Fluorescence in situ hybridisation (FISH) in histologically challenging conjunctival melanocytic lesions
Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK. The British journal of ophthalmology
(Impact Factor: 2.98).
11/2012; 97(1). DOI: 10.1136/bjophthalmol-2012-302261
Even in experienced hands, the classification of some melanocytic lesions of the conjunctiva remains challenging. In skin pathology, the recent application of fluorescence in situ hybridisation (FISH) has been demonstrated to be of use for the analysis and diagnosis of ambiguous melanocytic neoplasms of the skin. This study set out to evaluate this method on seven prospective conjunctival cases that were histologically equivocal.
18 unequivocal retrospective melanocytic controls were exposed to FISH. Commercially available probes assessing copy numbers of RREB1 (6p25), MYB (6q23) and CCND1 (11q13) genes compared with CEP6 (a chromosome six centromeric reference point) were used. After control verification, seven prospective, equivocal cases were identified and exposed to FISH.
There was complete correlation between FISH result and the control section histopathology report. Control cases of melanoma cases were all positive for FISH and control benign lesions were negative. Of the seven equivocal cases, five were positive and classed as invasive melanoma or melanoma-in situ, one was negative and one tetraploid, classed as negative (these last two cases were classed as naevi with careful clinical observation).
FISH is very useful in classifying equivocal conjunctival melanocytic lesions, especially those with atypical junctional activity and naevoid melanocytic proliferations of the conjunctiva.
Available from: Lorenzo Memeo
- "In addition, FISH analysis was performed for diagnostic purposes. In fact, in recent papers, the application of fluorescence in situ hybridisation has been demonstrated to be a useful tool for the diagnosis of ambiguous melanocytic neoplasms of the conjunctiva [9,10] as demonstrated in skin lesions [11,12]. Taking into account that the sensitivity of the technique is around 87%, a positive FISH result provides additional support in favor of melanoma, whereas a negative FISH result makes melanoma less likely. "
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Melanocytic nevi are the most common tumors of the conjunctiva, accounting for 28% of all neoplastic lesions. These tumors, despite their benign behavior, share some atypical histological features with nevi found in other anatomic sites like the genital and acral regions, globally designated as nevi with site-related atypia. Moreover, in children and adolescents, rapidly growing conjunctival nevi show sometimes worrisome histological patterns in association with a prominent inflammatory infiltrate that may lead to diagnostic problems. In this paper we describe a juvenile compound nevus characterized by marked melanocytic atypia and severe inflammation, which can be considered a rare case of juvenile conjunctival atypical nevus. The final diagnosis relied on morphological and immunohistochemical characterization of the large epithelioid melanocytic cells, and on the results of FISH analysis.
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ABSTRACT: The closure relation for a correlation function of third order suggested by Schwartz and Ehrenreich in the framework of the electron theory of liquid metals is substituted into the formal relation connecting g(2) with g(3). The equation determining the radial distribution function, obtained in this way, is solved for the fluid of hard spheres. Comparison of this solution with the solution of the Born-Green-Yvon equation and with the exact results for a hard-sphere fluid indicates that the closure relation due to Schwartz and Ehrenreich is inferior to the superposition approximation due to Kirkwood.
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