Early diagnosis and successful treatment of paraneoplastic melanocytic proliferation

Joyce C G Jansen, Joachim Van Calster, Jose S Pulido, Sarah L Miles, Richard G Vile, Tine Van Bergen, Catherine Cassiman, Leigh H Spielberg, Anita M Leys

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    BACKGROUND: Paraneoplastic melanocytic proliferation (bilateral diffuse uveal melanocytic proliferation, BDUMP) is a rare but devastating disease that causes progressive visual loss in patients who usually have an occult malignancy. Visual loss occurs as a result of paraneoplastic changes in the uveal tissue.

    METHODS: In a masked fashion, the serum of two patients with BDUMP was evaluated for the presence of cultured melanocyte elongation and proliferation (CMEP) factor using cultured human melanocytes. We evaluated the efficacy of plasmapheresis as a treatment modality early in the disease in conjunction with radiation and chemotherapy.

    RESULTS: The serum of the first case patient was investigated after plasmapheresis and did not demonstrate proliferation of cultured human melanocytes. The serum of the second case was evaluated prior to treatment with plasmapheresis and did induce this proliferation. These findings are in accordance with the diminution of CMEP factor after plasmapheresis. Treatment with plasmapheresis managed to stabilise the ocular disease progression in both patients.

    CONCLUSIONS: In the past, visual loss due to paraneoplastic melanocytic proliferation was considered progressive and irreversible. We treated two patients successfully with plasmapheresis and demonstrated a relation between CMEP factor in the serum of these patients and proliferation of cultured melanocytes.

    Original languageEnglish
    Pages (from-to)943-8
    Number of pages6
    JournalBritish Journal of Ophthalmology
    Volume99
    Issue number7
    DOIs
    Publication statusPublished - Jul 2015

    Keywords

    • Adenocarcinoma/secondary
    • Aged
    • Angiogenesis Inhibitors/therapeutic use
    • Antibodies, Monoclonal, Humanized/therapeutic use
    • Antineoplastic Agents/therapeutic use
    • Bevacizumab
    • Cell Proliferation/drug effects
    • Combined Modality Therapy
    • Early Diagnosis
    • Fluorescein Angiography
    • Humans
    • Intravitreal Injections
    • Lung Neoplasms/pathology
    • Lymphatic Metastasis
    • Male
    • Melanocytes/pathology
    • Paraneoplastic Syndromes, Ocular/diagnosis
    • Plasmapheresis
    • Subretinal Fluid
    • Tomography, Optical Coherence
    • Vascular Endothelial Growth Factor A/antagonists & inhibitors
    • Visual Acuity/physiology
    • Visual Field Tests
    • Visual Fields

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