Purpose: To evaluate arteriovenous malformations (AVM) with swept-source (SS) optical coherence tomography (OCT) angiography (OCTA) in iris racemose hemangioma and compare it with traditional ...intravenous iris fluorescein angiography (IVFA). Methods: A cross-sectional observational clinical study was conducted on patients with iris racemose hemangioma with the ZEISS PLEX Elite 9000 SS OCT & OCTA. Results: Three eyes of three patients were imaged. Iris racemose hemangiomas demonstrated a tortuous, well-defined, and continuous course of the AVM. The ZEISS PLEX Elite 9000 SS OCT & OCTA allowed for a detailed visualization of the ARM and was superior to IVFA in depicting small caliber, fine vessels. Conclusions: SS-OCTA may provide a dye-free, no-injection, cost-effective method comparable to spectral domain OCTA and IVFA for diagnosing and monitoring iris racemose hemangiomas for growth and vascularity.
To determine the size at which choroidal melanomas can metastasize and to report the characteristics of small fatal choroidal melanomas (SFCM).
Retrospective case series.
Ten ocular oncology services ...submitted 45 patients with a choroidal melanoma 3 mm or less in thickness and 9 mm or less in largest basal diameter (LBD), when treated, who developed metastases.
Median tumor thickness was 2.4 mm (range, 1.0–3.0 mm) and LBD 7.3 mm (range, 3.0–9.0 mm). Of 14 (31%) tumors that were first observed, 12 grew a median of 0.5 mm (range, 0.1–1.2 mm) in thickness and 1.0 mm (range, 0–3.0 mm) in LBD within a median of 7 months; 3 were initially smaller than 3 mm in LBD. Number of risk factors for growth and metastasis was 0 for 4% of the tumors; 60% were over 2 mm in thickness, 63% had subretinal fluid, 84% caused symptoms, 57% had orange pigment, and 92% were within 3 mm of the disc. Local recurrence occurred in 8 of 31 eyes (26%) treated conservatively. Median metastasis-free survival was 4.5 years (range, 0.8–15.7 years). Kaplan-Meier estimate of metastasis developing was 15% (95% confidence interval CI, 7–26), 51% (95% CI, 36–64) and 85% (95% CI, 71–92) by 2, 5, and 10 years, respectively. By the time of analysis, 37 patients had died of metastasis after a median of 7 months.
Choroidal melanomas less than 3.0 mm in LBD are highly unlikely to metastasize. Risk factors of an SFCM are similar to those for all choroidal melanomas of similar size.
•Choroidal melanomas more than 3.0 mm in diameter are able to metastasize.•Observation beyond this size limit may alter survival.•Small fatal melanomas appear clinically similar to reported small nonfatal ones.
Purpose
In a population‐based cohort of 960 uveal melanoma (UM) patients, we describe patients with three additional malignancies, including one unique patient with four synchronous primary ...malignancies.
Method
A descriptive presentation of the clinical course and outcome for UM patients with three additional primary malignancies.
Results
After more than 20 years of follow‐up of the UM cohort, 11 patients (1.1%) were diagnosed with three additional primary malignancies before, simultaneously or after UM. Among these, one patient had four synchronous primary malignancies, detected during workup for a symptomatic UM. All diagnoses were treated during the following 4 months, firstly the breast cancer, thereafter, the lung and pancreatic cancers and finally the UM. The patient died 3 years later of abdominal carcinomatosis due to the pancreatic cancer. The family history and gene testing did not disclose any genetic predisposition for cancer. A comparison of the four synchronous tumours, morphologically and immunohistochemically, showed no similarities and the expression of antibodies was different.
Conclusion
Patients with UM may be diagnosed with non‐ocular additional primary cancers. Thus, a comprehensive workup is obligatory and a further follow‐up of the UM patients seems necessary. The UM is not always the main problem.
Purpose
The purpose of this study was to evaluate treatment response and complications of transarterial chemoembolization using drug-eluting beads loaded with irinotecan (DEBIRI) in patients with ...liver metastases from uveal melanoma (UM).
Materials and Methods
Patients treated with DEBIRI (
n
= 14) were retrospectively analyzed regarding overall survival, compared to patients (
n
= 14) treated with intravenous dacarbazine (DTIC). Median overall survival was calculated from time of diagnosis of metastatic disease (OS1) and start of treatment (OS2). Radiological response for DEBIRI was assessed according to RECIST 1.1 on contrast-enhanced computed tomography (CT), obtained 1.5 months (range 1.2–3.7) post treatment. Major complications of DEBIRI were defined according to the Society of Interventional Radiology classification for complications by outcome.
Results
In the DEBIRI group, OS1 was 14.8 months (range 3.9–47.5), and OS2 was 9.4 months (range 1.7–39). Further, 11/13 (84.6 %) of these patients had progressive disease on first follow-up CT and new lesions were seen in nine. There were 12 major complications in nine patients, possibly including one case of mortality due to disseminated intravascular coagulation (DIC).
Conclusion
For patients with liver metastases from UM, the effect on overall survival of DEBIRI alone is questionable. Compared to previous reports, the response rate of DEBIRI was poor, with new liver lesions observed in the majority of patients. Major complications possibly included one case of DIC.
Objective: This study aimed to explore the relationship between self-reported cognitive difficulties, objective neuropsychological test performances, and subjective health complaints in chronic ...fatigue syndrome (CFS) and to examine the degree of impaired cognitive functions. Method: A total of 236 consecutively recruited outpatients, 18−62 years of age, completed the tests. Self-administered questionnaires were used for assessing fatigue, pain, depression, anxiety and subjective cognitive complaints (Everyday Memory Questionnaire EMQ). Also, neuropsychological tests, that is, Stroop I−IV, California Verbal Learning Test-Second Edition (CVLT−II) learning and delay, Wechsler Adult Intelligence Scale-Third Edition (WAIS−III) Letter Number (L−N) Sequencing, and the Paced Auditory Serial Addition Task were performed to examine whether these objective measures correlated with subjective complaints and were compared with normative data. Results: There was a trend of association (p < .05) between the unadjusted EMQ with Stroop IV (inhibition and shifting attention), the CVLT−II learning and delay (verbal learning and memory), and the WAIS−III L−N Sequencing (working memory), but none were statistically significant at the .001 level. The EMQ was positively associated with fatigue, pain, and depression (p < .001). The PASAT (working memory) was negatively associated with pain (p < .001). Between 21% and 38% of the patients performed below the 1.5-SD cutoff for clinically significant impairment on the Stroop tests. Conclusion: The self-reported cognitive performance was not strongly associated with the objective cognitive performances on any domains in patients with CFS. Patients with higher fatigue, pain, and depression levels reported greater subjective cognitive difficulties, as well as higher pain related to lower objective working memory function. The CFS patients had problems mainly in the domains of psychomotor speed and attention measured by the objective neuropsychological tests.
General Scientific Summary
In patients with chronic fatigue syndrome, their self-reported cognitive performance reflects, to some extent, the objective cognitive performances on certain domains. They reported a high level of cognitive difficulties, which were positively correlated with fatigue, pain, and depression; however, the relationships with objective tests were weak. They displayed problems mainly in the domains of psychomotor speed and attentional control measured by objective neuropsychological performance tests.
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