid hemangioendothelioma in immunocompetent patients.

Acquired Vasoproliferative Retinal Tumor: A Late Sequela of Retinopathy of Prematurity

Acquired Vasoproliferative Retinal Tumor: A Late Sequela of Retinopathy of Prematurity

Ultrasound diagnosis in vasoproliferative tumours of the ocular fundus

ObjectiveThe aim of this work is to describe the ultrasound features in vasoproliferative tumors of the ocular fundus (VPTOF). MethodsThe medical records corresponding to eight patients were retrospectively studied. Clinical data from the complete ophthalmologic examination and ultrasonographic findings were analyzed. ResultsNodular masses affecting either the retina or both the retina and the choroid were found. The surface contour of the tumor was regular in 5, and irregular in 3 cases. In terms of dimensions (mm/SD), the average major base was 7.14/2.56; the minor base was 6.74/2.48 and the height was 2.38/1.26. Internal structure was always solid and irregular, and reflectivity was mostly medium–high in 6 eyes. Angle kappa was not present in any case. No vascularity signs were detected. ConclusionAccording to the results it is suggested that when a differential diagnosis of VPTOF is carried out, not only should ophthalmoscopic signs be studied, but an ultrasound examination should also be done.

Diagnóstico ecográfico de los tumores vasoproliferativos del fondo de ojo

Objective The aim of this work is to describe the ultrasound features in vasoproliferative tumours of the ocular fundus (VPTOF). Methods The medical records corresponding to eight patients were retrospectively studied. Clinical data from the complete ophthalmologic examination and ultrasonographic findings were analysed. Results Nodular masses affecting either the retina or both the retina and the choroid were found. The surface contour of the tumour was regular in 5, and irregular in 3 cases. In terms of dimensions (mm/ SD), the average major base was 7.14/2.56; the minor base 6.74/2.48 and the height 2.38/1.26. Internal structure was always solid and irregular and reflectivity was mostly medium to high in 6 eyes. Angle kappa was not present in any case. No vascularity signs were detected. Conclusion According to the results it is suggested that when a differential diagnosis of VPTOF is carried out, not only should ophthalmoscopic signs be studied, but an ultrasound examination should also be done.

Management of Retinal Vasoproliferative Tumor Associated with ROP by Plaque Brachytherapy

The authors report a secondary exudative vasoproliferative tumor of the retina associated with retinopathy of prematurity, managed by plaque radiotherapy. A 15-year-old girl with a history of mild, stable retinopathy of prematurity in both eyes noted progressively reduced visual acuity to hand motions in the left eye. Examination disclosed a vasoproliferative tumor of 10-mm base and 3.5-mm thickness with near total (macula-off) exudative retinal detachment. She was treated with iodine-125 plaque radiotherapy, giving apex dose of 40 Gy over 4 days. The tumor regressed to 1.9 mm and retinal detachment resolved 8 months following therapy. Epiretinal membrane with significant macular pucker and edema later developed and was managed with pars plana vitrectomy and membrane peeling. Visual acuity was counting fingers due to photoreceptor loss. Retinopathy of prematurity is a rare cause of vasoproliferative tumor. Iodine-125 plaque radiotherapy can lead to tumor regression and reattachment of the retina in such cases.

The expanding spectrum of retinal vasoproliferative tumors in children

The expanding spectrum of retinal vasoproliferative tumors in children

Vasoproliferative retinale Tumoren

Vasoproliferative retinal tumors are benign tumors of unknown origin often accompanied by vitreoretinal inflammation. A 21-year-old female patient presented with acute reduced unilateral visual acuity. A solid yellow vascularized lesion was present in the inferior temporal retina accompanied by localized retinal detachment and accumulation of hard exudations. The only finding was an increased Bartonella henselae titer. Persistence of uveitis and blurred vision led to therapy for Bartonella henselae with macrolide antibiotics and successful tumor regression was achieved by cryotherapy.

Pars Plana Vitrectomy and Endoresection of a Retinal Vasoproliferative Tumor

A healthy 31-year-old woman developed decreased vision due to vitreous hemorrhage from 2 retinal vascular lesions. Because of the patient's desire for visual rehabilitation and the concern for von Hippel-Lindau (VHL) disease-associated retinal hemangioblastomas, pars plana vitrectomy and endoresection of both lesions were performed. Surgical techniques included the use of chandelier illumination to enable bimanual manipulation of tissue, endolaser around the tumor prior to resection, endodiathermy to cauterize the tumor's feeder vessels, and long-acting gas tamponade following the retinectomy. Histopathology showed a vascular anomaly within the retina that consisted of multiple large vessels with multiple lumens and no evidence of VHL-associated retinal hemangioblastoma. Long-term follow-up revealed no evidence of recurrent disease. This surgical technique may be valuable in select patients to differentiate between retinal vasoproliferative tumors and VHL disease-associated retinal hemangioblastomas for diagnostic, therapeutic, and counseling purposes.

Photodynamic therapy with verteporfin for vasoproliferative tumour of the retina

After discussing the treatment options with the patient, thermal laser photocoagulation was applied to treat the lesion. Six weeks after treatment, BCVA remained at 20 ⁄ 35 with no change in the lesion and no reduction in subretinal fluid on OCT. Given this lack of response, photodynamic therapy (PDT) with 6m g⁄ m 2 verteporfin and standard laser fluence of 600 mW for 83 sec- onds was performed. One month after PDT, OCT showed complete resolution of subretinal fluid at the fovea and the right eye BCVA improved to 20 ⁄ 25. One year after

This issue of Acta

This issue of <i>Acta</i>

Retinal Vasoproliferative Tumor in Association with Neurofibromatosis Type 1

Retinal vasoproliferative tumor is an uncommon benign vascular tumor that most often occurs sporadically. Vision loss can occur secondary to retinal fibrosis, subretinal exudation, and neovascular glaucoma. This report describes a functionally monocular patient with neurofibromatosis type 1 who had a vasoproliferative tumor with neovascularization of the iris that was successfully treated with intravitreal bevacizumab and cryotherapy.

The pediatric retina could be the clue to systemic disease

So what diseases should you think of when you see a child with Coats disease in both eyes? There are numerous pediatric retinal diseases that could imply a systemic disease including albinism, optic disc anomalies, retinal vascular diseases like bilateral Coats disease, vasoproliferative tumors, retinal arterial aneurysms, familial retinal arteriolar tortuosity, sickle cell, thallasemia, incontinentia pigmenti, and retinal vascular tumors and others. What systemic associations should come to mind? The clinical features of these conditions will be reviewed.

Retinal vasoproliferative tumours

Vasoproliferative tumours are uncommon retinal lesions that may occur in isolation (primary) or in association with another ocular condition (secondary). They may be unilateral or bilateral and have a predilection for the peripheral inferior temporal quadrant of the retina. Vasoproliferative tumours can be associated with abnormalities of the macular, including epiretinal membrane formation and cystoid macular edema. A number of modalities have been used to treat these tumours including cryotherapy and radiotherapy.

Vascular tumors of the retina and choroid: Diagnosis and treatment

The vascular tumors of the retina and choroid comprise a diverse group of congenital and acquired lesions. The major vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, retinal vasoproliferative tumor, and racemose hemangiomatosis of the retina or Wyburn–Mason syndrome. Choroidal vascular tumors include circumscribed choroidal hemangioma and diffuse choroidal hemangioma. While classified as benign, visual symptoms secondary to exudative retinal detachment and a variety of other mechanisms are common and are a major source of long-term visual disability. While many therapeutic modalities exist, treatment of symptomatic cases can be challenging. Of particular importance, many of the vascular tumors of the retina and choroid have significant associations with systemic disease. As ocular symptoms are often the most common presenting disease manifestation, the ophthalmologist plays an important role in accurate and early diagnosis. The ability to initiate prompt screening and treatment in appropriate cases is critical. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.