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Lynn Schoenfield, Thomas Plesec, Erinn Downs-Kelly, Mary Beth Aronow, Paula Carver, Raymond Tubbs, Arun Singh; Gender differences and estrogen and progesterone receptor expression in uveal melanoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4224.
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Older reports have not demonstrated estrogen receptor (ER) expression in uveal melanoma (UVM). However, recent publications and SEER data prompted a re-examination of gender differences and hormome receptor status with comparison to clinical outcome and chromosome 3 status.
Incidence and outcome data of 57 cases of UVM from 2004-10 were analyzed. The study was approved by the IRB, and this research adhered to the tenets of the Declaration of Helsinki. Of the 57 cases, 34 were enucleations and were stained with ER/PR by IHC using a red chromagen. Cases were considered positive if at least 1% of the tumor nuceli stained and were scored by 3 surgical pathologists who routinely do either ocular or breast pathology or both. Chromosome 3 status was determined by FISH and SNP array analysis.
There were 31 men (54%) and 26 women (46%). 17 patients were DOD: 13 men (76%) and 4 women (24%); 3 patients were alive with metastasis: 2 men (67%) and 1 woman (33%). Of the 34 stained cases, ER was positive in 20 (59%): 8 (40%) men and 12 (60%) women. ER was negative in 14 cases, 86% of which were from men. PR was positive in 18 cases (53%), 13 of which also expressed ER. Comparing IHC results to outcome showed: 10/20 ER positive cases (50%) were DOD or were alive with metastases. Of the 14 negative cases, only 3 (21%) were DOD. If male and ER positive, 5/8 (63%) were DOD or had metastases compared to if male and ER negative, 3/12 (25%) were DOD. If female and ER positive, 5/12 (42%) were DOD or with metastases and if female and ER negative, 0/2 (0%) were DOD or with metastases. When compared to monosomy 3 status, 18/20 ER positive cases (90%) showed monosomy 3 compared to 6/14 ER negative cases (43%) with monosomy 3. Agreement in scoring the IHC's for hormone receptors was excellent for ER (29/31 cases, 94%) but less for PR (19/31, 61%).
Gender may play a role in the incidence and behavior of UVM. ER expression was present in 59% of cases, with or without PR expression, and was only slightly more likely in women (60%) than men (40%). These findings are different than previous reports, and male gender and ER positive tumors may suggest a worse prognosis. These findings raise the possibility of treatment options with tamoxifen or other SERMs in the management of UVM. We propose studying more cases along with quantitative evaluation of receptor positivity using image analysis
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