CAJ | 학술논문

目的观察弥漫型脉络膜黑色素瘤临床病理特点.方法回顾分析119例病理学检查确诊的脉络膜黑色素瘤患者中11例弥漫型脉络膜黑色素瘤患者的临床病理资料.患者中10例因视力丧失或眼痛就诊,1例外地医院诊断Coats病,继发性青光眼和眼球萎缩要求眼球摘除.临床诊断脉络膜肿物或黑色素瘤8例,绝对期青光眼2例,Coats病、眼球萎缩1例.眼球摘除9例,眼球摘除和眶内肿物切除2例.应用Ki-67免疫组织化学染色,检测细胞增生情况. 结果 11例弥漫型脉络膜黑色素瘤均为基底广泛的扁平状肿物.肿瘤基底直径12～20 mm,厚度2～4 mm.混合细胞型9例,上皮样细胞型1例,坏死型1例.瘤细胞侵犯巩膜7例、侵犯眶内3例,继发性青光眼7例.Ki-67阳性细胞7%～13%,平均阳性细胞9%,多分布于肿瘤基底部,上皮样瘤细胞的表达高于梭形瘤细胞. 结论弥漫型脉络膜黑色素瘤具有特殊生长方式,早期临床诊断困难,有些病例容易诊断为其它脉络膜肿物或青光眼.由于肿瘤基底广泛,容易侵犯眶内和发生转移,预后较差.
목적 관찰미만형맥락막흑색소류림상병리특점.방법 회고분석119례병이학검사학진적맥락막흑색소류환자중11례미만형맥락막흑색소류환자적림상병리자료.환자중10례인시력상실혹안통취진,1예외지의원진단Coats병,계발성청광안화안구위축요구안구적제.림상진단맥락막종물혹흑색소류8례,절대기청광안2례,Coats병、안구위축1례.안구적제9례,안구적제화광내종물절제2례.응용Ki-67면역조직화학염색,검측세포증생정황. 결과 11례미만형맥락막흑색소류균위기저엄범적편평상종물.종류기저직경12～20 mm,후도2～4 mm.혼합세포형9례,상피양세포형1례,배사형1례.류세포침범공막7례、침범광내3례,계발성청광안7례.Ki-67양성세포7%～13%,평균양성세포9%,다분포우종류기저부,상피양류세포적표체고우사형류세포. 결론 미만형맥락막흑색소류구유특수생장방식,조기림상진단곤난,유사병례용역진단위기타맥락막종물혹청광안.유우종류기저엄범,용역침범광내화발생전이,예후교차.
Objective To evaluate the clinical and histopathological features of diffuse choroidal melanoma. Methods The clinical and histopathological data of 11 patients with diffuse choroidal melanoma were reviewed retrospectively. Those patients were referred to Tianjin Eye Hospital because of visual loss or ophthalmalgia (10 cases), or Coats disease with secondary glaucoma and atrophy bulbi (1 case). The clinical disgnosis included ehoroidal tumor or melanoma (8 cases), absolute-stage glaucoma (2 cases) and atrophy bulbi with Coats disease (1 case). Nine patients received enucleation, and 2 patients received enucleation combined with orbital exenteration. The cellular proliferation was assessed by Ki-67staining. Results All 11 tumors had grown flatly with a wide base ranged from 12 to 20 mm, and tumor thickness ranged from 2 to 4 mm. There were 9 cases of mixed cell type, 1 case of epithelioid cell type and 1 case of necrotic cell type. The tumors invaded into the sclera in 7 cases and orbital cavity in 3 cases. Secondary glaucoma was found in 7 cases. On average, 9% (7%-13%) of tumor cells were Ki-67 positive and most of them located at the tumor base. There were more Ki67 positive epithelioid tumor cells than Ki67 positive spindle-shaped cells. Conclusions Diffuse choroidal melanoma had a special growth pattern and is difficult to be recognized, sometimes could be misdiagnosed as glaucoma or other choroidal tumors. With its wide base, this tumor could easily invade the orbit and metastate, and its prognosis is very poor.