中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2010年
4期
308-311
,共4页
结膜肿瘤%黑色素瘤%肿瘤侵润
結膜腫瘤%黑色素瘤%腫瘤侵潤
결막종류%흑색소류%종류침윤
Conjunctival neoplasms%Melanoma%Neoplasm invasiveness
目的 总结结膜黑色素瘤临床和病理学特点,以利于早期正确诊断和治疗.方法 回顾性系列病例研究.对天津市眼科医院从1985年5月至2007年6月间收治的26例结膜黑色素瘤的临床和病理学特点进行回顾性分析.病理学检查采用常规石蜡切片、HE染色,S-100蛋白和HMB-45免疫组织化学染色.结果 26例患者年龄30.0～83.0岁,平均53.4岁;均为单眼发病.26例中,11例起源于结膜原发性获得性黑变病恶变、8例起源于结膜色素痣或黑色素细胞瘤恶变、7例为原发性结膜黑色素瘤;14例肿瘤累及到睑结膜和球结膜、6例肿瘤位于球结膜、4例肿瘤位于睑结膜、2例肿瘤位于角膜缘;22例为上皮样细胞型黑色素瘤、4例为上皮样瘤细胞和梭形瘤细胞混合型.7例原发性黑色素瘤中有3例为无色素性黑色素瘤,瘤细胞对S-100蛋白和HMB45呈阳性表达.大多数肿瘤表面和邻近的结膜上皮内伴有瘤细胞侵犯.术后随访到14例,随访时间为1～18年.其中12例在肿瘤切除术后有1～3次肿瘤复发,3例有耳前淋巴结转移,1例有同侧耳前淋巴结和双侧颌下淋巴结转移,4例死于肿瘤全身扩散或肝转移.结论 结膜黑色素瘤主要是起源于结膜原发性获得性黑变病或色素痣恶变,大部分为上皮样细胞型黑色素瘤,伴有邻近结膜上皮内侵犯.术后复发比较常见,尤其肿瘤范围较大或伴有PAM者.
目的 總結結膜黑色素瘤臨床和病理學特點,以利于早期正確診斷和治療.方法 迴顧性繫列病例研究.對天津市眼科醫院從1985年5月至2007年6月間收治的26例結膜黑色素瘤的臨床和病理學特點進行迴顧性分析.病理學檢查採用常規石蠟切片、HE染色,S-100蛋白和HMB-45免疫組織化學染色.結果 26例患者年齡30.0～83.0歲,平均53.4歲;均為單眼髮病.26例中,11例起源于結膜原髮性穫得性黑變病噁變、8例起源于結膜色素痣或黑色素細胞瘤噁變、7例為原髮性結膜黑色素瘤;14例腫瘤纍及到瞼結膜和毬結膜、6例腫瘤位于毬結膜、4例腫瘤位于瞼結膜、2例腫瘤位于角膜緣;22例為上皮樣細胞型黑色素瘤、4例為上皮樣瘤細胞和梭形瘤細胞混閤型.7例原髮性黑色素瘤中有3例為無色素性黑色素瘤,瘤細胞對S-100蛋白和HMB45呈暘性錶達.大多數腫瘤錶麵和鄰近的結膜上皮內伴有瘤細胞侵犯.術後隨訪到14例,隨訪時間為1～18年.其中12例在腫瘤切除術後有1～3次腫瘤複髮,3例有耳前淋巴結轉移,1例有同側耳前淋巴結和雙側頜下淋巴結轉移,4例死于腫瘤全身擴散或肝轉移.結論 結膜黑色素瘤主要是起源于結膜原髮性穫得性黑變病或色素痣噁變,大部分為上皮樣細胞型黑色素瘤,伴有鄰近結膜上皮內侵犯.術後複髮比較常見,尤其腫瘤範圍較大或伴有PAM者.
목적 총결결막흑색소류림상화병이학특점,이리우조기정학진단화치료.방법 회고성계렬병례연구.대천진시안과의원종1985년5월지2007년6월간수치적26례결막흑색소류적림상화병이학특점진행회고성분석.병이학검사채용상규석사절편、HE염색,S-100단백화HMB-45면역조직화학염색.결과 26례환자년령30.0～83.0세,평균53.4세;균위단안발병.26례중,11례기원우결막원발성획득성흑변병악변、8례기원우결막색소지혹흑색소세포류악변、7례위원발성결막흑색소류;14례종류루급도검결막화구결막、6례종류위우구결막、4례종류위우검결막、2례종류위우각막연;22례위상피양세포형흑색소류、4례위상피양류세포화사형류세포혼합형.7례원발성흑색소류중유3례위무색소성흑색소류,류세포대S-100단백화HMB45정양성표체.대다수종류표면화린근적결막상피내반유류세포침범.술후수방도14례,수방시간위1～18년.기중12례재종류절제술후유1～3차종류복발,3례유이전림파결전이,1례유동측이전림파결화쌍측합하림파결전이,4례사우종류전신확산혹간전이.결론 결막흑색소류주요시기원우결막원발성획득성흑변병혹색소지악변,대부분위상피양세포형흑색소류,반유린근결막상피내침범.술후복발비교상견,우기종류범위교대혹반유PAM자.
Objective To improve the knowledge of clinical and pathological features of conjunctival melanoma,in order to have an early diagnosis and treatment.Method Retrospective cases analysis.The clinical and pathological features of 26 cases of conjunctival melanoma were analyzed.These cases were treated from May in 1985 to June in 2007 in Tianjin Eye Hospital.Routine pathological examination and immunohistochemical staining of S-100 and HMB-45 were performed.Results The mean age was 53.4 years and ranging from 30.0-83.0 years.In these cases,11 cases arose from primary acquired melanosis (PAM),8 cases from conjunctival nevi or melanocytoma and 7 cases occurred de novo.Fourteen cases involved tarsal and bulbar conjunctiva,6 cases involved bulbar conjunctiva only,4 cases involved tarsal conjunctiva only and 2 cases were located at the limbus.Twenty two cases were epitheloid-cell-type melanoma,4 cases were mixed-cell-type melanoma.There were 3 amelanotic melanomas,the tumor cells were positively stained with S-100 and HMB-45.The follow-up period was 1-18 years postoperatively in 14 cases.Among them,12 cases showed 1-3 recurrences,3 cases with preauricular lymph node metastasize,1 cases with preauricular and submandibular lymph nodes metastasize;and 4 cases died from systematic extension or hepatic metastasis.Conclusions Conjunctival melanoma mainly arises from malignant transformation of PAM or conjunctival nevi and consists of epitheloid melanatic tumor cells.The neighbor intraepithelial invasion and recurrence are common,particularly in diffuse type of tumors or tumors arising from PAM.
