Program Book

Results. Follow-up was 31±8 months (range, 25-42 months). FISH
analysis revealed monosomy 3 in twelve cases (50%). MLPA revealed
monosomy 3 in thirteen cases (54%) and a 3p14-q29 deletion in one
case (4%) (classified as monosomy 3 by FISH). Nine patients (41%)
developed metastatic disease during follow-up, including the case
showing monosomy 3 only by MLPA. Patient with partial chromosome 3
deletion is still alive without metastases.
Conclusions. MLPA allows to obtain more information than standard
FISH in uveal melanoma prognostication. The biological and prognostic
value of partial chromosome 3 deletion, as well as others subtle
chromosomes alterations or complex MLPA results, remains unclear.
Financial disclosure. None
2331 UM11
UVEAL MELANOMA: AN ANALYSIS OF CELLULAR
FEATURES AND COMPARISON TO MONOSOMY 3
STATUS
C. V. Biscotti1, A Lott-Limbach1, R. R. Tubbs2, M. E. Turell3, Y Sun2, A. D.
Singh3 (biscotc@ccf.org)
1. Departments of Anatomic Pathology, 2. Molecular Pathology and 3.
Ophthalmology, Cleveland Clinic, Cleveland, Ohio USA
Purpose. Uveal melanoma patients segregate into two prognostic
groups. Approximately half will eventually manifest metastases.
Unfortunately, most experts agree that the die is cast by the time of
diagnosis. We analyzed a series of uveal melanoma FNA samples to
describe the cellular features and correlate these with the results of
FISH analysis for monosomy 3.
Methods. All patients had a clinical diagnosis of uveal melanoma
based on history and physical examination including ophthalmoscopic
examination performed by one of the authors (ADS).The patients
consented to this study which was funded by the Falk Trust. FNA using
a 25G needle was performed at the time of radiation therapy plaque
placement or enucleation/excision by two of the authors (ADS and
MET). In vivo samples were obtained by transvitreal or transscleral
approach depending on tumour location. Aspirate samples were entirely
rinsed into 2-3 ml of normal saline, visually examined for adequacy,
and then entirely transferred to a cell preservative, CytoLyt (Hologic
Corp, Marborough MA). ThinPrep® processing yielded 4 alcohol fixed
Papanicolaou stained slides per case. One of the authors (CVB) analyzed
the slides for cellular features including cell type (pure epithelioid,
pure spindle, or mixed), nuclear grade (1, 2, or 3), and the presence or
absence of necrosis, tumour infiltrating lymphocytes (Tils), and melanin.
Slides with well preserved melanoma cells in sufficient numbers were
destained and analyzed for monosomy 3 by FISH. An adequate FISH
study required 200 cells. A positive result required monosomy 3 in at
least 20% of cells.
Results. Ninety patients with a clinical diagnosis of uveal melanoma
consented to the study. This included 45 men and 45 women with
ages ranging from 26 to 96 years (mean 62). Tumours involved the
choroid 61(68%) cases, ciliochoroid 21(23%) cases, iridociliary 5(6%)
cases and iris 3(3%) cases and ranged from 3 x 3 mm to 20 x 24 mm
in basal dimensions and 1.2 mm to 15 mm in height. Fifty-eight (64%)
patients had in vivo FNA either transvitreal 33 (57%) or transscleral 25
(43%).While thirty-two (36%) patients had FNA of enucleation/excision
specimens. FNA samples had diagnostic melanoma cells in 80 (89%)
cases including 68 (76%) with a 200 cell FISH count. Six patients did
not have data recorded for the specific cellular features. This yielded
62 patients for the cytology-monosomy 3 correlation. Tumour cell type
UVEAL MELANOMA
Abstracts
99
included 40 (65%) mixed and 22(35%) spindle. There were no pure
epithelioid tumours. Most (40 cases, 65%) tumours had grade 2 nuclei.
Grade 3 and grade 1 nuclei occurred in only 13(21%) and 9(15%) tumors,
respectively. Tils occurred in 18 (29%) tumours. FISH analysis identified
monosomy 3 in 28(45%) tumours. Monosomy 3 occurred significantly
more often in tumours with grade 3 nuclei (69% versus 39% in tumours
with grade 1 or 2 nuclei, p=0.0498). Monosomy 3 occurred more often
in tumours with TILs (61% versus 39% in tumours lacking TILs); this
difference is not significant (p=0.11).
Conclusions In our series most uveal melanomas had a relatively
consistent cellular appearance characterized by at least some spindle
cells, no more than moderate nuclear atypia, and melanin. In our
experience monosomy 3 occurred more often in tumours with grade 3
nuclei or Tils; however, the positive predictive value of these cellular
features is low, limiting clinical utility.
Financial disclosure. None
2321 UM12
RETROSPECTIVE ANALYSIS OF 700 FINE-NEEDLE
ASPIRATION BIOPSIES OF SOLID INTRAOCULAR
TUMORS: CHANGING INDICATIONS DURING LONG-
TERM EXPERIENCE
Zélia M. Corrêa, James J. Augsburger correazm@uc.edu
Department of Ophthalmology, University of Cincinnati College of
Medicine, Cincinnati, Ohio, USA
Purpose. Describe the changing indications for and techniques of FNAB
of intraocular tumours in a single group’s experience during a period of
over 30 years.
Methods. Retrospective records review and data analysis on 700 cases
of FNAB of a solid intraocular tumour performed by the authors during
the period 9/1980 through 6/2011.
Results. During the first 5 years, most FNABs were investigational
(including post-enucleation & post-resection to evaluated different
calibers and lengths needles, different methods of aspiration, routes
of needle passage, cellular yield, specimen processing, cytologichistologic
correlation, and provide experience with cytology of the
various types of tumours to the pathologists reading these samples).
All clinical FNABs (diagnostic or confirmatory) during this period were
performed under an IRB approved protocol in which clinical diagnostic
accuracy, cytopathologic diagnostic accuracy, complications of FNAB,
and percentage of cases in which the results of FNAB changed patient
management were evaluated. In 1985, the IRB determined that FNAB
of intraocular tumours by us no longer needed to be regarded as
investigational. During the ensuing 10 to 15 years, most FNABs we
performed were clinical diagnostic or confirmatory biopsies. Initially,
amelanotic uveal melanoma versus metastatic cancer to uvea was the
most common differential diagnosis, and later on, it became large uveal
nevus versus small uveal melanoma. Our practice relocated to a different
institution in 1999 prompting a new round of post-enucleation FNABs
to familiarize our new pathologists with the cytopathologic features of
intraocular tumours. In 2006, retrospective analysis of 25-year experience
with FNAB of clinically diagnosed melanocytic uveal tumours showed that
cytologic classification to be an independently significant prognostic
factor for metastasis and metastatic death. From that point on, all of our
FNABs on clinically diagnosed melanocytic uveal tumours have been
regarded as prognostic. In 2007, we began to collaborate in a prospective
IRB-approved multicenter (COOG) study of the prognostic significance of