MELANOMA DE COROIDE





MELANOMA DE COROIDE

(especial para SIIC © Derechos reservados)
arcieri.jpg Autor:
Enyr Saran Arcieri
Columnista Experto de SIIC
Artículos publicados por Enyr Saran Arcieri
Coautores
Rafael Saran Arcieri* Cristiano Toesca Espinhosa** 
Acadêmico do Curso de Medicina da Universidade Federal do Mato Grosso do Sul, Campus Dourados, Brasil*
Médico Oftalmologista, Estagiário do Setor de Retina e Vítreo da Universidade Federal de Uberlândia, Brasil**
Recepción del artículo
24 de Julio, 2003
Primera edición
21 de Octubre, 2003
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
O melanoma maligno de coróide é o tumor primário intra-ocular mais comum em adultos, embora seja um tumor raro, com incidência calculada em 6 casos por 1.000.000 de habitantes por ano nos Estados Unidos. A apresentação é mais comum durante a 6 década de vida, sendo mais freqüente em brancos e raro em negros e asiáticos. Em alguns pacientes ele é assintomático, enquanto em outros pode causar baixa de visão, defeitos no campo visual, fotopsia ou dor. A propedêutica principal para o diagnóstico é a oftalmoscopia indireta, e a ultra-sonografia é outro método de grande valia, principalmente nos pacientes que apresentem opacidade de meios. Os tumores podem ser compostos por células fusiformes - menos agressivos, células epitelióides - mais agressivos, ou células mistas - prognóstico intermediário. Para o tratamento dos casos de melanoma de coróide, pode ser utilizado placas radioativas (Ex: iodo-125, cobalto-60), termoterapia transpupilar, enucleação, exenteração, quimioterapia ou imunoterapia. A conduta deve ser individualizada para cada caso. Em relação ao tamanho do tumor, tem sido referida sobrevida em 20 anos de 80% para os pequenos e 40% para os grandes, com prognóstico pior nos pacientes com mais de 65 anos. Metástases a distância ou a extensão extra escleral do tumor são as principais causas de morte.

Palabras clave
Melanoma/diagnóstico, neoplasia ocular, neoplasias da coróide/diagnóstico, diagnóstico diferencial


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Abstract
Malignant melanoma of the choroid is the most common primary intraocular tumor in adults, although it is a rare tumor, with an estimated incidence of 6 cases / 1.000.000 inhabitants per year in United States. Presentation is most commonly during the sixth decade of life. The tumor is more frequent in Caucasians and is extremely rare in African Americans and Asians. In some patients the tumor does not cause any symptoms, while in others it causes decreased visual acuity, defects in the visual field, photopsia or pain. Indirect ophthalmoscopy is one of the most important methods for diagnosis and ultrasonography also has great value. The latter is helpful in detecting tumors in eyes with hazy media. The tumors can be composed by spindle cells - have the best prognosis; epithelioid cells - have the worst prognosis; or mixed cells - have an intermediate prognosis. The management of choroial melanomas may include radioactive plaques (iodine-125, cobalt-60), transpupilary thermoterapy, enucleation, exenteration, chemotherapy or immunotherapy. The treatment should be individualized for each case.According to the size of the tumor, the survival rates at 20 years are 80% in small tumors and 40% in large tumors. Patients over 65 years have a worse prognosis than younger patients. Distant metastases from the ocular tumor or extraocular extension of the tumor are the main death causes

Key words
Melanoma/diagnóstico, neoplasia ocular, neoplasias da coróide/diagnóstico, diagnóstico diferencial


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Oftalmología
Relacionadas: Cirugía, Dermatología, Epidemiología, Medicina Interna, Oncología



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