CAJ | 학술논문

目的探讨视网膜母细胞瘤(RB)综合治疗后组织病理学和临床特点，以及综合治疗后RB的血管内皮细胞生长因子(VEGF)、Ki-67蛋白的表达情况。方法对9例综合治疗后行眼球摘除术的病例的组织病理学和临床资料进行回顾性分析。使用免疫组织化学和实时多聚合酶链反应方法测量VEGF的表达，用免疫组织化学法测Ki-67的表达。结果在9例眼球中，6例为RB国际分期D期的肿瘤，3例为E期。眼球摘除的原因为：肿瘤广泛玻璃体种植8例，肿瘤复发3例，大量视网膜下积液，肿瘤视网膜下种植3例，玻璃体出血2例，完全的牵引性视网膜脱离3例。在综合治疗期间肿瘤都表现为缩小，基底部宽度平均缩小43.7％，厚度平均缩小57.9％。3例表现为奶酪-芝士状消退模式，1例表现为鱼肉状消退模式，5例表现为混合型消退模式。计划性眼球摘除病例的VEGF表达低于复发性RB。结论综合治疗后眼球摘除的最主要原因为广泛玻璃体种植。混合型消退模式是较常见的消退模式。综合治疗过程中行计划性眼球摘除病例VEGF表达降低。VEGF表达增高在综合治疗后RB的复发中可能起到一定的作用。
목적 탐토시망막모세포류(RB)종합치료후조직병이학화림상특점，이급종합치료후RB적혈관내피세포생장인자(VEGF)、Ki-67단백적표체정황。방법 대9례종합치료후행안구적제술적병례적조직병이학화림상자료진행회고성분석。사용면역조직화학화실시다취합매련반응방법측량VEGF적표체，용면역조직화학법측Ki-67적표체。결과 재9례안구중，6례위RB국제분기D기적종류，3례위E기。안구적제적원인위：종류엄범파리체충식8례，종류복발3례，대량시망막하적액，종류시망막하충식3례，파리체출혈2례，완전적견인성시망막탈리3례。재종합치료기간종류도표현위축소，기저부관도평균축소43.7％，후도평균축소57.9％。3례표현위내락-지사상소퇴모식，1례표현위어육상소퇴모식，5례표현위혼합형소퇴모식。계화성안구적제병례적VEGF표체저우복발성RB。결론 종합치료후안구적제적최주요원인위엄범파리체충식。혼합형소퇴모식시교상견적소퇴모식。종합치료과정중행계화성안구적제병례VEGF표체강저。VEGF표체증고재종합치료후RB적복발중가능기도일정적작용。
Objective To investigate the clinic pathologic features of retinoblastoma (RB) after comprehensive treatment, and study the expression of vascular endothelial growth factor (VEGF) in retinoblastoma treated with chemotherapy prior to enucleation. MethodsRetrospective analysis was performed on retinoblastoma specimens obtained consecutively between 2006 and 2008 by enucleation, and patients' clinical information and clinic pathologic features were also collected. Immunohistochemical staining and real-time PCR were performed for the expression of VEGF. Immunohistochemical staining was also performed for Ki-67. Result Among the 9 chemotherapy-treated cases, six belonged to group D and three to group E of IIRC. The reasons for enucleation included extensive vitreous seeds, RB recurrence,extensive subretinal fluid/seeds, vitreous hemonr hage and total tractional detachment of the retina. During the comprehensive treatment, the main tumors regressed in all eyes. The main tumors showed a mean decrease of 43.7％ in the largest basal diameter and a mean decrease of 57.9％ in thickness. The average interval between the end of chemotherapy and enucleation was 5.7 months. The reason for enucleation was the recurrence of main tumor, recurrence of new tumors, recurrent vitreous seed or subretinal seed. Three eyes showed a type 1 regression pattern, one eye showed a type 2 pattern, and the other five eyes showed type 3 clinical regression patterns. The expression of VEGF was lower in eyes that underwent planned enucleation than eyes that suffered from RB recurrence. Conclusions The main reason for enucleation was extensive subretinal fluid/seeds after the comprehensive treatment. The type 3 clinical regression patterns were most common. In retinoblastoma, higher expression of VEGF may play an important role in the recurrence of retinoblastoma after comprehensive treatment.