CAJ | 학술논문

目的探讨眼眶恶性黑色素瘤的发病情况、临床表现、影像学特征、病理特点及其治疗.方法回顾分析1999年1月至2006年12月就诊的眼眶恶性黑色素瘤患者.结果眼眶恶性黑色素瘤最常见的症状为眼球突出及眼睑皮下肿物伴眼睑肿胀;最常见的体征为眼球突出、眼球运动受限及眶压升高,其次为眼睑肿胀和扪及皮下肿物;除脉络膜恶性黑色素瘤侵及眼眶者外,患侧眼底多无明显改变.彩色多普勒血流显像示病变区均可见较丰富的血流信号核磁共振检查示,病变区显示特征性的短T1,短T2信号影.病理检查见瘤细胞为圆形、椭圆形、上皮样多角形和梭形等,胞浆内有黑色素沉着;免疫组化示黑色素相关抗原(HMB45)和S-100蛋白均呈阳性.全部病例均手术治疗,经随访0.5～6年,半数无复发及转移.结论眶内恶性黑色素瘤较少见,多由脉络膜、结膜或眼睑蔓延而来,原发者甚为罕见.核磁共振检查的影像特点可做为重要的诊断依据,治疗以手术切除为主.
목적 탐토안광악성흑색소류적발병정황、림상표현、영상학특정、병리특점급기치료.방법 회고분석1999년1월지2006년12월취진적안광악성흑색소류환자.결과 안광악성흑색소류최상견적증상위안구돌출급안검피하종물반안검종창;최상견적체정위안구돌출、안구운동수한급광압승고,기차위안검종창화문급피하종물;제맥락막악성흑색소류침급안광자외,환측안저다무명현개변.채색다보륵혈류현상시병변구균가견교봉부적혈류신호핵자공진검사시,병변구현시특정성적단T1,단T2신호영.병리검사견류세포위원형、타원형、상피양다각형화사형등,포장내유흑색소침착;면역조화시흑색소상관항원(HMB45)화S-100단백균정양성.전부병례균수술치료,경수방0.5～6년,반수무복발급전이.결론 광내악성흑색소류교소견,다유맥락막、결막혹안검만연이래,원발자심위한견.핵자공진검사적영상특점가주위중요적진단의거,치료이수술절제위주.
Objective To investigate the clinical appearance,features of imageology and pathology,and treatment of orbital malignant melanoma.Methods Patients with orbital malignant melanoma treated between Jan 1999 and Dec 2006 in Zhongshan Ophthalmic Center,Sun Yat-sen University,China were reviewed retrospectively.Results Proptosis was the most common presentation of orbital malignant melanoma (60%),followed by a mass under the skin of eyelid with edema(40%).The physical examination showed that proptosis,motility restriction and high orbital pressure were the most frequent findings(60%),followed by a subcutaneous eyelid mass(40%).The ocular funduS was not involved except for patients with the lesion that originated from melanoma of choroid.Moderate blood flOW signal within the tumor was observed by color doppler ultrasonography.Magnetic resonance imaging revealed that the mass was characteristicly hypertense in T1 and hypotense in T2.Pathological examination demonstrated that the tumor was composed of spherical,ellipse,spindle and pleomorphic epithelioid melanoma cells with plenty of intrac～oplasm melanin.Immunohistochemical stain was positive for melanoma-associated antigen(HMB45)and S-100 protein.All of the cases were treated by surgery.After 0.5 to 6 years' follow-up,50 percent of the cases had been alive with no evidence of metastasis or recurrence.Conclusion Orbital malignant melanoma is quite rare that most commonly comes from direct orbital extension of choroidal,conjunctival or eyelid melanoma.The features of magnetic resonance imaging Can be the relative characteristic findings.Complete surgical excision is main choice for its treatment.