Choroidal melanoma recurrence after episcleral brachytherapy and transpupillary thermotherapy

ABSTRACT A 68-year-old man diagnosed with choroidal melanoma (CM) in the right eye underwent treatment with episcleral brachytherapy (I125) and transpupillary thermotherapy. Ultrasound, computed tomography, and magnetic resonance imaging were performed and revealed ocular recurrence of CM. Treatment with extended enucleation was performed. Macroscopic and microscopic examinations revealed extraocular extension and malignant cells, respectively. Immunohistochemistry demonstrated tumoral Melan-A and HMB-45 expression. No cytogenic abnormalities were detected with fluorescence in situhybridization of tumor cells using probes against chromosomes 3q27 and 8q24. The patient underwent adjuvant external beam radiotherapy for treatment of residual tumor tissue. This case represents the first reported case of recurrent CM with no cytogenetic abnormalities and the absence of metastatic disease, despite a number of the poorest prognostic factors.

摘要 一名68岁男性因右眼脉络膜黑色素瘤（choroidal melanoma, CM）接受巩膜近距离放射治疗（episcleral brachytherapy, I125）联合经瞳孔温热疗法（transpupillary thermotherapy）。后续行超声（ultrasound）、计算机断层扫描（computed tomography）及磁共振成像（magnetic resonance imaging）检查，提示脉络膜黑色素瘤眼部复发。遂为患者实施扩大眼球摘除术。大体标本检查与镜下病理检查分别提示存在眼外侵袭与恶性细胞。免疫组织化学检测证实肿瘤组织表达Melan-A及HMB-45。采用针对3号染色体q27区域及8号染色体q24区域的探针对肿瘤细胞行荧光原位杂交（fluorescence in situ hybridization）检测，未检测到细胞遗传学异常。患者后续接受辅助外照射放疗以清除残留肿瘤组织。本病例为首例报道的复发性脉络膜黑色素瘤病例：尽管存在多项极差的预后因素，但未出现细胞遗传学异常，亦未发生远处转移。