Journal of Pathology and Translational Medicine

Original Article

Clinicopathologic features and survival outcomes of ocular melanoma: a series of 31 cases from a tertiary university hospital: Selin Kestel, Feriha Pınar Uyar Göçün, Betül Öğüt, Özlem Erdem; J Pathol Transl Med. 2022;56(4):187-198. Published online May 3, 2022; DOI: https://doi.org/10.4132/jptm.2022.03.10

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Background
We aimed to determine the effect of clinicopathologic features on overall survival among Caucasian ocular melanoma patients in the Central Anatolia region of Turkey.
Methods
This single-center study included conjunctival (n = 12) and uveal (n = 19) melanoma patients diagnosed between January 2008 and March 2020. Clinicopathologic features and outcomes were reviewed retrospectively. Five cases were tested for BRAF V600 mutations with real-time polymerase chain reaction, and one case was tested with nextgeneration sequencing. Survival was calculated using the Kaplan-Meier method.
Results
Thirty-one patients had a mean initial age of 58.32 years (median, 61 years; range 25 to 78 years). There were 13 male and 18 female patients. The median follow-up time was 43.5 months (range, 6 to 155 months) for conjunctival melanoma and 35 months (range, 8 to 151 months) for uveal melanoma. When this study ended, eight of the 12 conjunctival melanoma patients (66.7%) and nine of the 19 uveal melanoma patients (47.4%) had died. The presence of tumor-infiltrating lymphocytes was related to improved overall survival in conjunctival melanoma (p = .014), whereas the presence of ulceration (p = .030), lymphovascular invasion (p = .051), tumor in the left eye (p = .012), tumor thickness of > 2 mm (p = .012), and mitotic count of >1/mm² (p = .012) reduced the overall survival in conjunctival melanoma. Uveal melanoma tumors with the largest diameter of 9.1–15 mm led to the lowest overall survival among subgroups (p = .035). Involvement of the conjunctiva (p=.005) and lens (p = .003) diminished overall survival in uveal melanoma. BRAF V600 mutation was present in one case of conjunctival melanoma, GNAQ R183Q mutation was present in one case of uveal melanoma. Patients with uveal melanoma presented with an advanced pathological tumor stage compared to those with conjunctival melanoma (p = .019).
Conclusions
This study confirmed the presence of tumor-infiltrating lymphocytes as a favorable factor in conjunctival melanoma and conjunctival and lens involvement as unfavorable prognostic factors in uveal melanoma for overall survival, respectively.

Citations

Citations to this article as recorded by

Uveal melanoma in the Iranian population: two decades of patient management in a tertiary eye center
Hamid Riazi-Esfahani, Abdulrahim Amini, Babak Masoomian, Mehdi Yaseri, Siamak Sabour, Ali Rashidinia, Mojtaba Arjmand, Seyed Mohsen Rafizadeh, Mohammadkarim Johari, Elias Khalili Pour, Fariba Ghassemi
International Journal of Retina and Vitreous.2024;[Epub] CrossRef
Clinical features and prognosis of patients with metastatic ocular and orbital melanoma: A bi‐institutional study
Xin Liu, Han Yue, Shiyu Jiang, Lin Kong, Yu Xu, Yong Chen, Chunmeng Wang, Yan Wang, Xiaoli Zhu, Yunyi Kong, Xiaowei Zhang, Jiang Qian, Zhiguo Luo
Cancer Medicine.2023; 12(15): 16163. CrossRef
Metastatic melanoma: clinicopathologic features and overall survival comparison
Selin Kestel, Feriha Pınar Uyar Göçün, Betül Öğüt, Özlem Erdem
Acta Dermatovenerologica Alpina Pannonica et Adriatica.2022;[Epub] CrossRef

Case Reports

Solitary Fibrous Tumor of the Conjunctiva with Heretofore Undescribed Pathologic Findings.: Na Rae Kim, Jae Y Ro, Kyung Hwan Shin, Hae Jung Paik, Jung Suk An, Seung Yeon Ha; Korean J Pathol. 2011;45(3):315-318.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.3.315

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Abstract PDF

A 37-year-old female presented with a conjunctival mass discovered 3 years prior. An excisional biopsy revealed a patternless proliferation of round and spindle-shaped cells with an eosinophilic fibrillary cytoplasm and vesicular nuclei with occasional inclusions. Psammoma bodies were arranged around the dilated irregularly-shaped vessels. Differential diagnoses included conjunctival solitary fibrous tumor (SFT), nevus, glomangioma, ectopic meningioma, and mesectodermal leiomyoma. The tumor cells were immunoreactive for CD34, CD99, bcl-2 and vimentin, and were negative for smooth muscle actin, desmin, glial fibrillary acidic protein, S-100 protein, epithelial membrane antigen, and human melanoma black-45. Ultrastructurally, the tumor cells had rough endoplasmic reticulum, free ribosomes, and scattered mitochondria without basal lamina or cellular junctions, which are features of fibroblasts. A diagnosis of SFT was rendered based on the light microscopic, immunohistochemical, and electron microscopic findings. We report here on the second case of a SFT arising in the conjunctiva, which clinically and histologically mimics conjunctival nevus, glomangioma, ectopic meningioma, and a hybrid neurogenic-myogenic tumor such as mesectodermal leiomyoma.

Citations

Citations to this article as recorded by

Meningeal Solitary Fibrous Tumors with Delayed Extracranial Metastasis
Nayoung Han, Hannah Kim, Soo Kee Min, Sun-Ha Paek, Chul-Kee Park, Seung-Hong Choi, U-Ri Chae, Sung-Hye Park
Journal of Pathology and Translational Medicine.2016; 50(2): 113. CrossRef

CK20 Negative and CK7 Positive Merkel Cell Carcinoma of the Conjunctiva: Brief Case Report.: Jung Ha Shin, Jae Young Park, Hyun Seung Kim, Ok Ran Shin, Kyo Young Lee; Korean J Pathol. 2010;44(6):675-678.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.675

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Abstract PDF: Merkel cell carcinoma (MCC) is an uncommon but potentially aggressive neuroendocrine carcinoma of the skin. It typically develops on sun-exposed areas of the head and neck, particularly the eyelid, periorbital region, and extremities. We report a case of unusually located MCC, presenting as a conjunctival mass, which has only been reported once in the English literature. An 83-year-old male presented with a 0.8 x 0.7 cm sized mass protruding from the lower fornix of the right conjunctiva. The mass was excised. The tumor was located in the submucosa without connection to the overlying mucosa. Light microscopic findings showed a carcinoma with undifferentiated small round cells and the presence of cytokeratin (CK AE1/3, CK7) and neuroendocrine markers. We established a diagnosis of MCC. As reported in the literature, the majority of MCCs are positive for CK20 but negative for CK7. But, this case showed an uncommon cytokeratin immunohistochemical profile of positive for CK7 and negative for CK20, suggesting a new immunophenotypic MCC variant.

Conjunctival Pigmented Actinic Keratosis: A Case Report.: Jinyoung Yoo, Ji Han Jung, Hyun Joo Choi, Seok Jin Kang, Chang Suk Kang; Korean J Pathol. 2004;38(2):113-115.

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Abstract PDF: We recently had a case of pigmented actinic keratosis arising in the conjunctiva, and this is an unusual site for the lesion. Most actinic keratoses are seen on sun-exposed areas of the skin, especially for Caucasians living in sunny climates. When these lesions are pigmented, they may resemble lentigo maligna. A 56-year-old man was referred to the ophthalmology clinic for a pigmented conjunctival lesion. An ophthalmologic examination revealed multiple dark brown-colored, linear or irregular shaped patches located on the lateral side of the conjunctiva in his right eye, partially covering the cornea, and this made a clinical differentiation from other possible pigmented lesions somewhat difficult. A histologic examination of the subsequent biopsy specimen demonstrated acanthosis with melanocytes containing heavy melanin, scattered dyskeratotic cells, atypical keratinocytes, and solar elastosis, and all of their findings are consistent with pigmented actinic keratosis.

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