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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Ophthalmol
2013 ; 155
(3
): 593-608.e1
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Reactive retinal astrocytic tumors (so-called vasoproliferative tumors):
histopathologic, immunohistochemical, and genetic studies of four cases
#MMPMID23219067
Poole Perry LJ
; Jakobiec FA
; Zakka FR
; Reichel E
; Herwig MC
; Perry A
; Brat DJ
; Grossniklaus HE
Am J Ophthalmol
2013[Mar]; 155
(3
): 593-608.e1
PMID23219067
show ga
PURPOSE: To evaluate the cellular nature of and diagnostic terminology used in
connection with acquired retinal "vasoproliferative tumors." DESIGN:
Retrospective clinicopathologic study. METHODS: Clinical records and microscopic
slides of 4 enucleated globes were reviewed. Special stains and
immunohistochemical probes for CD31, CD34, p53, glial fibrillary acidic protein
(GFAP), CD163, and Ki67 (cell replication) were employed; ultrastructural and
fluorescence in situ hybridization (FISH) analyses were performed. RESULTS:
Tumors were located inferotemporally in middle-aged patients. They were uniformly
composed of compacted elongated, GFAP-positive spindle cells (due to intermediate
filaments identified ultrastructurally) with a Ki67 index of less than 1%.
Rosenthal fibers and eosinophilic granular bodies were observed. Hyalinized
periodic acid-Schiff-positive vessels were widely separated. CD31 and CD34
revealed a sparse microvasculature. Tumor-associated exudate spread predominantly
subretinally. The retinal pigment epithelium had undergone extensive placoid
fibrous metaplasia with focal ossification. P53 upregulation, BRAF-KIAA gene
rearrangement, and IDH1R132H mutation typically associated with low-grade
astrocytic neoplasms were absent. CONCLUSIONS: Retinal "vasoproliferative" tumors
have been mischaracterized, because they actually display a paucity of
microvessels. Proliferating fibrous astrocytes with a very low proliferation
index predominate, without immunohistochemical or genetic evidence favoring a
neoplasm. Subretinal exudate appeared capable of provoking widespread fibrous
metaplasia of the pigment epithelium that was mainly responsible for secondary
retinal damage. The term "reactive retinal astrocytic tumor" is proposed as more
appropriate for this entity. In carefully selected progressive lesions,
consideration should be given to earlier surgical intervention before extensive
subretinal exudate accumulates and pigment epithelial proliferation with fibrous
metaplasia ensues.