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A.A. Pineiro, M.J. Blanco, M. Sanchez–Salorio, C. Capeans; Ultrasonographic assessment of cavitary intraocular tumors . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5211.
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Purpose: The origin of intratumoral lacunae in intraocular tumors is not well known. Spontaneous tumoral necrosis or hemorrhage, accumulation of mucoproteinaceous or serous exudates, and necrosis after radiotherapy has been proposed (Lois et al., 1998) as cause of cavitation. The aim of this work was to describe the ultrasonographic findings in cavitary intraocular tumors. Methods: A retrospective study was carried out in the Ocular Oncology Unit (Servicio de Oftalmología. Complejo Hospitalario Universitario de Santiago de Compostela) and Instituto Galego de Oftalmoloxía. 110 consecutive patients diagnosed as having choroidal or ciliary body tumors were studied. For ultrasonographic examination we have in all cases utilized the I3–System ABD (Innovative Imaging Inc.). This system provides a probe of 20 MHz for B–mode anterior high resolution ultrasonography and a probe of 10 MHz with sector scan angle of 53º for A– and B–modes posterior segment ocular ultrasonography. Moreover, we have utilized the UBM model 840 ultrasound biomicroscope (Humphrey, Zeiss) for examination and measurement of ciliary body tumors. Results: In 11 cases (9 choroidal melanomas, 1 ciliary body melanocytoma and 1 choroidal leiomyoma) intratumoral cavities were detected. All studied tumors showed typical ultrasonographic characteristics consistent with choroidal melanoma: dome–shaped masses, low to medium reflectivity and regular internal structure. Cavities were identified as solitary (10 cases) or multiple (1 case) well–delimited hypoechogenic lacunae. All cases of choroidal melanoma (9) were medium in thickness and base and received 125I–brachytherapy: in 5 cases the lacunae appeared after radiation and in 4 cases were detected before treatment, in the first ultrasonographic examination. The patient diagnosed of leyomioma elected enucleation as treatment. In that case, pathologic studies revealed multiple empty cavities included into a large tumoral mass. The ciliary body melanocytoma was diagnosed after the mass biopsy. This patient is periodically revised and modifications in size of the mass or cavity were no detected to date. Conclusions: Tumoral cavities cannot be detected by means of ophthalmoscopy. They could appear in different kinds of intraocular tumors and spontaneously or secondary to radiotherapy in choroidal melanoma. Ocular ultrasonography techniques allow to detect the presence and measurement of intratumoral cavities.
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