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N. Raoof, I. G. Rennie, S. M. Salvi, H. M. Mudhar; Vortex Vein Invasion in Intra-Ocular Melanomas: Correlation With Prognostic Factors. Invest. Ophthalmol. Vis. Sci. 2008;49(13):37. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To identify prognostic risk factors associated with vortex vein invasion in uveal melanomas.
A database of enucleated eyes with a confirmed diagnosis of ocular melanoma at the regional oncology unit in Sheffield (United Kingdom) is maintained. We performed a retrospective study and identified eyes with vortex vein invasion from this database over a ten year period. The casenotes, histopathological features and genetic status were evaluated. Vortex vein invasion was then correlated with patient survival.
Of our series of 244 intraocular melanomas, 29 had evidence of vortex vein invasion. Of these, only 6/29 (20.7%) were seen to have macroscopic evidence of vortex vein invasion. 14/29 (48.3%) eyes also showed evidence of direct scleral invasion. 23/29 (79.3%) melanomas involved the choroid, 2/29 (6.9%) involved the ciliary body and 4/29 (13.8%) involved both choroid and ciliary body. The mean maximum diameter of tumour in eyes with vortex vein invasion was 15.7 mm (range 10.3 mm to 20.8 mm). and the mean thickness was 9.8 mm (range 2.9 mm to 15.0 mm). The uveal melanoma took the shape of a solitary nodule in 27/29 (93.1%) cases and a diffuse pattern was observed in 2/29 (6.9%) cases. 8/29 (27.6%) tumours had a spindle cell shape, 19/29 (65.5%) had a mixed cell shape and 2/29 (6.9%) had an epitheliod cell shape. 22/28 (78.6%) uveal melanomas with vortex vein invasion contained vascular loops (data not available for one uveal melanoma with vortex vein invasion). Genetic imbalance (less signals for chromosome 3 in relation to chromosome 8) was seen in 25/29 (89.3%) tumours. Liver metastases were confirmed in 19/29 (65.5%) patients. The mean survival of patients who died from liver metastases was 31.9 months (range 9 to 108 months) from the time of enucleation.
Prognostic risk factors for vortex vein invasion include a choroidal location, large tumour size, spindle cell shape, presence of vascular loops and genetic imbalance. A higher proportion of patients with vortex vein invasion progress to develop liver metastases and therefore have a poorer prognosis than the general uveal melanoma population.
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