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A Quantitative Histologic Analysis

Nikolaos E. Bechrakis, MD; K. Weng Sehu, MD; William R. Lee, MD, FRCPath, FRCOphth, FRSE; Bertil E. Damato, PhD, FRCS, FRCOphth; Michael H. Foerster, MD

Arch Ophthalmol. 2000;118:1406-1412.

Objective  To describe the cytologic transformation and tumor progression in a series of uveal melanomas.

Methods  Fifteen cases of uveal melanoma, treated by primary transscleral local resection without primary adjuvant treatment, needed enucleation because of local tumor recurrence. Cytologic and cell morphometric features of the primary tumor and the intraocular recurrence were compared, with evaluation of the amounts of intermediate cells, epithelioid cells, mitotic figures, and nucleolar area.

Results  The cases were categorized into 2 groups, according to their cytologic characteristics. In the first group (5 cases), there was no cytopathological transformation in the recurrent tumor. The nucleolar area was increased in only 1 case. In the second group (10 cases), the recurrent tumors showed transformation into a more epithelioid cell type. In all but 1 case there was an increase in epithelioid cells in the tumor recurrence. The nucleolar area was increased significantly in all cases. The mean local recurrence interval in all cases was 15.3 months, with no difference between the groups. Death from metastases occurred in 7 cases in which the nucleolar area was 4.2 µm² in the primary tumor.

Conclusions  These findings demonstrate that, in an individual tumor, the cytologic phenotype can change considerably even after a relatively short time, resulting in an increase in tumor-related mortality.

Clinical Relevance  Studies on the natural course of uveal melanoma have been very limited and based purely on observations on the progression of melanomas in terms of size and alteration of various clinical characteristics.

From the Department of Ophthalmology, Klinikum Benjamin Franklin, Free University Berlin, Berlin, Germany (Drs Bechrakis and Foerster); Sydney Eye Hospital, University of Sydney, Sydney, Australia (Dr Sehu); Department of Pathology, Western Infirmary, University of Glasgow, Glasgow, Scotland (Dr Lee); and St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England (Dr Damato).

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