Diagnostic algorithm in small pigmented choroid tumors (less than 3 mm thick)

Abstract

Objectives: The aim of this paper is to present a diagnostic algorithm for a controversial topic in ophthalmic oncology, small pigmented choroidal tumors (<3 mm thick). Material and Methods: Nineteen consecutive patients with a clinical diagnosis of small choroidal pigmented tumors were included in the study. The group of patients studied consisted of 9 patients (47.36%) female and 10 patients (52.64%) male, the age range was 14–68 years. All cases were ophthalmologically evaluated, including best-corrected visual acuity, anterior and posterior segment biomicroscopy, intraocular pressure, binocular indirect ophthalmoscopy, and as additional complementary examinations, ocular ultrasound was performed, which in 100% of the cases was inconclusive, optical coherence tomography, autofluorescence, and angiography in selected cases according to location and symptomatology. In 13 patients (68.50%), transvitreous puncture was performed with or without vitrectomy. Trans-scleral puncture was performed in 6 patients (31.50%), located at the equator (4 patients) and ciliary body (2 patients). Post-surgical follow-up was performed within the first 3 weeks after the procedure and then controlled every 3 months within the 1st year. The material obtained by fine-needle aspiration (FNA) was placed in non-hemolytic preservative liquid. Hematoxylin and eosin, Pas, Masson’s trichrome, and immunohistochemistry (HMB 45, MELAN A, PROT. S-100 base) were performed. Results: The yield of cytologic material was 100% in the sampled patients. The most frequent complication was subretinal hemorrhage in three patients with transvitreous access and two patients with trans-scleral access, in all cases, there was a favorable evolution without requiring further action. In three patients, there were mild vitreous hemorrhages that resolved spontaneously, all of them had undergone transvitreous access. Conclusion: In TPPC of less, we propose a diagnostic algorithm with FNA to obtain cytological sample which allows not only the diagnosis of certainty to indicate treatment but also to determine cytological and molecular prognostic factors that allow classifying melanoma of high or low grade and potentially in case of metastatic disease to indicate systemic treatments. We believe that it is essential to diagnose this type of lesions in which a diagnosis of certainty is required. The alternative is the observation that we consider potentially dangerous in these cases.